Identifying a Relationship Between Executive Dysfunction, Poor Sleep Hygiene/Sleep Apnea, and Ventriculomegaly in Cancer-related Cognitive Impairment (CRCI)
Rhonna Shatz1, Sophie Kushman1, Alique Topalian2
1Neurology and Rehabilitation, 2Family Practice, University of Cincinnati
To investigate the incidence and type of sleep disorders (SD) in cancer-related cognitive impairment (CRCI), the association of sleep disorders (SD) with executive dysfunction, and evidence of altered glymphatic circulation in SD as measured by the Evan's Index (EI) on MRI.

CRCI, most commonly executive dysfunction, presents anytime from diagnosis to years after remission indicating the impact of other comorbidities. 

Disordered sleep leads to executive dysfunction and may contribute to CRCI.  SD prevent progression to deep sleep associated enhanced glymphatic circulation and clearance of toxic proteins and inflammatory by-products, leading to ventriculomegaly. The Evan’s Index (EI) is a measure of ventricular volume, with a ratio >0.3 indicating enlarged ventricles.



164 consecutive CRCI patients underwent standardized evaluations using NIH Toolbox, CERAD, sleep history (PSQI), and NPSG. Retrospective data including diagnoses, test scores, and sleep study results obtained from Epic and entered into REDCap.  Data was generated within REDCap software.  MRI images were analyzed in McKesson to calculate EI.
76.4% met clinical indication for NPSG (snoring and hypersomnia).  Only 16.4% reported good quality sleep.  46% had sleep apnea (OSA): mild 34.2%, moderate 44.7%, severe 21.1%, median AHI 16 (moderate OSA).  All OSA patients displayed some degree of executive dysfunction.  Processing speed and phonemic fluency declined with increasing AHI severity and increasing ventriculomegaly as measured by EI.

Of 164 CRCI patients, 84% had sleep disruptions.  NPSG identified OSA in 46%; therefore, routine standardized sleep assessments including NPSGs should be considered in the evaluation of CRCI.  OSA correlated with ventriculomegaly, measured by EI. The inverse relationship of processing speed and phonemic fluency scores with increasing EI suggests that OSA-related ventriculomegaly and altered glymphatic circulation mediate the executive impairments.  Inflammation, SD, and OSA increase neurodegenerative risk.  Cancer-related inflammation in combination with SD may explain the increased risk of neurodegenerative disease in individuals with CRCI.