Advances in sleep-relate biomarkers for predicting the development of Alzheimer disease

Sleep disturbances may hold potential predictive value for the development of Alzheimer disease (AD). Recent studies indicate that sleep macrostructure, sleep microstructure, circadian rhythm disruption, and sleep-disordered breathing are associated with AD development and AD-related biomarkers. Evidence suggests that different sleep measures hold stratification value throughout the AD disease course. Reduced slow-wave sleep, abnormalities in rapid eye movement (REM) sleep, attenuated slow-wave activity, and alterations in sleep spindles are associated with AD-related biomarkers and primarily reflect the current pathological burden. In contrast, decreased sleep efficiency, increased sleep fragmentation, reduced REM sleep, and sleep-disordered breathing are associated with incident AD risk in longitudinal studies. Certain sleep measures, such as sleep efficiency and slow-wave activity, are also associated with the rate of core AD pathological deposition. In addition, treatment of sleep-disordered breathing with continuous positive airway pressure is accompanied by changes in AD-related biomarkers. Overall, sleep-related measures have important research value for AD risk assessment, pathological stratification, and studies of disease progression.