APOE4 allele linked with impairment of deep sleep and deadly sleep apnea | Matthew Walker
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APOE4, one of three common genetic variants of the APOE (apolipoprotein E) gene, is present in approximately 10 to 15 percent of people. Having one or more APOE-4 alleles markedly increases a person's risk of developing Alzheimer's disease. Adding to this risk is apnea, a common sleep problem in which a person temporarily stops breathing. Apnea interferes with deep sleep, induces hypoxia, and promotes amyloid-beta accumulation in the brain. In this clip, Dr. Matthew Walker describes the dual risk of carrying the APOE4 allele and having sleep apnea.
Matt: But how do you tell that especially to people who, you know, have one ApoE allele...apoe-4, sorry, allele. What I would also say that's important for people, if you know your ApoE status, and if you are apoe-4, be mindful of snoring as well. Because people who are apoe-4-positive, they also have a significantly elevated risk of a sleep disorder that we call sleep apnea, which is sleep-disordered breathing, which is heavy snoring and a cessation of breathing entirely. And then you gasp when you wake up again.
Heavy snoring sleep apnea is a killer. It is an outright killer. It increases your risk of basically everything you don't want: cardiovascular disease, stroke, diabetes, and obesity. It also increases your risk of immediate death through a higher risk of car accidents.
But one of the other problems with sleep apnea is that you don't get the amount of deep sleep that you need. And you have hypoxic damage. Because you stopped breathing, your oxygen saturation goes down. You get hypoxia damage particularly in a region that is most sensitive to it in the brain, which is, drumroll, the hippocampus, the very same memory structure that is attacked in Alzheimer's disease.
So now you can see why I appeal for this sensitivity in this danger to sleep apnea. Because if you are apoe-4, you're already at high risk of Alzheimer's disease, you need to pay attention to your sleep. If you start snoring, and you have sleep apnea untreated, you will get less deep sleep. So you're compromising the thing that you need to try and lower your amyloid risk to begin with, because you're going to build up that amyloid, because you're not going to get the amyloid clearance elsewhere in the body, for example, in the liver. And then worse still, the part of the brain that is attacked severely by Alzheimer's disease and atrophies, which is the hippocampus, which is why memory fades, is a part of the brain that is damaged when you stop breathing because of oxygen desaturation.
So, as an appeal, even if you are not apoe-4-positive, but you are snoring, or you know someone who is snoring, go and see your doctor and get a sleep apnea test. It is potentially life-saving.
Rhonda: Actually, I had a sleep apnea test because of my night awakenings. I didn't know. It was, like, maybe I have apnea and I couldn't...And so I'm having this terror. And of course, that wasn't it. I don't have sleep apnea. But I didn't know about the connection between apoe-4 and sleep apnea. That's terrible because...
Matt: It's quite a dramatic...
Rhonda: Yeah.
Matt: I mean, you combine those two together. It's a real...I mean, it’s gasoline on an already started fire.
Rhonda: People with apoe-4 also don't repair damage and their brain as well as people with apoe-3.
Matt: They don't.
Rhonda: So you're talking about hypoxic damage in addition, you know, there's sort of just this potentially compounding effect.
Matt: And I think that's, you know, that's part of the reason...I mean, so I have some family members that have been associated with Alzheimer's disease, one recently passed away. And it's been a big motivation for me personally. I started, you know, 20 years ago. My PhD was looking at people with degenerative dementia. That's how I actually got into sleep, because I was seeing these sleep abnormalities.
And, you know, I'm so desperately trying to find ways to help and to combat that incredible epidemic of dementia.
A neurodegenerative disorder characterized by progressive memory loss, spatial disorientation, cognitive dysfunction, and behavioral changes. The pathological hallmarks of Alzheimer's disease include amyloid-beta plaques, tau tangles, and reduced brain glucose uptake. Most cases of Alzheimer's disease do not run in families and are described as "sporadic." The primary risk factor for sporadic Alzheimer's disease is aging, with prevalence roughly doubling every five years after age 65. Roughly one-third of people aged 85 and older have Alzheimer's. The major genetic risk factor for Alzheimer's is a variant in the apolipoprotein E (APOE) gene called APOE4.
One of three common genetic variants of the APOE (apolipoprotein E) gene. The APOE4 allele, which is present in approximately 10-15% of people, increases the risk of developing Alzheimer's disease and lowers the age of onset. Having one copy of E4 increases risk 2- to 3-fold, while having two copies increases risk as much as 15-fold.
A general term referring to cognitive decline that interferes with normal daily living. Dementia commonly occurs in older age and is characterized by progressive loss of memory, executive function, and reasoning. Approximately 70 percent of all dementia cases are due to Alzheimer’s disease.
A small organ located within the brain's medial temporal lobe. The hippocampus is associated primarily with memory (in particular, the consolidation of short-term memories to long-term memories), learning, and spatial navigation. Amyloid-beta plaque accumulation, tau tangle formation, and subsequent atrophy in the hippocampus are early indicators of Alzheimer’s disease.
Condition in which the body or a region of the body is deprived of adequate oxygen supply. Hypoxia may be classified as either generalized, affecting the whole body, or local, affecting a region of the body.
A sleep disorder characterized by repeated interruptions in breathing during sleep, reducing oxygen levels and disrupting sleep patterns. Two primary types of apnea have been identified: obstructive sleep apnea (OSA, caused by airway blockage) and central sleep apnea (CSA, caused by the brain's failure to signal breathing). Sleep apnea causes brain hypoxia and has been associated with an increased risk of many serious health conditions, including hypertension, cardiovascular disease, diabetes, depression, and stroke.[1]
- ^ Javaheri, Shahrokh; Barbe, Ferran; Dempsey, Jerome A.; Khayat, Rami; Javaheri, Sogol; Malhotra, Atul, et al. (2017). Sleep Apnea Journal Of The American College Of Cardiology 69, 7.
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