New research suggests a sex-specific vulnerability in patients with both obstructive sleep apnea and insomnia, potentially identifying a pathway to cognitive decline.
Key takeaways:
- Older women with comorbid insomnia and sleep apnea (COMISA) demonstrated significantly worse verbal memory performance, an association not found in men.
- The study involved 110 adults aged 65 to 83 with diagnosed obstructive sleep apnea, 37% of whom had COMISA.
- Post hoc analyses suggest sex differences in sleep architecture, such as reduced REM sleep in women with COMISA, may explain the cognitive vulnerability.
- The findings support the need for sex-specific screening and treatment strategies to potentially protect memory and reduce dementia risk in this population.
New research finds that older women with comorbid insomnia and sleep apnea (COMISA) exhibit significantly worse verbal memory performance compared to those with sleep apnea alone, a vulnerability not observed in men.
The study, published in the Journal of Clinical Sleep Medicine, shows that while COMISA was associated with worse memory performance overall compared to sleep apnea alone, the interaction was only statistically significant in women after adjusting for age, body mass index, sleep apnea severity, and education.
“We expected that having both insomnia and sleep apnea would worsen memory for everyone, but only older women showed this vulnerability. That was striking, especially because women typically outperform men on verbal memory tasks,” says lead author Breanna Holloway, PhD, a postdoctoral researcher at UC San Diego School of Medicine, in a release. “The fact that COMISA seemed to offset that advantage hints at a hidden sleep-related pathway to cognitive decline in women.”
The observational study involved 110 older adults between the ages of 65 and 83 diagnosed with obstructive sleep apnea. Participants completed an overnight sleep study and cognitive testing, with insomnia and verbal memory assessed using validated tools. COMISA was present in 37% of participants.
According to the authors, sex differences in sleep architecture may explain the cognitive vulnerability seen in women with COMISA. Post hoc analyses revealed that women with the comorbid condition had reduced rapid eye movement sleep and more slow wave sleep compared with men.
The researchers note that these findings highlight the importance of considering sex-specific patterns when evaluating COMISA and support developing tailored screening and treatment strategies.
“These results point to an overlooked risk in women with both insomnia and sleep apnea,” says Holloway in the release. “Because women are more likely to have insomnia and often go undiagnosed for sleep apnea, recognizing and treating COMISA early could help protect memory and reduce dementia risk.”
