Publications by authors named "Magali Saint-Martin"

18 Publications

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Reply to "Letter to the Editor: Physical activity differently affects bone mineral density in obstructive sleep apnea at different age".

Sleep Med 2017 04 29;32:274. Epub 2016 Nov 29.

Service de Physiologie Clinique et de l'Exercice, Faculté de Médecine Jacques Lisfranc, COMUE de Lyon, Université Jean Monnet, Saint-Etienne, France.

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http://dx.doi.org/10.1016/j.sleep.2016.11.005DOI Listing
April 2017

Is there an association between altered baroreceptor sensitivity and obstructive sleep apnoea in the healthy elderly?

ERJ Open Res 2016 Jul 28;2(3). Epub 2016 Sep 28.

Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, EA SNA-EPIS, Faculté de Médecine J. Lisfranc, UJM Saint-Etienne, PRES Université de Lyon, Saint-Etienne, France.

Obstructive sleep apnoea (OSA) is associated with a rise in cardiovascular risk in which increased sympathetic activity and depressed baroreceptor reflex sensitivity (BRS) have been proposed. We examined this association in a sample of healthy elderly subjects with unrecognised OSA. 801 healthy elderly (aged ≥65 years) subjects undergoing clinical, respiratory polygraphy and vascular assessment were examined. According to the apnoea-hypopnoea index (AHI), the subjects were stratified into no OSA, mild-moderate OSA and severe OSA cases. OSA was present in 62% of the sample, 62% being mild-moderate and 38% severe. No differences were found for BRS value according to sex and OSA severity. 54% of the group had normal BRS value, 36% mild impairment and 10% severe dysfunction. BRS was negatively associated with body mass index (p=0.006), 24-h systolic (p=0.001) and diastolic pressure (p=0.001), and oxygen desaturation index (ODI) (p=0.03). Regression analyses revealed that subjects with lower BRS were those with hypertension (OR 0.41, 95% CI 0.24-0.81; p=0.002) and overweight (OR 0.42, 95% CI 0.25-0.81; p=0.008), without the effect of AHI and ODI. In the healthy elderly, the presence of a severe BRS dysfunction affects a small amount of severe cases without effect on snorers and mild OSA. Hypertension and obesity seem to play a great role in BRS impairment.
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http://dx.doi.org/10.1183/23120541.00072-2016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140016PMC
July 2016

Does Subjective Sleep Affect Bone Mineral Density in Older People with Minimal Health Disorders? The PROOF Cohort.

J Clin Sleep Med 2016 11 15;12(11):1461-1469. Epub 2016 Nov 15.

Service de Physiologie Clinique et de l'Exercice, CHU Nord, Saint-Etienne, Faculté de Médecine Jacques Lisfranc, PRES de Lyon, Université Jean Monnet, Saint-Etienne, France.

Study Objectives: Clinical and epidemiological studies suggest a relation between bone mineral density (BMD) and self-assessment of sleep with an effect on bone formation and osteoporosis (OS) risk in short and long sleepers. This study explores this association in a large sample of older subjects.

Methods: We examined 500 participants without insomnia complaints aged 65.7 ± 0.8 y. Each participant had a full evaluation including anthropometric measurement, clinical examination and measurements of BMD at the lumbar spine and femoral sites by dual-energy X-ray absorptiometry. The daily energy expenditure (DEE) was measured by the Population Physical Activity Questionnaire. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index. The subjects were stratified into three groups according to sleep duration, i.e., short (< 6 h), normal (6-8 h), and long (≥ 8 h) sleepers.

Results: Osteopenia was found in 40% of the subjects at the femoral level and 43% at the vertebral level. The prevalence of OS was lower both at femoral (8%) and vertebral (12%) levels. Short, normal, and long sleepers accounted for 29%, 40%, and 31% of subjects, respectively. After adjustments for metabolic, anthropometric, and DEE, multinomial logistic regression analysis indicated that long sleepers were more likely to have femoral neck OS with a slight effect of DEE at vertebral spine.

