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Volume 15 No. 07
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Accepted Papers

Scientific Investigations

Associations Between the Apnea-Hypopnea Index During REM and NREM Sleep and Cognitive Functioning in a Cohort of Middle-Aged Adults

Maria Devita, PhD1; Paul E. Peppard, PhD2; Arthur E. Mesas, PhD3; Sara Mondini, PhD4,5; Maria Luisa Rusconi, MD, PhD6; Jodi H. Barnet, MS2; Erika W. Hagen, PhD2
1Department of Medicine – DIMED, University of Padua, Padua, Italy; 2Department of Population Health Sciences, University of Madison-Wisconsin, Madison, Wisconsin; 3State University of Londrina, Paraná, Brazil; 4Department of General Psychology, University of Padua, Padua, Italy; 5Human Inspired Technology Research Centre, University of Padua, Padua, Italy; 6Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy

Study Objectives:

Prior research has linked obstructive sleep apnea (OSA) to varied cognitive deficits. Additionally, OSA in rapid eye movement (REM) versus non-rapid eye movement (NREM) sleep has been shown to be a stronger predictor of outcomes such as hypertension. The present study aimed to investigate whether OSA—as characterized by the apnea-hypopnea index (AHI)—during REM and NREM sleep is associated with performance on a range of cognitive tasks. We also investigated whether the presence/absence of the apolipoprotein E4 allele (APOE4) modifies the associations between AHI during REM and NREM sleep and cognitive performance.


A cross-sectional sample of 1,250 observations from 755 community-dwelling adults (mean [standard deviation] age, 62.3 [8.2] years) participating in the Wisconsin Sleep Cohort study was carried out by means of overnight polysomnography, paper-and-pencil cognitive tasks, and genetic data. Linear mixed effects models with repeated measures estimated associations of AHI during REM and NREM sleep with cognitive outcomes, stratified by APOE4 status (carrier versus noncarrier).


No significant associations were found between REM AHI and cognitive outcomes for either APOE4 carriers and non-carriers. Higher NREM AHI was associated with worse memory retention among APOE4 carriers; among noncarriers of APOE4, higher NREM AHI was associated with worse performance on a test of psychomotor speed, but better performance on two tests of executive function.


Sleep state-specific (REM, NREM) OSA may be differentially associated with varying dimensions of cognitive deficits in middle-aged to older adults, and such associations are likely to be modified by genetic factors, include APOE polymorphisms.


Devita M, Peppard PE, Mesas AE, Mondini S, Rusconi ML, Barnet JH, Hagen EW. Associations between the apnea-hypopnea index during REM and NREM sleep and cognitive functioning in a cohort of middle-aged adults. J Clin Sleep Med. 2019;15(7):965–971.

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