Comparison of polysomnography in people with Alzheimer's disease and insomnia versus non-demented elderly people with insomnia

Background: We used baseline polysomnography (PSG) data obtained during the clinical program development for suvorexant to compare the PSG profiles of people with Alzheimer's disease and insomnia (ADI) versus age-matched elderly individuals with insomnia (EI).Methods: Sleep laboratory baseline PSG data from participants age 55-80 years from 2 trials in people with insomnia and a trial in people with ADI were included. ADI participants had dementia of mild-to-moderate severity. Diagnostic criteria for insomnia, exclusion for other sleep problems, PSG recording procedures, and endpoint derivations were similar across the trials. All participants underwent a night of in-laboratory PSG prior to the baseline night to allow for screening/adaptation. Participants in the EI and ADI groups were compared with regard to sleep architecture, sleep micro-structure, and quantitative EEG power spectral endpoints. The analysis was performed on a post hoc basis using propensity score matching to compare sleep parameters separately in women and men while accounting for age group and total sleep time.Results: A total of 837 EI and 239 ADI participants were included, with the majority in each population (similar to 65%) being women. Compared to EI, those with ADI had a lower percentage of time spent in slow wave sleep (and a corresponding higher percentage of time spent in the lighter N1 sleep), a lower number of spindles per minute of N2 sleep, and lower absolute EEG power during NREM sleep, particularly in the lower-frequency bands. Trends for lower REM sleep percentage in ADI did not reach statistical significance.Conclusions: Our findings in this large data set, in which the influence of sleep problems was effectively subtracted out (since both groups had insomnia), provide strong confirmatory support of results from previous smaller studies in indicating that AD of mild-to-moderate severity is associated with less slow wave sleep, spindles, and lower-frequency EEG power. Trial registration: ClinicalTrials.gov, numbers NCT01097616, NCT01097629, NCT02750306 (c) 2022 Merck Sharp & Dohme LLC., a subsidiary Merck & Co., Inc., Rahway, NJ, USA and The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).

Automated summary

This study compared the polysomnography (PSG) profiles of Alzheimer's disease and insomnia (ADI) patients with age-matched elderly individuals with insomnia (EI). The results showed that ADI patients had lower percentages of slow wave sleep and higher percentages of lighter N1 sleep, lower number of spindles in N2 sleep, and lower absolute EEG power during NREM sleep, particularly in the lower-frequency bands. These findings suggest abnormalities in light sleep and EEG spectrum in ADI patients.