Ageing
Women with sleep apnoea more likely to have dementia
A common yet underdiagnosed sleep disorder contributes to the development of dementia among adults — particularly women.
Investigators uncovered this by examining survey and cognitive screening data from more than 18,500 adults to determine the potential effect of known or suspected obstructive sleep apnoea on the risk for dementia.
Obstructive sleep apnoea is a chronic sleep disorder characterised by episodes disrupted or restricted breathing during sleep.
For all adults age 50 and older, having known obstructive sleep apnoea or its symptoms — as people often do not know they have the problem — was associated with a higher chance of having signs or a diagnosis of dementia in coming years.
While the overall difference in those dementia diagnoses never rose above 5 per cent, the association remained statistically significant even after researchers accounted for many other factors that can affect dementia risk, such as race and education.
At every age level, women with known or suspected sleep apnoea were more likely than men to be diagnosed with dementia.
In fact, the rate of dementia diagnosis decreased among the men and grew larger for the women as they aged.
The results are published in SLEEP Advances.
“Our findings offer new insight into the role of a treatable sleep disorder on long-term cognitive health at the population level for both women and men,” said first author Tiffany J. Braley, M.D., M.S., neurologist, director of the Multiple Sclerosis/Neuroimmunology Division and co-founder of the Multidisciplinary MS Fatigue and Sleep Clinic at University of Michigan Health.
Reasons for the sex-specific differences in dementia diagnosis by sleep apnoea status, researchers say, are not yet known. However, they pose several possible explanations.
Women with moderate sleep apnoea may have a greater risk of cardiovascular disease and are more likely to have insomnia, both of which can negatively impact cognitive function.
“Oestrogen starts to decline as women transition to menopause, which can impact their brains,” said co-author Galit Levi Dunietz, Ph.D., M.P.H., an associate professor in the University of Michigan Department of Neurology and Division of Sleep Medicine.
“During that time, they are more prone to memory, sleep and mood changes that may lead to cognitive decline. Sleep apnoea increases significantly post-menopause yet remains underdiagnosed. We need more epidemiologic studies to better understand how sleep disorders in women impact their cognitive health.”
Six million Americans have been officially diagnosed with sleep apnoea, yet the disorder is believed to affect closer to 30 million people.
In a 2024 report, a Lancet Commission identified several modifiable risk factors that together account for around 40 per cent of global dementia.
While sleep was not included as an official risk factor, the commission noted that sleep apnoea “might be associated with dementia” and to consider adding screening questions about dementia for people with the sleep disorder.
Other modifiable risk factors for dementia include cardiovascular disease and mental health problems, both of which may be exacerbated by untreated sleep apnoea.
“These potential harms caused by sleep apnoea, many of which threaten cognitive performance and decline, highlight the importance of early diagnosis and treatment,” Braley said.
“Obstructive sleep apnoea and resultant sleep deprivation and fragmentation are also associated with inflammatory changes in the brain that may contribute to cognitive impairment.”
The Michigan Medicine study used existing data from the Health and Retirement Study, an ongoing survey that is representative of Americans aged 50 and older.
“This study design cannot fully prove that sleep apnoea causes dementia — that would likely require a randomized trial, over many years, to compare effects of sleep apnoea treatment to the effects of no treatment,” said co-author Ronald D. Chervin, M.D., M.S., director of the Division of Sleep Medicine in the Department of Neurology at U-M Health.
“As it may be a long time if ever until such a trial occurs, backward-looking analyses such as ours, within large databases, may be among the most informative for years to come. In the meantime, the results provide new evidence that clinicians and patients, when making decisions about testing for sleep apnoea and treating it, should consider the possibility that untreated sleep apnoea causes or exacerbates dementia.”
Ageing
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Insight
Pregnancy and breastfeeding linked to higher cognitive ability in postmenopausal women
Pregnancy and breastfeeding are linked to stronger cognition in postmenopausal women, a long-term study suggests.
Greater cumulative time spent pregnant and time spent breastfeeding correlated with higher overall scores in the study, including verbal and visual memory, in later life.
