A-60: Sleep Apnea and Accelerated Functional Decline in Older Adults

Abstract

Objective: To examine whether sleep apnea is associated with cognitive and functional decline and incident AD, and whether hypertension modifies these associations. Method/Data Selection: Data were drawn from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (N = 201,352). Analyses included 107,307 participants who were cognitively normal (N = 98,451) or had MCI (n = 8,856) at baseline. Mean age was 73.51 years (SD = 10.29), and 35.4% were male. Sleep apnea and hypertension were clinician-assessed. Cognition and function were measured longitudinally using the Montreal Cognitive Assessment (MoCA) and the Clinical Dementia Rating (CDR). Linear mixed-effects models estimated rates of decline, and logistic regression assessed incident AD, with interaction terms for hypertension. Results/Data Synthesis: Sleep apnea was associated with faster functional decline (CDR Sum of Boxes: p = .005; CDR Global: p .05). The association between sleep apnea and cognitive decline varied significantly by baseline cognitive status (p < .001). Conclusions: Sleep apnea was associated with accelerated functional decline but did not independently increase Alzheimer’s disease risk. Its cognitive effects varied by baseline cognitive status, suggesting differential vulnerability across groups. The absence of an interaction with hypertension indicates that sleep apnea may contribute to decline through non-vascular mechanisms. These findings highlight sleep apnea as a potentially modifiable target for preserving functional independence in older adults.