Obstructive Sleep Apnea and Other Vascular Risk factors' Impact on Non‐Motor Symptoms in Parkinson's Disease

Abstract

Background Previous studies revealed an association between vascular comorbidities and obstructive sleep apnea (OSA) and the severity of motor and cognitive symptoms in Parkinson's disease (PD). However, there is a lack of studies assessing the entire spectrum of non‐motor symptoms (NMS). Objective To investigate the relationship between vascular comorbidities and NMS in PD patients. Methods Patients were assessed at baseline and 4 years later with the Non‐Motor Symptom Assessment Scale, Parkinson's Psychosis Questionnaire, Unified Parkinson's Disease Rating Scale (UPDRS), Montreal Cognitive Assessment, and Apathy scale. After tetrachoric correlation matrix, we conducted linear regression models (adjusted for age, gender, disease duration, and UPDRS‐III) to investigate the relationship between vascular comorbidities and NMS. Results In 73 PD patients, (mean disease duration 7.1 [5.3]), 57% had hypertension, 44% body mass index >25, 44% elevated cholesterol, 15% diabetes mellitus, 15% OSA, 14% cigarette‐smoking history, 8% prior stroke, and 8% coronary disease. Cognition, psychotic symptoms, apathy, urinary function, and miscellaneous domains significantly worsened at the 4‐year follow‐up. OSA was significantly associated with higher severity of hallucinations/illusions at baseline and with a more severe deterioration of attention/memory, psychotic symptoms, and apathetic mood at the 4‐year follow‐up. At baseline, but not at follow‐up, hypertension was negatively associated with miscellaneous domain scores and coronary disease with autonomic function scores (gastrointestinal tract and urinary function domains). Conclusion Among PD‐associated comorbidities, OSA was the main factor of decline. In addition to cognitive impairment, OSA might also potentially worsen psychotic symptoms and apathy. Treatment of OSA could be a strategy to improve these important NMS.

Prevalence and clinical aspects of obstructive sleep apnea in Parkinson disease: A meta‐analysis

“…Our results are in line with previous studies that failed to demonstrate a link between the occurrence of OSA and more severe neuropsychiatric symptoms [64,65], whereas the absence of a relationship with cognition seems to be in contrast with previous results in both PD [2] and non-PD populations [66][67][68]. It should be noted that the cross-sectional methodology we employed in the present meta-analysis might have affected this result, because a recent study performed by Meira et al [32] Although OSA does not appear to affect patients' QoL, the possible detrimental effect of intermittent hypoxia on the brain, which is already vulnerable to PD degenerative processes, should not be underestimated due to its prevalence and adverse consequences [2,69].…”

“…It should be noted that the cross‐sectional methodology we employed in the present meta‐analysis might have affected this result, because a recent study performed by Meira et al. [32] provided a positive ES (PD patients with OSA reporting higher scores on global cognitive tests than PD patients without OSA) considering baseline data, whereas they demonstrated a progressive cognitive decline through a follow‐up methodology. Moreover, none of the included studies assessed cognitive functions by using an extensive neuropsychological battery.…”

“…As for global cognitive status, six studies reported data on cognition using the MoCA [11,[29][30][31][32][33], with an average score of 23.37 for the PD-OSA+ group and 23.31 for the PD-OSA− group; five studies employed the MMSE [9,11,30,31,34], with an average score of 26.33 for the PD-OSA+ group and 26.98 for the PD-OSA− group, whereas one study [35] used the Parkinson Neuropsychometric Dementia Assessment.…”

The relationship between obstructive sleep apnea and visual hallucinations in PD patients: a polysomnography study

“…OSA patients with PD exhibit a lower desaturation index, lower mean and nadir oxygen saturation values, and longer time with an oxygen saturation below 90% throughout the night than OSA patients without PD ( 36 , 37 ). Previous studies have shown an association between vascular comorbidities and OSA as well as the severity of motor and cognitive symptoms in PD ( 38 ). However, there is a lack of studies assessing the relationship between OSA and VHs.…”

Editorial: Sleep disturbances in Parkinson's disease

“…Indeed, features related to OSA, including intermittent hypoxia and sleep fragmentation, can accelerate the accumulation of β-Amyloid and Tau-proteins in the brain and independently trigger an Alzheimer's-type neuropathology in PD. Longitudinal investigation reported that PD-OSA showed a more severe deterioration, especially of executive functions at the 4-year follow-up (Meira et al, 2022 ). Interestingly, CPAP treatment of OSA in PD improved overall non-motor symptoms and global cognitive functions over a 12-month period (Kaminska et al, 2018 ).…”