Researchers analysed annual assessments of more than 7,000 women aged about 70 for up to 13 years using data from the Women’s Health Initiative Memory Study and the Women’s Health Initiative Study of Cognitive Aging.
On average, those who were pregnant for around 30.5 months were expected to have a 0.31 per cent higher global cognition score than those who had never been pregnant.
A lifetime average of 11.6 months of breastfeeding was linked to a 0.12 per cent higher global score.
Each additional month spent pregnant was associated with a 0.01-point rise in overall ability.
Each extra month of breastfeeding showed the same increase, and a 0.02-point gain in verbal and visual memory. Although small, these effects are similar to known protective factors such as not smoking and high physical activity.
The work was led by Molly Fox, an anthropology professor at the University of California, Los Angeles.
Fox said: “Any ways in which we can focus public health outreach or clinical interventions towards higher-risk populations leads to more effective and efficient efforts.”
Participants who had ever been pregnant scored, on average, 0.60 points higher than those who had never been pregnant.
Those who had breastfed scored 0.19 points higher overall and 0.27 points higher for verbal memory than those who had never breastfed.
Women are disproportionately affected by Alzheimer’s disease, a progressive condition that impairs memory and thinking skills, and this is not fully explained by life expectancy differences.
The authors say biology and social factors may both play roles.
They noted that more adult children could contribute to cognitive health by buffering stress, supporting wellbeing or encouraging healthy behaviour.
“If we can figure out, as a next step, why those reproductive patterns lead to better cognitive outcomes in old age, then we can work towards figuring out how to craft therapies, for example, new drugs, repurposed drugs or social programmes, that mimic the naturally occurring effect we observed,” said Fox.
The study team is now working to identify the mechanisms that link reproductive histories to cognitive resilience.
Insight
‘Rejuvenated’ eggs raise hopes for improved IVF outcomes
Scientists say they have ‘rejuvenated’ human eggs, in work that could improve IVF success rates for older women.
The team reports that an age-related defect causing genetic errors in embryos may be reversed by supplementing eggs with a key protein.
In eggs donated by fertility patients, microinjection of the protein cut the share showing the defect from 53 per cent to 29 per cent.
The findings were presented at the British Fertility Conference in Edinburgh by researchers from the Max Planck Institute for Multidisciplinary Sciences in Göttingen.
The technique is being commercialised by Ovo Labs, co-founded by professor Melina Schuh, who led the research.
The approach targets problems in meiosis, the process where eggs halve their genetic material before fertilisation.
In older eggs, chromosome pairs can loosen and separate too soon, leading to embryos with too many or too few chromosomes, known as aneuploidy.
The researchers found levels of a protein called Shugoshin 1, which helps hold chromosome pairs together, decline with age. Microinjections appeared to restore this “molecular glue” and reduce errors.
Professor Schuh said: “Overall we can nearly halve the number of eggs with [abnormal] chromosomes. That’s a very prominent improvement.
“Most women in their early 40s do have eggs, but nearly all of the eggs have incorrect chromosome numbers. This was the motivation for wanting to address this problem.
“What is really beautiful is that we identified a single protein that, with age, goes down, returned it to young levels and it has a big effect.
We are just restoring the younger situation again with this approach.
Declining egg quality is a major reason IVF success rates fall steeply with age.
UK figures show an average birth rate of 35 per cent per embryo transferred for patients under 35, dropping to 5 per cent for women aged 43 to 44.
Dr Agata Zielinska, co-founder and co-chief executive of Ovo Labs, said: “Currently, when it comes to female factor infertility, the only solution that’s available to most patients is trying IVF multiple times so that, cumulatively, your likelihood of success increases.
“What we envision is that many more women would be able to conceive within a single IVF cycle.”
The approach would not extend fertility beyond menopause.
The team is in talks with regulators about a clinical trial.
Dr Güneş Taylor, of the University of Edinburgh, who was not involved, said: “This is really important work because we need approaches that work for older eggs because that’s the point at which most women appear.
“If there’s a one-shot injection that substantially increases the number of eggs with properly organised chromosomes, that gives you a better starting point.”
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