World Sleep 2022 | Critical knowledge gaps in the relationship between sleep and Alzheimer’s disease
Bryce Mander, PhD, University of California Irvine, Irvine, CA, discusses significant knowledge gaps on the treatment side of understanding the relationship between sleep and Alzheimer’s disease. Dr Mander describes how it is known that there are some links between sleep disturbances increasing the risk for Alzheimer’s disease – and that Alzheimer’s increases the prominence of sleep disturbances. However, it is not known if it is an association built on the preclinical symptoms of the disease – being expressed before disease onset disrupting sleep. It is also unknown if the sleep disturbances are actively disrupting and causing the onset of disease. Dr Mander follows on to state that the largest knowledge gap resides in whether it is possible to improve sleep in individuals with sleep disorders; this could help in improving health, reducing pathology, and ultimately reduce the risk of developing Alzheimer’s disease. This is a major goal for many labs around the world. There is preliminary work looking into obstructive sleep apnea, treating it with positive airway pressure to try and understand if this can reduce the risk of disease. Some results have implied that this is the case – however, large-scale studies are needed. There is no knowledge on the treatment of insomnia impacting the risk of dementia, nor is there any knowledge on improving sleep quality in the older population who do not have these disorders – yet suffer from generalized sleep disturbances. Dr Mander also identifies the understanding of mechanisms linking abnormalities in the circadian rhythm to dementia risk as another necessary avenue of research. This interview took place at the World Sleep Congress 2022 in Rome, Italy.
Transcript (edited for clarity)
There are significant knowledge gaps on the treatment side of things. So we know that there’s links between sleep and increasing risk for Alzheimer’s disease, sleep disturbance. We know that Alzheimer’s disease increases the prevalence of sleep disturbances itself. But we don’t know if this is association built on just preclinical symptoms of the disease being expressed before disease onset disrupting sleep, or if sleep disturbance itself is actively disrupting and causing the disease...
There are significant knowledge gaps on the treatment side of things. So we know that there’s links between sleep and increasing risk for Alzheimer’s disease, sleep disturbance. We know that Alzheimer’s disease increases the prevalence of sleep disturbances itself. But we don’t know if this is association built on just preclinical symptoms of the disease being expressed before disease onset disrupting sleep, or if sleep disturbance itself is actively disrupting and causing the disease. And the real way to address that would be, can we intervene? Can we improve sleep in people with sleep disorders and improve their health and reduce pathology, reduce the buildup of pathology and reduce ultimately the risk of developing it later on? That’s the biggest and most important knowledge gap there is.
This is a goal, to study this, for a lot of labs around the world and some studies are ongoing. There is some preliminary work in obstructive sleep apnea and how treating obstructive sleep apnea with, say, positive airway pressure, whether it’s CPAP or BiPAP or AutoPAP, to try to understand if treating that can reduce risk. And there’s some evidence that may be the case, but large scale studies are needed. We know nothing about treatment in insomnia impacting risk for dementia. We don’t know anything about improving sleep quality in older people that don’t have these disorders but have sleep disturbance in general, whether that can actually impact risk. And another area that needs a lot more work is trying to understand the mechanisms linking circadian rhythm abnormalities and dementia risk, and whether treatment to improve rhythms in older people can reduce risk for dementia as well.
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