Sleep Disturbances, Changes in Sleep, and Cognitive Function in Low-Income African Americans

Article type: Research Article

Authors: Troxel, Wendy M.^{a; *} | Haas, Ann^a | Dubowitz, Tamara^a | Ghosh-Dastidar, Bonnie^b | Butters, Meryl A.^c | Gary-Webb, Tiffany L.^d | Weinstein, Andrea M.^c | Rosso, Andrea L.^d

Affiliations: [a] Division of Social and Economic Well-Being, RAND Corporation, Pittsburgh, PA, USA | [b] Division of Economics, Sociology, and Statistics, RAND Corporation, Santa Monica, CA, USA | [c] Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA | [d] Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

Correspondence: [*] Correspondence to: Wendy M. Troxel, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA. Tel.: +1 412 683 2300 x4427; E-mail: wtroxel@rand.org.

Abstract: Background:Sleep problems may contribute to the disproportionate burden of Alzheimer’s disease and related dementias (ADRD) among African Americans (AAs). Objective:To examine the role of sleep problems in contributing to cognitive function and clinically adjudicated cognitive impairment in a predominantly AA sample. Methods:This study (n = 216, 78.8% female; mean age = 67.7 years) examined associations between 1) the level (i.e., measured in 2018) and 2) change over time (from 2013 to 2018; n = 168) in actigraphy-assessed sleep with domain-specific cognitive function and clinically adjudicated cognitive impairment (2018) in a community-dwelling, predominantly AA (96.9%) sample. A comprehensive cognitive battery assessed global cognitive function (3MS) and domain-specific cognitive function (attention, visuo-spatial ability, language, delayed recall, immediate recall, and executive function) in 2018. Sleep was measured in 2013 and 2018 via actigraphy. Results:Higher sleep efficiency and less wakefulness after sleep onset (WASO; measured in 2018) were associated with greater attention, executive function, and visuospatial ability. Increases in sleep efficiency between 2013 and 2018 were associated with better executive function, language, immediate recall, and visuospatial ability, whereas increases in WASO (2013–2018) were associated with poorer attention, executive function, and visuospatial ability. Level or change in sleep duration were not associated with domain-specific cognitive function, nor were any sleep measures associated with clinically adjudicated cognitive impairment. Conclusion:In a predominantly AA sample of older adults, both the level and change (i.e., worsening) of sleep efficiency and WASO were associated with poorer cognitive function. Improving sleep health may support ADRD prevention and reduce health disparities.

Keywords: Actigraphy, African Americans, Alzheimer’s disease, cognitive function, disparities, race, sleep, structural racism

DOI: 10.3233/JAD-215530

Journal: Journal of Alzheimer's Disease, vol. 87, no. 4, pp. 1591-1601, 2022