Tiffany Braley, MD, MS, is a physician scientist and recipient of the AASM Foundation Strategic Research Grant. Her work is focused on positive airway pressure therapy and dementia risk in OSA-affected older adults.

Tiffany Braley, MD, MS, is an associate professor of neurology at the University of Michigan. Her research focuses on sleep-related predictors of cognitive dysfunction and other symptoms in people with neurological conditions, as well as older adults. She is also recipient of the 2015 Strategic Research Grant, Recognition and Treatment of Obstructive Sleep Apnea among Medicare Beneficiaries, which aimed to characterize population-based pattens in obstructive sleep apnea (OSA) recognition and treatment in older adults and to clarify the relationships between OSA and health outcomes, using data from the National Health and Aging Trends Study and Medicare claims data. The project was conducted in collaboration with co-investigators Galit Levi Dunietz PhD, MPH, James Burke MD, MS, and Ronald Chervin MD, MS, at the University of Michigan.

“We found that elevated OSA risk is common and yet seldom investigated in older adults, but that among high-risk individuals who do receive diagnostic evaluations, OSA is usually confirmed,” said Braley. “Further, among older adults with OSA, treatment with positive airway pressure therapy is associated with a lower short-term risk of dementia, including Alzheimer’s dementia. These population-based data highlight a potentially protective role for PAP therapy on short-term dementia risk in older persons with OSA.”

Her team’s work was published in the Journal of Clinical Sleep Medicine and Sleep in 2021.

The findings of this project are important as a high proportion of the older adult population is at risk for OSA, and vulnerable to many of the health consequences associated with OSA, including dementia. As OSA is treatable, research to promote improved recognition and treatment may offer new opportunities to improve cognitive and other health outcomes. One of the surprising results that Braley’s research team found was related to healthcare disparities among the elderly, as published in the Journal of the American Geriatric Society in 2018.

“Our team was struck by the low proportion of at-risk patients who received diagnostic evaluations for OSA, suggesting that adults over age 65 may be vulnerable to disparities in OSA care,” said Braley.

In 2021, Braley and Dunietz were awarded a R01 grant from the National Institute on Aging to assess the long-term impact of OSA and positive airway therapy on dementia risk in older women and men, and uncover unexplored pathways between pathological sleep and cognitive outcomes on a population level.

“We will accomplish this through use of cognitive, health, and biomarker data from the Health and Retirement Study – a nationally representative, multi-ethnic longitudinal cohort study of older adults, and Medicare claims datasets,” said Braley. “In this project, we hope to elucidate modifiable sleep-based pathways that underlie cognitive outcomes in older adults, to guide future dementia research.”

In terms of next steps in continuing to address research gaps in sleep and cognition, Braley’s team is analyzing other large datasets to study the impact of other sleep disturbances on cognition, and their relationship with other predictors of cognitive decline. Braley, a clinical neuroimmunologist, also remains heavily focused on ongoing epidemiological and interventional studies to address the impact of sleep disorders on cognitive dysfunction, health, and other symptoms in people with multiple sclerosis, which is another neurological population that is vulnerable to sleep disorders and their impact.