This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Background and Objectives Alzheimer disease (AD) and other forms of dementia represent a rising global public health crisis. Because 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 the incidence of cognitive disorders and cognitive decline among middle-aged and older adults with OSA.
Methods We performed a systematic search of MEDLINE, EMBASE, Scopus, and CINAHL before 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) the incidence of cognitive disorders among individuals ≥40 years of age diagnosed with OSA and (2) the progression of cognitive decline among people with preexisting cognitive disorders and OSA.
Results We identified 11 studies (3 clinical trials and 8 observational studies). In these studies, 96% participants had OSA (n = 60,840) and 9% had baseline cognitive impairment (mild cognitive impairment [MCI] or AD) (n=5,826). Of all study participants, 43,970 obtained PAP therapy, and 16,400 were untreated or in a placebo group. Nine out of 11 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 for OSA as a modifiable risk factor for cognitive decline. Identification of modifiable risk factors is imperative for alleviating the impact of cognitive disorders on aging adults and their family members. 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 groups who have been underrepresented and underinvestigated in the extant literature.
Glossary
- AD=
- Alzheimer disease;
- AHI=
- apnea-hypopnea index;
- DNOS=
- dementia not otherwise specified;
- ICD=
- International Classification of Diseases;
- MCI=
- mild cognitive impairment;
- OR=
- odds ratio;
- OSA=
- obstructive sleep apnea;
- PAP=
- positive airway pressure;
- RCT=
- randomized controlled trial;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Barbara Jobst, MD, PhD, FAAN.
Podcast: NPub.org/Podcast9828
- Received October 5, 2021.
- Accepted in final form February 25, 2022.
- © 2022 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
Letters: Rapid online correspondence
- Reader Response: Positive Airway Pressure and Cognitive Disorders in Adults With Obstructive Sleep Apnea: A Systematic Review of the Literature
- Reader Response: Positive Airway Pressure and Cognitive Disorders in Adults With Obstructive Sleep Apnea: A Systematic Review of the Literature
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Podcast
Costs and Utilization of New-to-Market Neurologic Medications
Dr. Robert J. Fox and Dr. Mandy Leonard