Use of positive airway pressure in mild cognitive impairment to delay progression to dementia

Abstract

Study Objectives: The aim was to assess the relationship between continuous positive airway pressure (CPAP) therapy and cognitive function in patients with mild cognitive impairment (MCI) and obstructive sleep apnea (OSA). Methods: This was a retrospective chart review of patients with MCI and OSA. CPAP therapy compliance was defined as average use of CPAP therapy for at least 4 hours per night. Kaplan-Meier estimates, log-rank tests, and Cox proportional hazards regression were done to compare the compliance groups in terms of progression to dementia, defined as a Clinical Dementia Rating of 1 or greater. Linear mixed models were used to assess the relationships between CPAP therapy compliance and neurological cognitive function outcomes over time. Results: Ninety-six patients were included with mean age at MCI diagnosis of 70.4 years, mean apnea-hypopnea index of 25.9 events/h, and mean duration of neurology follow-up of 2.8 years. Forty-two were CPAP compliant, 30 were noncompliant, and 24 had no CPAP use. No overall difference between the groups was detected for progression to dementia (P =.928, log-rank test). Patients with amnestic MCI had better CPAP use (P =.016) and shorter progression time to dementia (P = .042), but this difference was not significant after adjusting for age, education, and race (P = .32). Conclusions: CPAP use in patients with MCI and OSA was not associated with delay in progression to dementia or cognitive decline.

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

“…Of the 11 identified studies, 6 considered apnea-hypopnea index (AHI) a measure for OSA severity (AHI ≥10, mild to severe 21,24,26 ; AHI 10–14, mild 25 ; and AHI ≥30, severe 28 ) and all levels of OSA severity. 13 Baseline cognitive impairment (MCI or AD) was present among 9% (n = 5,826) of study participants. Data extraction summaries are reported in Tables 1 and 2.…”

“…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). 14,21,22,26,28…”

“…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%.…”

PAP use in mild cognitive impairment to delay progression to dementia

“…We read with interest the paper from Skiba et al 1 about the effect of obstructive sleep apnea (OSA) treatment by continuous positive airway pressure (CPAP) in patients with mild cognitive impairment. Treating OSA in patients at risk of Alzheimer disease (AD) is a hot research topic, considering that OSA can represent a risk factor for AD, accelerate cognitive decline, and contribute to alter AD pathology biomarkers (eg, clinical, biofluid, neuroimaging).…”

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

“…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. Conversely, Skiba et al [ 71 ] reported no significant differences between CPAP compliant, CPAP non-compliant and no CPAP use on a sample of 96 MCI patients. However, when looking at the timing before conversion, it appeared evident that patients CPAP compliant (77.3 months) presented a longer time before conversion than non-compliant (52.1 months) or non-use (47.3 months) CPAP groups.…”