Daytime Sleepiness Is Associated with Lower Cognitive Scores: The Look AHEAD Study

BACKGROUND: Daytime sleepiness is common in older adults and may result from poor nighttime sleep due to sleep disordered breathing, fragmented sleep, or other sleep disorders. Daytime sleepiness may be associated with cognition in older adults. OBJECTIVES: We investigated the association between self-reported daytime sleepiness and cognitive function in the Look AHEAD clinical trial. DESIGN: Observational follow-up of a randomized clinical trial of an intensive lifestyle intervention. SETTING: Clinic. PARTICIPANTS: Participants (n=1,778) aged 45-76 years at baseline with type 2 diabetes and overweight or obesity. INTERVENTIONS: Participants were randomized to an intensive lifestyle intervention for weight loss or a control condition of diabetes support and education. MEASUREMENTS: Participants provided self-reported levels of daytime sleepiness at baseline and years 12-13. Cognitive function was assessed with a neurocognitive battery at years 12-13 and 18-20. RESULTS: Participants who reported having frequent daytime sleepiness (often or always) performed significantly worse than others on the cognitive composite (-0.35; p-value=0.014) after controlling for covariates. When stratified by intervention arm, participants assigned to the intensive lifestyle intervention who reported often/always having daytime sleepiness performed worse on Digit Symbol Coding (-0.63; p-value=0.05) and Trail Making Part-B (-0.56; p-value=0.02) after controlling for covariates. Statistical interactions revealed associations between daytime sleepiness and the following covariates: race and ethnicity, APOE ε4 carrier status, baseline history of cardiovascular disease, and depression. CONCLUSIONS: Daytime sleepiness over ~13 years predicted poorer cognitive performance in older individuals who, by virtue of having diabetes and overweight/obesity, are at high risk for sleep disorders and cognitive impairment.