ArticleNature and science of sleep2026
Associations Between Obstructive Sleep Apnea, Macro-Scale Glymphatic Coupling, and Episodic Memory Impairment in Middle-Aged and Older Adults.
Article in Nature and science of sleep, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Sleep disorders are highly prevalent among middle-aged and older adults and represent a crucial modifiable risk factor for cognitive decline. Impaired brain waste clearance is hypothesized to underlie this association, but clinical evidence remains limited. We utilized global blood-oxygen-level-dependent and cerebrospinal fluid (gBOLD-CSF) coupling as a non-invasive macro-scale surrogate of fluid clearance dynamics to investigate its associations across distinct clinical phenotypes, including obstructive sleep apnea (OSA), insomnia, and comorbid insomnia and sleep apnea (COMISsA) and to delineate how objective respiratory metrics and subjective insomnia severity differentially relate to domain-specific cognitive impairment. Methods: A total of 143 adults were enrolled and categosrized into four groups: healthy controls (HCs, n = 30), obstructive sleep apnea (OSA, n = 46), insomnia (n = 32), and comorbid insomnia and sleep apnea (COMISA, n = 35). Participants underwent home sleep apnea testing, comprehensive neuropsychological assessments, and 3.0 T magnetic resonance imaging. gBOLD-CSF coupling strength was quantified by computing the peak negative cross-correlation between the global cortical BOLD signal and the signal extracted from the CSF regions at the bottom slice of the fMRI acquisition. Results: Compared with HCs, individuals with sleep disorders exhibited significantly reduced gBOLD-CSF coupling strength (all Bonferroni-corrected Conclusion: In summary, gBOLD-CSF coupling characteristically tracks distinct sleep disorder subtypes, showing significant reductions in middle-aged and older adults with OSA, insomnia, and COMISA. Our findings suggest that respiratory event-related hypoxic stress is associated with increased susceptibility to delayed episodic memory deficits in relation to glymphatic impairment, highlighting that cross-disciplinary sleep interventions may represent a promising strategy for preserving brain clearance and mitigating cognitive aging.
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