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Erika CS Künstler,1,2 Peter Bublak,1 Kathrin Finke,1 Nicolas Koranyi,1 Marie Meinhard,1 Matthias Schwab,1,2 Sven Rupprecht1,2 1Department of Neurology, Jena University Hospital, Jena, Germany; 2Interdisciplinary Centre for Sleep and Ventilatory Medicine, Jena University Hospital, Jena, GermanyCorrespondence: Erika CS Künstler, Department of Neurology, Jena University Hospital, Am Klinikum 1, Jena, 07747, Germany, Tel +49 3641 9323525, Email Erika.Kuenstler@med.uni-jena.deStudy Objectives: Persistent insomnia disorder (pID) is linked to neurocognitive decline and increased risk of Alzheimerâs Disease (AD) in later life. However, research in this field often utilizes self-reported sleep quality data - which may be biased by sleep misperception - or uses extensive neurocognitive test batteries - which are often not feasible in clinical settings. This study therefore aims to assess whether a simple screening tool could uncover a specific pattern of cognitive changes in pID patients, and whether these relate to objective aspect(s) of sleep quality.Methods: Neurocognitive performance (Montreal Cognitive Assessment; MoCA), anxiety/depression severity, and subjective sleep quality (Pittsburgh Sleep Quality Index: PSQI; Insomnia Severity Index: ISI) data were collected from 22 middle-aged pID patients and 22 good-sleepers. Patients underwent overnight polysomnography.Results: Compared to good-sleepers, patients had lower overall cognitive performance (average: 24.6 versus 26.3 points, MannâWhitney U = 136.5, p = < 0.006), with deficits in clock drawing and verbal abstraction. In patients, poorer overall cognitive performance correlated with reduced subjective sleep quality (PSQI: r(42) = â 0.47, p = 0.001; and ISI: r(42) = â 0.43, p = 0.004), reduced objective sleep quality (lower sleep efficiency: r(20) = 0.59, p = 0.004 and less REM-sleep: r(20) = 0.52, p = 0.013; and increased sleep latency: r(20) = â 0.57, p = 0.005 and time awake: r(20) = â 0.59, p = 0.004). Cognitive performance was not related to anxiety/depression scores.Conclusion: Using a simple neurocognitive screening tool, we found that pID patients showed cognitive deficiencies that related to both subjective/self-reported and objective/polysomnographic measures of sleep quality. Furthermore, these cognitive changes resembled those seen in preclinical non-amnestic AD, and thus could indicate incumbent neurodegenerative processes in pID. Interestingly, increased REM-sleep was correlated with better cognitive performance. However, whether REM-sleep is protective against neurodegeneration requires further investigation.Keywords: insomnia, sleep, neurodegeneration, Alzheimerâs disease, polysomnography, cognitive screening |
