Obstructive sleep apnea syndrome and Alzheimer’s disease pathology: may continuous positive airway pressure treatment delay cognitive deterioration?

Liguori, Claudio; Cremascoli, Riccardo; Maestri, Michelangelo; Fernandes, Mariana; Izzi, Francesca; Tognoni, Gloria; Scarpina, Federica; Siciliano, Gabriele; Mercuri, Nicola Biagio; Priano, Lorenzo; Bonanni, Enrica; Placidi, Fabio

doi:10.1007/s11325-021-02320-4

Cited by 19 publications

(26 citation statements)

References 18 publications

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“…29 These studies used diverse cohorts, including nationwide databases (National Health Insurance Research Database of Taiwan, 29 a 5% sample of US Medicare beneficiaries), 14,22 a cohort from the Alzheimer's Disease Neuroimaging Initiative, 23 a cohort from the Alzheimer's Disease Research Center, and clinical samples of adults who obtained care at neurology, sleep, and memory clinics. 13,21,24-28 In US-based studies, participants were predominantly White (range 59%–98%), and across all studies, the proportion of women ranged between 25% and 53%. Six studies included both middle-aged and older participants, 13,23-25,27,29 while 5 focused on older adults (≥65 years of age).…”

Section: Resultsmentioning

confidence: 99%

“…We identified 11 studies that examined PAP therapy in relation to cognitive disorders: 1 randomized controlled trial (RCT), 2 quasi-experimental clinical trials, 2 prospective observational studies, 5 retrospective observational studies, and 1 cross-sectional study. The majority of studies (n = 8) were conducted in the United States 13,14,[21][22][23][24][25][26] ; 2 were conducted in Europe 27,28 ; and 1 was conducted in Asia. 29 These studies used diverse cohorts, including nationwide databases (National Health Insurance Research Database of Taiwan, 29 a 5% sample of US Medicare beneficiaries), 14,22 a cohort from 13,21,[24][25][26][27][28] In US-based studies, participants were predominantly White (range 59%-98%), and across all studies, the proportion of women ranged between 25% and 53%.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…29 These studies used diverse cohorts, including nationwide databases (National Health Insurance Research Database of Taiwan, 29 a 5% sample of US Medicare beneficiaries), 14,22 a cohort from 13,21,[24][25][26][27][28] In US-based studies, participants were predominantly White (range 59%-98%), and across all studies, the proportion of women ranged between 25% and 53%. Six studies included both middle-aged and older participants, 13,[23][24][25]27,29 while 5 focused on older adults (≥65 years of age). 14,21,22,26,28 Most study participants carried a diagnosis of OSA (96%, n = 60,840), and most (70%, n = 43,970) received PAP therapy.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Positive Airway Pressure and Cognitive Disorders in Adults With Obstructive Sleep Apnea

et al. 2022

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Background and Objectives:Alzheimer’s disease (AD) and other forms of dementia represent a rising global public health crisis. As effective treatments to prevent, cure, or slow progression of dementia are unavailable, identification of treatable risk factors that increase dementia risk, such as obstructive sleep apnea (OSA), could offer promising means to modify dementia occurrence or severity. Here we systematically reviewed the impact of positive airway pressure (PAP) therapy on incidence of cognitive disorders and cognitive decline among middle-aged and older adults with OSA.Methods:A systematic search of MEDLINE, EMBASE, Scopus, and CINAHL was performed prior to May 2021 to identify articles that focused on associations between PAP therapy use and cognitive disorders. We included studies that examined the effects of PAP treatment on: 1) incidence of cognitive disorders among individuals ages 40 or older diagnosed with OSA; and 2) progression of cognitive decline among people with pre-existing cognitive disorders and OSA.Results:Eleven studies (three clinical trials and eight observational studies) were identified. In these studies, 96% participants had OSA (n= 60,840) and n=5,826 had baseline cognitive impairment (mild cognitive impairment [MCI] or AD). Of all study participants, n=43,973 obtained PAP therapy, and n=16,397 were untreated or in a placebo group. Most studies reported a protective effect of PAP therapy on MCI and AD incidence, e.g., delayed age at MCI onset, reduced MCI or AD incidence, slower cognitive decline, or progression to AD.Discussion:These findings suggest a role of OSA as a modifiable risk factor for cognitive decline. The burden of cognitive disorders on aging adults and their families calls for identification of modifiable risk factors to alleviate their impact among aging adults and their families. Future research should build on this review and focus on PAP interventions as a potential means to alleviate the incidence of cognitive disorders and cognitive decline, particularly among ethnoracial minority groups who have been underrepresented and under-investigated in the extant literature.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

