Treatment of Sleep Apnea May Reduce Risk of Alzheimer Disease, Dementia

Treating obstructive sleep apnea (OSA) through positive airway pressure therapy (PAP) may also reduce risk of developing Alzheimer disease (AD) and dementia in older adults, according to study findings published in Sleep.

With a growing prevalence among the US population, OSA is characterized by upper airway obstruction during sleep leading to sleep fragmentation and intermittent hypoxemia. Moreover, OSA has been found to be associated with neuropsychiatric symptoms, including cognitive impairment, depression, and anxiety.

As the current gold standard of treatment for OSA, PAP therapy works to prevent the collapse of the airway during sleep and has been associated with improving depressive symptoms and cognitive impairment in a prior single patient case study.

Researchers of the present study sought to further assess the impact of PAP therapy on cognition in older adults, including risk of developing AD, mild cognitive impairment (MCI), and dementia.

Conducting a retrospective analysis of data derived from Medicare 5% fee-for-service claims (N = 53,321; ≥ 65 years), participants with OSA diagnoses prior to 2011 were evaluated via International Classification of Diseases, Ninth Revision (ICD-9) codes for the neurocognitive conditions (AD, n = 1057; dementia, n = 378; MCI, n = 443) over a 3-year period.

“Logistic regression models, adjusted for demographic and health characteristics, were used to estimate associations between PAP treatment or adherence and new AD, dementia, and MCI diagnoses,” noted the study authors.

Of the study cohort, more than half were men (59%), 90% were non-Hispanic White, and 62% were younger than 75 years. Furthermore, 78% of the recruited Medicare beneficiaries were prescribed PAP, of which 74% showed adherent therapy usage.

After accounting for potential confounders, findings of adjusted models indicated that patients treated with PAP were at lower risk of incident diagnoses of AD (odds ratio [OR], 0.78; 95% CI, 0.69-0.89) and dementia (OR, 0.69; 95% CI, 0.55-0.85), compared with non-users.

"If a causal pathway exists between OSA treatment and dementia risk, as our findings suggest, diagnosis and effective treatment of OSA could play a key role in the cognitive health of older adults," said study principal investigator Tiffany J. Braley, MD, MS, an associate professor of neurology at the University of Michigan, in a statement.

Additionally, PAP users were found to have lower odds of developing MCI (OR, 0.82; 95% CI, 0.66-1.02), with PAP-adherent patients also presenting with lower odds of incident diagnoses of AD (OR, 0.65; 95% CI, 0.56-0.76).

Reference

Dunietz GL, Chervin RD, Burke JF, Conceicao AS, Braley TJ. Obstructive sleep apnea treatment and dementia risk in older adults. Sleep. Published online March 26, 2021. doi:10.1093/sleep/zsab076