Conclusions: In a sample of older subjects, self-reported long sleep was the best predictor of OS risk at the femoral level. This finding suggests an association between OS and self-reported sleep duration in older subjects.

Clinical Trial Registration: NCT 00759304 and NCT 00766584.
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http://dx.doi.org/10.5664/jcsm.6266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078700PMC
November 2016

Risk factors of osteoporosis in healthy elderly with unrecognized obstructive sleep apnea: role of physical activity.

Sleep Med 2016 06 7;22:25-32. Epub 2016 Jun 7.

Service de Physiologie Clinique et de l'Exercice, Faculté de Médecine Jacques Lisfranc, COMUE de Lyon, Université Jean Monnet, Saint-Etienne, France.

Objective: Several studies suggest a relationship between bone mineral density (BMD) anthropometric and metabolic variables, and obstructive sleep apnea (OSA); all of these factors have an effect on osteoporosis (OS) risk. This cross-sectional study explores these associations in a large sample of older subjects with and without OSA.

Methods: Volunteers were recruited from the PROgnostic indicator OF cardiovascular and cerebrovascular events survey. A total of 461 subjects, aged 68.7 ± 0.8 years, were examined, blood samples were taken, and they were subjected to home polygraphy, assessment of daily energy expenditure (DEE), and dual-energy X-ray absorptiometry.

Results: Osteopenia (OP) was detected in 44% of subjects at the femoral and 39% at the vertebral level, while the prevalence of OS was lower at the femoral (4%) and vertebral (12%) levels. As expected, women had a higher prevalence of OP and OS. Subjects with OP and OS had a tendency to have lower DEE and values of obesity, apnea-hypopnea index (AHI), and indices of hypoxemia (ODI). At the correlation analyses, anthropometric factors and DEE were significantly related to BMD with a slight effect of indices of OSA severity. After adjustment for confounding variables, univariate and multivariate regression analyses showed a strong significant association between femoral and lumbar BMD and T-score and DEE without contribution of metabolic data and with a slight negative effect of respiratory factors.

Conclusions: In this sample of the elderly, physical activity was the best predictor of OS with a slight effect of body mass index. The indices of OSA confirm their protective effect on bone mineral density.
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http://dx.doi.org/10.1016/j.sleep.2016.04.010DOI Listing
June 2016

Mood disorders in healthy elderly with obstructive sleep apnea: a gender effect.

Sleep Med 2016 03 25;19:57-62. Epub 2015 Nov 25.

Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, EA SNA-EPIS, Faculté de Médecine J. Lisfranc, UJM Saint-Etienne, PRES Université de Lyon, Saint-Etienne, France.

Objective: Previous studies have suggested an association between obstructive sleep apnea (OSA) and anxiety and depression, but it remains unclear as to whether this is due to OSA or other factors. The aim of this study was to evaluate this association in a large sample of healthy elderly with unrecognized OSA.

Methods: 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory home polygraphic study and completion of questionnaires related to depression, anxiety and sleepiness were examined. According to the apnea-hypopnea index (AHI), the subjects were stratified into no-OSA, mild-moderate and severe OSA cases.

Results: Anxiety was present in 38% of the sample and depression in 8%. Anxiolytic treatment was reported by 9% of the population and antidepressant treatment in 5%. Women had high scores for anxiety and depression and they were more frequently taking anxiolytic and antidepressant medications. No differences were found for anxiety and depression scores and medication intake in the three groups of subjects stratified according to the AHI. Regression analyses adjusted for age, gender, body mass index, hypertension (HT), AHI, and indices of hypoxemia revealed that females were 5.44 times more likely to have depression with a low contribution of the time with SaO2 < 90%.

