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Association of Sleep Quality on Memory-Related Executive Functions in Middle Age

  • Brinda K. Rana (a1) (a2), Matthew S. Panizzon (a1) (a3), Carol E. Franz (a1) (a3), Kelly M. Spoon (a3) (a4), Kristen C. Jacobson (a5), Hong Xian (a6) (a7), Sonia Ancoli-Israel (a1) (a8), Michael Lyons (a9) and William S. Kremen (a1) (a3) (a10)...


Objectives: Sleep quality affects memory and executive function in older adults, but little is known about its effects in midlife. If it affects cognition in midlife, it may be a modifiable factor for later-life functioning. Methods: We examined the association between sleep quality and cognition in 1220 middle-aged male twins (age 51–60 years) from the Vietnam Era Twin Study of Aging. We interviewed participants with the Pittsburgh Sleep Quality Index and tested them for episodic memory as well as executive functions of inhibitory and interference control, updating in working memory, and set shifting. Interference control was assessed during episodic memory, inhibitory control during working memory, and non-memory conditions and set shifting during working memory and non-memory conditions. Results: After adjusting for covariates and correcting for multiple comparisons, sleep quality was positively associated with updating in working memory, set shifting in the context of working memory, and better visual-spatial (but not verbal) episodic memory, and at trend level, with interference control in the context of episodic memory. Conclusions: Sleep quality was associated with visual-spatial recall and possible resistance to proactive/retroactive interference. It was also associated with updating in working memory and with set shifting, but only when working memory demands were relatively high. Thus, effects of sleep quality on midlife cognition appear to be at the intersection of executive function and memory processes. Subtle deficits in these age-susceptible cognitive functions may indicate increased risk for decline in cognitive abilities later in life that might be reduced by improved midlife sleep quality. (JINS, 2018, 24, 67–76)


Corresponding author

Correspondence and reprint requests to: Brinda K. Rana and William S. Kremen, Department of Psychiatry, University of California, 9500 Gilman Drive, MC-0738, La Jolla, CA 92093. E-mail: and


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