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

Abstract

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.

Circadian disruption and sleep disorders in neurodegeneration

“…More evidence from the AD biomarker perspective suggests that cognitively intact OSA individuals have higher Aβ burden indicated by blood, CSF and imaging biomarkers compared to individuals free of OSA [ 138 , 139 ]. Moreover, adherence to positive airway pressure therapy may lower the odds of incident diagnosis of AD or MCI and slow cognitive impairment or its progression to AD [ 140 , 141 ]. Consistently, another longitudinal analysis revealed increased risk of PD in individuals with sleep apnea [ 142 , 143 ].…”

The mobile sleep medicine model in neurologic practice: Rationale and application

“…A review of five systematic reviews and meta-analyses concluded that treatment with CPAP improved attention/vigilance, executive dysfunction, memory, and global cognitive functioning in non-demented individuals ( 114 ). A more recent systematic review demonstrated a protective effect that treatment with CPAP has on MCI and AD incidence ( 115 ). Several studies have suggested that treating OSA using CPAP in AD patients may slow the rate of cognitive decline ( 58 , 59 , 116 ).…”

Impaired glymphatic drainage underlying obstructive sleep apnea is associated with cognitive dysfunction

“…Obstructive sleep apnea (OSA) is a common sleep related disorder with the symptoms of upper airway collapse, apnea, hypoxia and recurrent arousals, accompanied by decline in cognitive function [ 8 , 9 ]. Sleep-disordered breathing was linked to an increased risk of cognitive impairment and AD in the elderly population [ 10 – 14 ].…”