Conclusions: In a large sample of healthy elderly with OSA, neither the existence nor the severity of the OSA was associated with anxiety and depression score, with women having higher anxiety and depression scores. This finding supports the hypothesis that depressive symptoms originate from factors other than measures of OSA severity.
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http://dx.doi.org/10.1016/j.sleep.2015.11.007DOI Listing
March 2016

Hippocampus volume and subjective sleepiness in older people with sleep-disordered breathing: a preliminary report.

J Sleep Res 2016 Apr 14;25(2):190-3. Epub 2015 Dec 14.

Service de Physiologie Clinique et de l'Exercice (Pôle Hospitalier NOL), Faculté de Médecine Jacques Lisfranc, CHU Nord, Université Jean Monnet, Saint-Etienne, France.

Unlabelled: Sleep-disordered breathing (SDB) is associated with excessive daytime sleepiness (EDS) and explained by sleep fragmentation and hypoxaemia, both contributing to brain morphology abnormalities. Recent data on middle-aged SDB patients suggest a link between hippocampus volume (HV) and EDS. We tested this hypothesis in a group of SDB older subjects. A total of 232 healthy participants aged 75 ± 0.9 years were examined. Subjective EDS was assessed by the Epworth Sleep Questionnaire (ESS), with a mean score of 5.6 ± 3.5. Volumetric segmentation of the right (RHV) and left HV (LHV) were measured using FreeSurfer software. All subjects underwent extensive cognitive testing to exclude neurological disease, as well as ambulatory polygraphy to assess SDB status. Sleepy subjects showed a lower HV. In a correlation analysis, RHV (r = -0.162, P = 0.01) and LHV (r = -170, P = 0.05) were correlated negatively with ESS and not associated with respiratory data. Multiple regression analysis did not reveal any effect of age, gender, SDB severity and hypoxia. ESS was the only factor possibly explaining the lower RHV (P = -0.03) and LHV (P = -0.04). In older people with SDB, the subjective EDS was associated with lower HV. This morphological finding should be considered on the pathogenesis of sleepiness in SDB patients.

Clinical Trial Registration: NCT 00759304 and NCT 00766584.
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http://dx.doi.org/10.1111/jsr.12367DOI Listing
April 2016

Prevalence and determinants of subjective sleepiness in healthy elderly with unrecognized obstructive sleep apnea.

Sleep Med 2015 Aug 15;16(8):981-6. Epub 2015 Apr 15.

Faculté de Médecine Jacques Lisfranc, Service de Physiologie Clinique et de l'Exercice (Pole Hospitalier NOL), CHU Nord, Université Jean Monnet, Saint-Etienne, SNA EPIS EA 4607, PRES de Lyon, France.

Objective: Obstructive sleep apnea (OSA) is associated with behavioral consequences such as excessive daytime sleepiness (EDS). The aim of this study was to establish the presence of sleepiness in elderly with unrecognized OSA and the factors explaining its occurrence.

Methodology: A total of 825 healthy elderly (aged ≥65 years) undergoing clinical, respiratory polygraphy, and heart-rate variability analysis were studied. According to the apnea-hypopnea index (AHI), the subjects were stratified in four categories: no-OSA (AHI <5), mild (5 > AHI <15), moderate (15 ≥ AHI <30), and severe OSA (AHI ≥30). Participants with EDS were defined on the basis of the Epworth Sleepiness Scale (ESS) score ≥10.

Results: Overall, the mean ESS score was 5.7 ± 5.6, 14.9% showing EDS with an increasing trend according to OSA severity (p <0.001). Sleepy subjects were more frequently men, having a greater body mass index (BMI), alcohol intake, depression score, and indices of OSA severity (23% of severe OSA cases being sleepy). No differences were present between sleepy and non-sleepy subjects in regard to other clinical, metabolic, and autonomic nervous system measurements. Regression analyses adjusted for age, gender, BMI, hypertension, depression score, autonomic sleep fragmentation, and AHI and/or oxygen desaturation index revealed that gender (p <0.0001), depression score (p <0.0001), and BMI (p = 0.01) were the only significant factors affecting the presence of sleepiness in this population.

