Sleep changes contribute to the pathogenesis of neurodegenerative diseases

The results of an Austrian cohort study support the assumption that sleep changes contribute to the pathogenesis of neurodegenerative diseases. An altered sleep architecture at baseline, with reduced sleep efficiency, REM sleep, N3 sleep, or increased wake periods in sleep period time (SPT), was robustly associated with incident neurodegeneration after 5 years and more.

The aim of this retrospective cohort study was to investigate whether polysomnography-based sleep features are associated with the long-term risk of neurodegenerative disease [1]. Dr Abubaker Ibrahim (Medical University of Innsbruck, Austria) explained that the study cohort consisted of patients who were referred to the Sleep Disorders Unit of the Medical University Innsbruck between 2004 and 2007. The participants had to be ≥18 years of age, undergo polysomnography, and be free of neurodegeneration at baseline and during the first 5 years of follow-up. Of 1,454 assessed patients, 999 met these criteria (31.7% women; median age 54.9 years). Dr Ibrahim and colleagues wanted to know how many patients of this core group would be diagnosed with a neurodegenerative disease before the year 2022.

After a median of 12.8 years of follow-up, 75 patients developed a neurodegenerative disease; 924 did not. Dr Ibrahim showed that a 1% decrease in sleep efficiency, N3 sleep (i.e. deep sleep), or REM sleep was associated with a 1.9%, 6.5%, and 5.2% increased risk of incident neurodegeneration, respectively (HR 1.019, 1.065, and 1.052, respectively), after adjusting for demographic, sleep, and clinical covariates. A 1% decrease in waking within the SPT corresponded with a 2.2% reduced risk of incident neurodegenerative disease (HR 0.978). Assessed patients in the highest wake-in-SPT quartile (>18.6%) or the lowest REM sleep (<13.0%) or N3 sleep (0%) quartile had the shortest overall mean disease-free survival (14.9 years; 95% CI 14.6–15.3 years). Dr Ibrahim added that random Forest analysis showed that wake was the strongest predictor of neurodegeneration, followed by deep sleep and REM sleep (see Figure).

He concluded that altered sleep architecture can be used as a marker of neurodegenerative disease but perhaps also as a future target for neuroprotective strategies. “With this, I hope to have convinced you to have a good night's sleep and to convince your patients to do the same.”

Figure: Permutation importance of individual features derived from a random Forest analysis [1]

1. Ibrahim A, et al. Sleep features and long-term incident neurodegenerative diseases: a polysomnographic study. EAN 2023 Annual Meeting, 1–4 July, Budapest, Hungary.

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Posted on 7 September, 202320 February, 2024