Prevalence and Misperception: Exploring the Gap Between Objective and Subjective Assessment of Sleep Apnea in a...

Background: Aging is a well-established independent risk factor for both cognitive impairment and sleep disorders, including obstructive sleep apnea (OSA), a modifiable yet underrecognized condition. OSA has been implicated in biological mechanisms contributing to Alzheimer's disease, including amyloid-β accumulation, tau phosphorylation, and neuroinflammation. This underscores the need to optimize OSA diagnosis in individuals with an increased risk of dementia. Methods: This cross-sectional observational study enrolled adults aged 60-85 years with a CAIDE dementia risk score ≥6. Subjective sleep was evaluated using validated questionnaires (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the Oviedo Sleep Questionnaire), while objective sleep data were obtained through a single-night peripheral arterial tonometry (PAT)-based wearable device, complemented by a 7-day sleep diary. Participants also completed the STOP-BANG and Berlin questionnaires, with clinically relevant findings communicated to participants. Results: Among 322 participants (48.8% women; mean age 71.4 ± 6.4 years), moderate-to-severe OSA (apnea-hypopnea index [AHI] ≥ 15) was identified in 48.49%, despite the absence of prior diagnoses. Subjective screening tools frequently underestimated OSA severity compared to objective assessments. While no significant sex-based differences were noted, higher AHI values correlated strongly with increased body mass index and elevated dementia risk scores. Conclusions: A marked discrepancy between subjective and objective sleep measurements complicates the accurate diagnosis and management of most sleep disorders, including OSA. Sleep disorders remain significantly underdiagnosed in individuals at increased risk for dementia. Integrating wearable technologies and structured tools such as sleep diaries into routine assessments can enhance diagnostic precision, enabling timely interventions for these modifiable risk factors of dementia.