Conclusions: In healthy elderly with OSA, the prevalence of EDS was low, and it affected only severe cases. Despite a weak association between the ESS score and the AHI index, male gender and depression score were the most significant predictors for the occurrence of sleepiness.
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http://dx.doi.org/10.1016/j.sleep.2015.03.010DOI Listing
August 2015

Association of body fat composition and obstructive sleep apnea in the elderly: A longitudinal study.

Obesity (Silver Spring) 2015 Jul 7;23(7):1511-6. Epub 2015 Jun 7.

Service De Physiologie Clinique Et De L'exercice, CHU Nord, Saint-Etienne, Faculté De Médecine Jacques Lisfranc, Université Jean Monnet, Saint-Etienne, France.

Objective: Obesity and aging are considered risk factors for developing sleep apnea syndrome (OSA). The aim of this study was to determine the association between body fat composition and OSA in healthy elderly subjects examined in a 7-year longitudinal study.

Methods: A total of 209 elderly with unrecognized OSA aged 68.3 ± 0.8 years underwent a clinical, ambulatory nocturnal respiratory recording, and anthropometric as well as body fat composition assessment by dual-energy X-ray absorptiometry (DEXA) at baseline and follow-up.

Results: At study entry, 50.3% of the population showed an apnea+hypopnea index (AHI) <15 with a mean AHI of 16.8 ± 11. At follow-up, a reduction of OSA cases (42%) was evident with a mean AHI of 14.6 ± 10.2. The DEXA data demonstrated that body mass and total lean mass were reduced at follow-up, while central and peripheral fat mass showed a slight increase. Correlation analysis between the changes in DEXA measurements versus the changes in AHI and the indices of nocturnal hypoxemia showed an absence of a statistical correlation.

Conclusions: The lack of correlation between the DEXA measurement changes and the changes in the AHI confirm our previous data on the absence of a central fat mass effect on OSA in the elderly.
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http://dx.doi.org/10.1002/oby.21121DOI Listing
July 2015

Protective Effect of Long-Term CPAP Therapy on Cognitive Performance in Elderly Patients with Severe OSA: The PROOF Study.

J Clin Sleep Med 2015 Apr 15;11(5):519-24. Epub 2015 Apr 15.

Laboratoire de Physiologie de l'exercice, Equipe SNA Epis EA 4607, Université Jean Monnet, Faculté de médecine J. Lisfranc, Hôpital universitaire, Saint-Etienne, France.

Objective: Obstructive sleep apnea syndrome (OSA) leads to a deterioration in cognitive functions, with regard to memory and executive functions. However, few studies have investigated the impact of treatment on these cognitive functions in elderly subjects.

Methods: The study was conducted in a large cohort of subjects aged 65 years or older (the PROOF cohort). Subjects were not diagnosed or treated for OSA. Subjects underwent a polygraphic recording. Cognitive performance was assessed in all OSA subjects at baseline and 10 years later, whether or not they were receiving continuous positive airway pressure (CPAP) therapy.

Results: A group of 126 patients were analyzed. Only 26% of them were treated, with therapy initiated at the discretion of the primary care physician. Among treated subjects, self-reported compliance with therapy was good (> 6 h/night on average), and 66% of them reported an improvement in their quality of life. Patients receiving CPAP treatment had a higher apneahypopnea index (p = 0.006), a higher oxygen desaturation index (p < 0.001), and experienced more pronounced daytime repercussions (p = 0.004). These patients showed a statistically significant improvement in mental agility (similarities test; p < 0.0001) and memory performance (Grober and Buschke delayed free recall; p = 0.02).

Conclusion: CPAP treatment is associated with the maintenance of memory performance over time.
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http://dx.doi.org/10.5664/jcsm.4694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410925PMC
April 2015

Eight-year parallel change in baroreflex sensitivity and memory function in a sample of healthy older adults.

