# Sleep stability, emotional memory and risk for neurodegeneration in World Trade Center Responders

> **NIH ALLCDC R21** · ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI · 2024 · $249,750

## Abstract

Project Summary
World Trade Center (WTC) Responders self-report high levels of poor sleep quality and exhibit a high
prevalence of sleep disorders such as obstructive sleep apnea (OSA) and insomnia. Research
investigating brain health in this population indicates early-age cognitive impairments and
neurodegeneration associated with both physical exposures of particulate neurotoxins at the WTC site
and chronic post-traumatic stress disorder (PTSD). There is evidence that poor sleep quality is
associated with cognitive impairments, biomarkers of neurodegeneration and dementia in both sleep
disorders and the general community. However, it is not known if poor sleep quality contributes to
increased risk of neurodegeneration in WTC Responders. Sleep quality is a term that encompasses
multiple aspects of sleep initiation, maintenance, quantity, and refreshment upon awakening. It is
typically assessed subjectively using questionnaires that evaluate general satisfaction with current
sleep-related quality of life, sleep behaviors or symptoms. A potentially useful, and objectively
measured, proxy for sleep quality is sleep stability. Metrics of sleep stability can be obtained through
the lens of the central nervous system (CNS) with electroencephalography (EEG) or the corresponding
autonomic nervous system (ANS) activity using cardiopulmonary coupling (CPC). EEG-measured rapid
eye movement (REM) and non-REM (NREM) sleep instability is characteristic of insomnia and OSA.
Sleep instability caused by OSA results in impaired sleep-dependent memory and increases in markers
of neurodegeneration. Reduced and delayed REM, manifestations of REM instability, are associated
with increased risk of dementia in a large community cohort. Quality EEG signals are difficult to obtain
at-home but newer, wearable CPC-measuring devices can provide sleep quality and disorder severity
measures from the home. CPC measured sleep demonstrates exaggerated night-to-night variability in
insomnia. Highly variable sleep schedules predict successful response to treatment with cognitive
behavioral therapy for insomnia (CBTi). We plan to enroll 40 WTC Responders who will undergo 2
weeks at-home CPC sleep monitoring followed by an overnight in-lab PSG with pre/post-sleep
emotional memory picture task and blood sampling. Aim 1a is to test whether single-night REM sleep
instability measured by EEG activity is associated with impaired emotional memory. Exploratory Aim
1b is to test any potential association between impaired overnight memory processing and overnight
change in plasma biomarkers Tau and NFL. Aim 2 is to test whether inconsistent sleep quality
measured by night-to-night variability in CPC is associated with greater evening plasma Tau and NFL
levels.

## Key facts

- **NIH application ID:** 10903702
- **Project number:** 5R21OH012623-02
- **Recipient organization:** ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
- **Principal Investigator:** Anna Mullins
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2024
- **Award amount:** $249,750
- **Award type:** 5
- **Project period:** 2023-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10903702

## Citation

> US National Institutes of Health, RePORTER application 10903702, Sleep stability, emotional memory and risk for neurodegeneration in World Trade Center Responders (5R21OH012623-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10903702. Licensed CC0.

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