From the Whitehall II study, data involving 5431 older participants (45-69 at baseline) has revealed a significant effect of midlife sleep changes on later cognitive function. Sleep duration was assessed at one point between 1997 and 1999, and again between 2002 and 2004. A decrease in average night’s sleep from 6, 7, or 8 hours was significantly associated with poorer scores on tests of reasoning, vocabulary, and the MMSE. An increase from 7 or 8 hours (but not from 6 hours) was associated with lower scores on these, as well as on tests of phonemic and semantic fluency. Short-term verbal memory was not significantly affected. The magnitude of these effects was equivalent to a 4–7 year increase in age.

Around 8% of participants showed an increase from 7-8 hours of sleep over the five-year period (7.4% of women; 8.6% of men), while around a quarter of women and 18% of men decreased their sleep amount from 6-8 hours. About 58% of men and 50% of women reported no change in sleep duration during the study period. Some 27% of the participants were women.

The optimal amount of sleep (in terms of highest cognitive performance) was 7 hours for women, closely followed by 6 hours. For men, results were similar at 6, 7 and 8 hours.

Analysis took into account age, sex, education and occupational status. The Whitehall II study is a large, long-running study involving British civil servants. Sleep duration was assessed simply by responses to the question "How many hours of sleep do you have on an average week night?"

A very large Chinese study, involving 28,670 older adults (50-85), of whom some 72% were women, also supports an inverted U-shaped association between sleep duration and cognitive function, with 7-8 hours sleep associated with the highest scores on a delayed word recall test.

I would speculate that this finding of an effect of short-term verbal memory (in contrast to that of the Whitehall study) may reflect a group distinction in terms of education and occupation. The Whitehall study is the more homogenous (mostly white-collar), with participants probably averaging greater cognitive reserve than the community-based Chinese study. The findings suggest that memory is slower to be affected, rather than not affected.

Comparison of 17 people with severe obstructive sleep apnea (OSA) with 15 age-matched controls has revealed that those with OSA had reduced gray matter in several brain regions, most particularly in the left parahippocampal gyrus and the left posterior parietal cortex, as well as the entorhinal cortex and the right superior frontal gyrus. These areas were associated with deficits in abstract reasoning and executive function. Deficits in the left posterior parietal cortex were also associated with daytime sleepiness.

Happily, however, three months of treatment with continuous positive airway pressure (CPAP), produced a significant increase in gray matter in these regions, which was associated with significant improvement in cognitive function. The researchers suggest that the hippocampus, being especially sensitive to hypoxia and innervation of small vessels, is the region most strongly and quickly affected by hypoxic episodes.

The findings point to the importance of diagnosing and treating OSA.

A study involving 135 adults (33-65) has found that, not only did patients with obstructive sleep apnea who were being treated with CPAP therapy outperform untreated OSA patients on an overnight picture memory task, but they outperformed controls who did not have OSA. The memory task involved being shown 20 photographs before spending the night in the sleep lab, and then having to choose the familiar photo from 20 similar pairs in the morning. CPAP therapy provides a steady stream of air through a mask that is worn during sleep.

A national study involving some 8,000 children, has revealed receptive and expressive language, phonological awareness, literacy and early math abilities were all better in 4-year-old children whose parents reported having rules about what time their child goes to bed. Having an earlier bedtime also was predictive of higher scores for most developmental measures. Recommendations are that preschool children get a minimum of 11 hours of sleep each night. These findings (which confirm earlier studies) indicate not only that lower scores on phonological awareness, literacy and early math skills are associated with getting less than this recommended amount of sleep, but that many children are not getting the recommended amount of sleep.