J Am Geriatr Soc 2015 Feb 2;63(2):270-5. Epub 2015 Feb 2.

Département de Physiologie Clinique et de l'exercice, Pôle Neuro-Ostéo Locomoteur, Centre Hospitalo-Universitaire, Faculté de Mèdecine de Saint-Etienne, Université Jean Moulin, Saint-Etienne, France; pôle de Recherche et d'Enseignement Supérieur, Université de Lyon, Lyon, France; Laboratoire d'Etude des Mécanismes Cognitifs, University of Lyon 2, Lyon, France.

Objectives: To examine whether changes in the cardiac autonomic nervous system (ANS) over time, as expressed by baroreflex sensitivity (BRS), were associated with long-term changes in cognitive performance in elderly individuals without dementia.

Design: Community-based 8-year longitudinal study.

Setting: Clinical settings.

Participants: Individuals aged 66.9 ± 0.9 (N = 425).

Measurements: At baseline and follow-up, subjects underwent a clinical interview, autonomic and vascular measurements, and a neuropsychological evaluation including attentional, executive, and memory tests using standardized Z-scores. BRS was defined as being normal, moderate, or severe alteration at each evaluation. On the basis of the longitudinal changes subjects were stratified as being stable, moderate or improved.

Results: Mean attentional, executive, and memory change Z-scores were -0.41 ± 0.9, -0.15 ± 0.7, and -0.14 ± 0.8, respectively. BRS of 56% of the subjects remained unchanged, of 20% decreased, and of 24% improved. After regression analysis, the worsened BRS group was 1.88 times as likely to have greater memory change as the group with stable BRS (P = .02). No significant association was found between longitudinal change in BRS and attentional and executive changes.

Conclusion: In healthy elderly individuals, BRS decrease was associated with a weak but significant decrease in memory function. The long-term effect of BRS on memory changes may suggest a role of the ANS in cognitive decline.
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http://dx.doi.org/10.1111/jgs.13252DOI Listing
February 2015

Sleep breathing disorders and cognitive function in the elderly: an 8-year follow-up study. the proof-synapse cohort.

Sleep 2015 Feb 1;38(2):179-87. Epub 2015 Feb 1.

EMC Laboratory, EA 3880, University of Lyon 2, Lyon, France.

Study Objectives: Sleep breathing disorder (SBD) may be an important factor in age-related cognitive decline. In a cohort of healthy elderly subjects, we performed an 8-y longitudinal study to assess whether changes in cognitive function occur in untreated elderly patients with SBD and without dementia and the factors implicated in these changes.

Design: A population-based longitudinal study.

Setting: Clinical research settings.

Participants: A total of 559 participants of the PROOF study aged 67 y at the study entry and free from neurological disorders were examined.

Interventions: N/A.

Measurements And Results: Abnormal breathing events were defined by an apnea-hypopnea index (AHI) > 15. The raw cognitive data and averaged Z-scores for the attentional, executive, and memory functions were collected at the baseline and follow-up. At baseline, AHI > 15 was found in 54% of subjects with 18% having an AHI > 30. At follow-up, the presence of abnormal breathing events was associated with a slight but significant decline in the attentional domain (P = 0.01), which was more evident in the subjects with an AHI > 30 (P = 0.004). No significant changes over time were observed in the executive and memory functions. Several indices of chronic hypoxemia, defined either as a cumulative peripheral oxygen saturation (SpO2) < 90% or a minimal SpO2, accounted for portions of the variance in the decline in attention. All observed effects were small, accounting for 4-7% of variance in multivariate models.

Conclusion: In healthy elderly subjects, various components of sleep breathing disorder at baseline were associated with small changes in selected cognitive functions specific to the attention domain after controlling for multiple comorbidities, such as sleepiness, hypertension, diabetes, anxiety, and depression.

Clinical Trial Registration: ClinicalTrials.gov identifiers NCT 00759304 and NCT 00766584.
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http://dx.doi.org/10.5665/sleep.4392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288598PMC
February 2015

Association of self-reported sleep and hypertension in non-insomniac elderly subjects.