“…29 These studies used diverse cohorts, including nationwide databases (National Health Insurance Research Database of Taiwan, 29 a 5% sample of US Medicare beneficiaries), 14,22 a cohort from 13,21,[24][25][26][27][28] In US-based studies, participants were predominantly White (range 59%-98%), and across all studies, the proportion of women ranged between 25% and 53%. Six studies included both middle-aged and older participants, 13,[23][24][25]27,29 while 5 focused on older adults (≥65 years of age). 14,21,22,26,28 Most study participants carried a diagnosis of OSA (96%, n = 60,840), and most (70%, n = 43,970) received PAP therapy.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Positive Airway Pressure and Cognitive Disorders in Adults With Obstructive Sleep Apnea

et al. 2022

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“…However, in this study, OSA diagnosis and CPAP use were self-reported. Another recent, retrospective study [ 69 ], found a significant difference in cognitive and functional performances assessed with clinical dementia rating scale, between the CPAP non-compliant and the CPAP compliant group, with patients CPAP non-compliant reporting a significant longitudinal worsening in cognitive and functional performances compared to CPAP compliant patients. In line with these findings, another recent retrospective study [ 70 ], considering a large sample of patients diagnosed with OSA, documented that PAP adherence was associated with lower odds of incident diagnoses of AD.…”

Section: The Effects Of Cpap Therapy On Cognitionmentioning

confidence: 99%

“…Although higher levels of IL-6 can significantly improve memory and learning processes via its effects on neuronal excitability at hippocampal synapses [ 105, 106 ], as an inflammatory cytokine, its effects can also be detrimental and induce neurodegeneration [ 107 ]. Hence, it has been reported that high IL-6 blood levels in OSA patients can reflect both the negative effects of the excessive inflammatory response, triggered by intermittent hypoxia and the positive effects of neurogenesis against neurodegeneration as an attempt to counteract the pathological processes induced by OSA [ 69 ]. In line with this hypothesis, although IH parameters correlated with high IL-6 blood levels in patients with OSA, these high IL-6 blood levels give a reduced propensity to develop dementia [ 108 ].…”

Section: The Role Of Sleep Physiological Mechanisms On Cognitive Functioningmentioning

confidence: 99%

The Importance of Diagnosing and the Clinical Potential of Treating Obstructive Sleep Apnea to Delay Mild Cognitive Impairment and Alzheimer’s Disease: A Special Focus on Cognitive Performance

Fernandes

Placidi

Mercuri

et al. 2021

ADR

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Obstructive sleep apnea (OSA) is a highly frequent sleep disorder in the middle-aged and older population, and it has been associated with an increased risk of developing cognitive decline and dementia, including mild cognitive impairment (MCI) and Alzheimer’s disease (AD). In more recent years, a growing number of studies have focused on: 1) the presence of OSA in patients with MCI or AD, 2) the link between OSA and markers of AD pathology, and 3) the role of OSA in accelerating cognitive deterioration in patients with MCI or AD. Moreover, some studies have also assessed the effects of continuous positive airway pressure (CPAP) treatment on the cognitive trajectory in MCI and AD patients with comorbid OSA. This narrative review summarizes the findings of studies that analyzed OSA as a risk factor for developing MCI and/or AD in the middle-aged and older populations with a special focus on cognition. In addition, it describes the results regarding the effects of CPAP treatment in hampering the progressive cognitive decline in AD and delaying the conversion to AD in MCI patients. Considering the importance of identifying and treating OSA in patients with MCI or AD in order to prevent or reduce the progression of cognitive decline, further larger and adequately powered studies are needed both to support these findings and to set programs for the early recognition of OSA in patients with cognitive impairment.

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Subclinical epileptiform activity and sleep disturbances in Alzheimer's disease

Devulder,

Macea,

Kalkanis

et al. 2023

Brain and Behavior

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IntroductionSubclinical epileptiform activity (SEA) and sleep disturbances are frequent in Alzheimer's disease (AD). Both have an important relation to cognition and potential therapeutic implications. We aimed to study a possible relationship between SEA and sleep disturbances in AD.MethodsIn this cross‐sectional study, we performed a 24‐h ambulatory EEG and polysomnography in 48 AD patients without diagnosis of epilepsy and 34 control subjects.ResultsSEA, mainly detected in frontotemporal brain regions during N2 with a median of three spikes/night [IQR1–17], was three times more prevalent in AD. AD patients had lower sleep efficacy, longer wake after sleep onset, more awakenings, more N1%, less REM sleep and a higher apnea‐hypopnea index (AHI) and oxygen desaturation index (ODI). Sleep was not different between AD subgroup with SEA (AD‐Epi+) and without SEA (AD‐Epi–); however, compared to controls, REM% was decreased and AHI and ODI were increased in the AD‐Epi+ subgroup.DiscussionDecreased REM sleep and more severe sleep‐disordered breathing might be related to SEA in AD. These results could have diagnostic and therapeutic implications and warrant further study at the intersection between sleep and epileptiform activity in AD.

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Obstructive sleep apnea syndrome and Alzheimer’s disease pathology: may continuous positive airway pressure treatment delay cognitive deterioration?

Cited by 19 publications

References 18 publications

Positive Airway Pressure and Cognitive Disorders in Adults With Obstructive Sleep Apnea

Positive Airway Pressure and Cognitive Disorders in Adults With Obstructive Sleep Apnea

The Importance of Diagnosing and the Clinical Potential of Treating Obstructive Sleep Apnea to Delay Mild Cognitive Impairment and Alzheimer’s Disease: A Special Focus on Cognitive Performance

Subclinical epileptiform activity and sleep disturbances in Alzheimer's disease

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