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Authors Response to Dr. Munakomi

  • Matthew P. Pase, Sidney Sax Senior Research Fellow, Swinburne University of Technology; Boston University School of Medicine; Framingham Heart Studymatthewpase@gmail.com
  • AJ Westwood; A Beiser; N Jain; C DeCarli; JJ Himali; SH Auerbach; S Seshadri
Submitted June 22, 2017

We thank Dr. Munakomi for the letter regarding our recent article on prolonged sleep duration as a potential marker of early-onset neurodegeneration and subsequent dementia. [1] We agree it is important to unpack the associations between sleep and Alzheimer disease (AD). The fascinating study by Xie et al. [2] demonstrated that the rate of beta-amyloid clearance is increased during sleep. However, the role of REM sleep or sleep hygiene in the neurodegenerative process is unclear. In the experiments of Xie et al, sleep was characterized by an increased prevalence of delta wave activity, [2] typical of deep sleep as compared with REM sleep. Cross-sectionally, REM sleep is reduced in patients with dementia and cognitive impairment. [3, 4] However, dementia is associated with comorbidities that can affect sleep and associations between sleep and AD may be bidirectional. [5] Prospective studies are needed to investigate the association between sleep architecture and the future risk of AD and dementia; this is a project that we are currently pursuing using home-based polysomnography and prospective follow-up for incident dementia in the Framingham Heart Study.

1. Westwood AJ, Beiser A, Jain N, et al. Prolonged sleep duration as a marker of early neurodegeneration predicting incident dementia. Neurology 2017;88:1172-1179.

2. Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. Science 2013;342:373-377.

3. Haba-Rubio J, Marti-Soler H, Tobback N, et al. Sleep characteristics and cognitive impairment in the general population: The HypnoLaus study. Neurology 2017;88:463-469.

4. Liguori C, Romigi A, Nuccetelli M, et al. Orexinergic system dysregulation, sleep impairment, and cognitive decline in Alzheimer disease. JAMA Neurol 2014;71:1498-1505.

5. Ju YE, Lucey BP, Holtzman DM. Sleep and Alzheimer disease pathology--a bidirectional relationship. Nat Rev Neurol. 2014;10:115-119.

For disclosures, please contact the editorial office at journal@neurology.org.

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