J Clin Sleep Med 2014 Sep 15;10(9):965-71. Epub 2014 Sep 15.

Objectives: Sleep duration and sleep quality play important roles in the development of hypertension (HT) in middle-aged subjects, with controversial data in elderly. In this study, we investigated the link between HT and self-reported sleep in non-insomniac elderly subjects.

Methods: We examined 500 participants without insomnia complaints aged 72 ± 1 years. An extensive instrumental evaluation was carried out, including 24-h blood pressure (BP) monitoring and an assessment of nocturnal BP dipping. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index (PSQI). The subjects were stratified into three groups according to sleep duration: short (< 6 h), normal (> 6h to < 8 h), and long (> 8 h) sleepers. A PSQI < 5 defined good sleepers (GS, n = 252), and a PSQI > 5 (n = 248) defined poor sleepers (PS).

Results: PS represented 50% of the subjects, more frequently females. Compared to GS, PS did not differ in terms of HT, BP, baroreflex sensitivity (BRS), and BP dipping. Short, normal, and long sleepers accounted for 28%, 42%, and 30% of subjects, with HT, BP values, BRS, and gender not differing between groups. No relationship was found between nocturnal BP values and self-reported sleep measures. Logistic regression analysis indicated that neither sleep duration nor sleep quality predicts the prevalence of HT, the body mass index being the only factor affecting this association.

Clinical Trial Registration: ClinicalTrials.gov identifiers NCT00759304 and NCT00766584.

Conclusions: In a sample of non-insomniac elderly subjects, neither sleep duration nor sleep quality affected the prevalence of HT. These data argue against a relationship between self-reported sleep duration and quality and HT in elderly without insomnia.
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http://dx.doi.org/10.5664/jcsm.4026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153106PMC
September 2014

Stress hormones in obstructive sleep apnea complications: the role of cortisol.

Sleep Med 2014 Jan 6;15(1):3-4. Epub 2013 Nov 6.

Laboratoire de Physiologie de l'exercice, Equipe SNA Epis EA 4607, Université Jean Monnet, Faculté de médecine J. Lisfranc, Hôpital universitaire, 42055 Saint-Etienne, France; Centre VISAS, Université Jean Monnet, Faculté de médecine J. Lisfranc, Hôpital universitaire, 42055 Saint-Etienne, France.

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http://dx.doi.org/10.1016/j.sleep.2013.10.004DOI Listing
January 2014

Baroreflex sensitivity, vascular risk factors, and cognitive function in a healthy elderly population: the PROOF cohort.

J Am Geriatr Soc 2013 Dec 26;61(12):2096-2102. Epub 2013 Nov 26.

Département de Physiologie Clinique et de l'Exercice, Pôle Neuro-OstéoLocomoteur, Centre Hospitalo-Universitaire, Saint-Étienne, France.

Objectives: To assess the role of the cardiac autonomic nervous system (ANS), as measured according to spontaneous cardiac baroreflex sensitivity (BRS), in the type and degree of cognitive performance in healthy young-elderly individuals, taking into account the presence of other vascular risk factors.

Design: Community-based cross-sectional study.

Setting: In-home and clinical settings.

Participants: A subset of participants, aged 66.9±0.9, from a prospective study that aimed to assess the influence of ANS activity on cardiovascular and cerebrovascular morbidity and mortality (N=916).

Measurements: All subjects underwent a clinical interview, neuropsychological testing, and autonomic and vascular measurements. Three cognitive domains were defined: attentional (Trail-Making Test Part A, Stroop code and parts I & II), executive (Trail-Making Test Part B, Stroop part III, verbal fluency and similarity tests), and memory (Benton visual retention test, Grober and Buschké procedure). Subjects were stratified according to their scores into normal, low, and impaired performers.

