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BMC Neurology
Published in: BMC Neurology 1/2023

Open Access 01-12-2023 | Sleep Apnea | Research

The association of upper airway anatomy with cognitive test performance: the Multi-Ethnic Study of Atherosclerosis

Authors: Robin M. Nance, Alison E. Fohner, Robyn L. McClelland, Susan Redline, R. Nick Bryan, Annette Fitzpatrick, Mohamad Habes, WT Longstreth, Jr., Richard J. Schwab, Andrew S. Wiemken, Susan R. Heckbert

Published in: BMC Neurology | Issue 1/2023

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Abstract

Background

Numerous upper airway anatomy characteristics are risk factors for sleep apnea, which affects 26% of older Americans, and more severe sleep apnea is associated with cognitive impairment. This study explores the pathophysiology and links between upper airway anatomy, sleep, and cognition.

Methods

Participants in the Multi-Ethnic Study of Atherosclerosis underwent an upper airway MRI, polysomnography to assess sleep measures including the apnea-hypopnea index (AHI) and completed the Cognitive Abilities Screening Instrument (CASI). Two model selection techniques selected from among 67 upper airway measures those that are most strongly associated with CASI score. The associations of selected upper airway measures with AHI, AHI with CASI score, and selected upper airway anatomy measures with CASI score, both alone and after adjustment for AHI, were assessed using linear regression.

Results

Soft palate volume, maxillary divergence, and upper facial height were significantly positively associated with higher CASI score, indicating better cognition. The coefficients were small, with a 1 standard deviation (SD) increase in these variables being associated with a 0.83, 0.75, and 0.70 point higher CASI score, respectively. Additional adjustment for AHI very slightly attenuated these associations. Larger soft palate volume was significantly associated with higher AHI (15% higher AHI (95% CI 2%,28%) per SD). Higher AHI was marginally associated with higher CASI score (0.43 (95% CI 0.01,0.85) per AHI doubling).

Conclusions

Three upper airway measures were weakly but significantly associated with higher global cognitive test performance. Sleep apnea did not appear to be the mechanism through which these upper airway and cognition associations were acting. Further research on the selected upper airway measures is recommended.
Appendix
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Metadata
Title
The association of upper airway anatomy with cognitive test performance: the Multi-Ethnic Study of Atherosclerosis
Authors
Robin M. Nance
Alison E. Fohner
Robyn L. McClelland
Susan Redline
R. Nick Bryan
Annette Fitzpatrick
Mohamad Habes
WT Longstreth, Jr.
Richard J. Schwab
Andrew S. Wiemken
Susan R. Heckbert
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2023
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-023-03443-9

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