Abstract Introduction Obstructive sleep apnea (OSA) is a common nocturnal breathing disorder characterized by frequent intermittent hypoxia and represents a significant public health concern. OSA severity, typically measured by the apnea-hypopnea index (AHI), has been linked to cognitive impairment and an increased risk of Alzheimer’s disease. This study aimed to examine whether OSA-related physiological burdens, specifically hypoxic burden (HB) and ventilatory burden (VB), are associated with cognitive performance in community-dwelling older adults. Methods This study utilized data from a longitudinal cohort of 135 clinically cognitively normal (CDR=0) older adults (median age 65.9 years), comprising 37.8% white non-Hispanic and 56.3% black African American participants enrolled in the Sleep, Aging, and Brain Health study at NYU. Cognitive performance was assessed using the Uniform Dataset (UDS 3), a comprehensive neuropsychological battery measuring dementia severity (MoCA), verbal memory, visuospatial skills, attention, language category fluency, processing speed, and executive function. Total sleep time (TST), VB, and HB were derived from overnight polysomnography at the Mount Sinai Integrated Sleep Center. Linear mixed-effects regression models evaluated associations between HB, VB, and cognitive performance, adjusting for age, sex, race, BMI, TST, and slow-wave activity. Results Participants had a median TST of 5.31 hours (Q1-Q3: 4.5–6.8) and a median BMI of 29.4 (Q1-Q3: 24.6–32.6). Higher HB and VB were associated with decreased performance on the MoCA (HB: β=-0.179, p 0.001) and attention tasks (HB: β=-0.102; VB: β=-0.761, p 0.001), and longer completion times for executive function tasks (HB: β=0.295; VB: β=0.834, p 0.001). Conversely, elevated HB and VB were linked to improved language fluency (HB: β=0.163; VB: β=0.569, p 0.001) and memory performance (HB: β=0.128; VB: β=0.345, p 0.001). No significant associations were observed for visuospatial or processing speed tasks. Adjusted models revealed significant effects for males and non-Hispanic white participants. Conclusion In older community-dwelling adults, OSA-related hypoxic and ventilatory burdens are associated with reduced cognitive performance in domains of dementia severity, attention, and executive function. These findings underscore the potential impact of OSA on age-related cognitive decline. Support (if any) This research was supported by NIH/NIA/NHLBI, the Alzheimer’s Association AARG-D-21-848397, and the BrightFocus Foundation A2022033S.
Pahari et al. (2026) studied this question.