Results: After adjustments to demographic and vascular data, participants with moderate autonomic dysregulation (36).

Conclusion: In older individuals without dementia, autonomic dysregulation seems to have a direct, gradual, and independent effect on memory. Future studies are needed to evaluate the long-term effects of BRS and other markers of the ANS on cognitive decline.
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http://dx.doi.org/10.1111/jgs.12548DOI Listing
December 2013

Sleep perception in non-insomniac healthy elderly: a 3-year longitudinal study.

Rejuvenation Res 2014 Feb;17(1):11-8

1 Department of Clinical Physiology and Exercise, Pole NOL, CHU, and Faculty of Medicine of Saint-Etienne, UJM and PRES University of Lyon , EA 4607 SNA-EPIS, Saint-Étienne, France .

Objectives: Older adults complain of sleep disturbances more often than younger adults do. It is not clear whether the age-related rise in sleep problems is related to aging itself or to health-related quality of life. The aim of this study was to explore the presence of self-reported sleep problems in healthy elderly individuals and to evaluate whether changes occurred over a 3-year follow-up.

Methods: A total of 314 older community-dwelling volunteers, aged 71.6±1.0 years old, were examined and followed for 3 years. All of the subjects completed questionnaires evaluating anxiety, depression, and sleepiness and the Pittsburgh Sleep Quality Index (PSQI) at the first and second evaluations. On the basis of the PSQI items, the subjects were classified as good or bad sleepers and as short, normal, or long sleepers.

Results: At baseline, 53% of the subjects reported good sleep, with 61% reporting a sleep duration of approximately 7 hr. The total sleep time and the numbers of short, normal, and long sleepers were similar at baseline and at 3 years later. Over time, there was a slight increase (p<0.001) in bad sleepers (53%) and a rise in the occasional hypnotic intake (p<0.001). Considering individual variation, the majority of subjects remained stable at follow-up for sleep duration (65%), sleep quality (75%), and medication (83%).

Conclusions: In a healthy older population, the majority of the subjects did not report bad and short sleep at baseline and did not have significant changes in self-perceived sleep 3 years later. These findings suggest that the reported sleep disturbances described in the elderly are more dependent on physical, environmental, and health factors rather than on age-dependent sleep changes.

Clinical Trial Registration: NCT 00759304 and NCT 00766584.
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http://dx.doi.org/10.1089/rej.2013.1457DOI Listing
February 2014

Association between severe obstructive sleep apnea and incident arterial hypertension in the older people population.

Sleep Med 2013 Sep 3;14(9):838-42. Epub 2013 Jul 3.

Jean Monnet University, Saint-Etienne, France.

Objectives: The impact of sleep-related breathing disorders on the incidence of arterial hypertension (AHT) in the older adults is not well-established. The aim of our study was to test the link between severe obstructive sleep apnea (OSA) and the occurrence of hypertension in older subjects after 3 years.

Methods: 372 normotensive subjects with a mean age of 68.2 years were included in our longitudinal study. All participants had a ventilatory polygraphic recording and an ambulatory blood pressure (BP) monitoring at baseline and after 3 years. Severe OSA was defined by an apnea-hypopnea index (AHI) of ≥ P30 per hour. A new onset of hypertension was defined according to a mean 24-hour value >140mmHg for systolic BP and >85mmHg for diastolic BP or the use of antihypertensive medication.

Results: The baseline factors significantly associated with an increased risk for new-onset hypertension were male gender, obesity, diabetes mellitus (DM), dyslipidemia, and OSA. Multiple logistic regression analyses showed that an AHI ≥30 per hour was independently associated with incident hypertension after 3 years (P=.02; odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8).

Conclusions: The presence of severe OSA is associated with new-onset AHT in normotensive elderly (mean age, 68.2 y) subjects.
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http://dx.doi.org/10.1016/j.sleep.2013.05.002DOI Listing
September 2013

Carotid artery atherosclerosis and sleep disordered breathing in healthy elderly subjects: the Synapse cohort.

Sleep Med 2013 Jan 3;14(1):66-70. Epub 2012 Nov 3.

Service de Physiologie Clinique et de l'Exercice, Pole NOL, CHU, EA 4607 SNA-EPIS, Faculté de Médecine Jacques Lisfranc, Université Jean Monnet, PRES Université de Lyon, Saint-Etienne, France.

Background: Sleep-disordered breathing (SDB) has emerged as an independent risk factor for carotid atherosclerosis (CA) and cerebrovascular disease in middle-aged subjects. Currently, there is no study providing a causal relationship between SDB and cerebrovascular lesions in elderly.

Objective: To assess the impact of SDB on CA in a cohort of healthy elderly subjects.

Methods: Seven hundred and fifty-five participants of a cross-sectional study on the association between SDB and cardiovascular morbidity, aged 68yr at study entry, were examined. All subjects underwent carotid ultrasonography and risk factors for atherosclerosis including smoking, metabolic syndrome and hypertension were examined. An apnea + hypopnea index (AHI)>15 was considered indicative of SDB.

Results: Presence of carotid lesion was found in 35% of the sample, predominantly in men and in overweight subjects. The most frequent alteration was arteriosclerosis present in 74% of cases, with stenosis >50% found in only 9% of subjects. No significant difference in the prevalence of carotid lesion was found between subjects with and without SDB, subjects with an AHI>30, even though, having a slight increase in CA. At the logistic regression analysis, male gender (p<0.001), systolic and diastolic blood pressure (p<0.001), dyslipidemia (p=0.003) and hypertension (p=0.009) were the variables independently associated with carotid lesions even in severe cases.

Conclusion: The incidence of CA in healthy elderly subjects is mediated more by gender, metabolic factors and hypertension than by presence of SDB. Further clinical studies including extensive evaluation of all atherosclerotic factors are needed to elucidate the predisposing role of SDB for cerebrovascular risk.
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http://dx.doi.org/10.1016/j.sleep.2012.08.016DOI Listing
January 2013

Does subjective sleep affect cognitive function in healthy elderly subjects? The Proof cohort.

Sleep Med 2012 Oct 6;13(9):1146-52. Epub 2012 Aug 6.

Department of Clinical Physiology and Exercise, Pole NOL, CHU and Faculty of Medicine of Saint-Etienne, UJM and PRES University of Lyon, France.

Objective: Some epidemiological data are available on the association between sleep duration and sleep quality, sleep complaints, and the aging related cognitive impairment in the elderly. In this study we examined a large sample of healthy elderly subjects to assess the relationship between sleep quality, subjective cognitive complaints, and neuropsychological performance.

Methods: A total of 272 elderly subjects (mean age 74.8 ± 1.1 years) were recruited from a population-based cross-sectional study on aging and cardiovascular morbidity. All subjects filled in self-assessment questionnaires evaluating cognitive function, anxiety, depression, sleep-related parameters, and the Pittsburgh Sleep Quality Index (PSQI). Ambulatory polygraphy and extensive neuropsychological tests were also performed. Based on the total PSQI score, subjects were classified as good sleepers (GS, PSQI<5, n=116) and poor sleepers (PS, PSQI≥5, n=156).

Results: Poor sleep did not affect the subjective cognitive function score, subjective cognitive impairment being mainly related to anxiety, depression, and sleep medication intake. No significant differences were seen between GS and PS in any of the objective cognitive function tests except for the Trail Making Test A (TMA-A), processing speed being longer in the PS group (p<0.001). Neither the presence of sleep-related breathing disorders nor gender affected cognitive performance.

Conclusions: Our results suggest that in healthy elderly subjects, subjective sleep quality and duration did not significantly affect subjective and objective cognitive performances, except the attention level, for that the interference of sleep medication should be considered.
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http://dx.doi.org/10.1016/j.sleep.2012.06.021DOI Listing
October 2012