Sustained Use of CPAP Slows Deterioration of Cognition, Sleep, and Mood in Patients with Alzheimer's Disease and Obstructive Sleep Apnea: A Preliminary Study

Department of Medicine, University of California, San Diego, CA, USA.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine (Impact Factor: 3.05). 08/2009; 5(4):305-9.
Source: PubMed


Obstructive sleep apnea (OSA) is common among patients with Alzheimer's disease (AD). Untreated OSA exacerbates the cognitive and functional deficits. Continuous positive airway pressure (CPAP) has recently been shown to have beneficial effects on cognition in AD. Little attention has focused on the long-term benefits of CPAP in these patients.
This was an exploratory study of sustained CPAP use (mean use = 13.3 months, SD = 5.2) among a subset of participants from an initial 6-week randomized clinical trial (RCT) of CPAP in patients with mild to moderate AD. Follow-up included 5 patients who continued CPAP (CPAP+) after completion of the RCT and 5 patients who discontinued CPAP (CPAP-), matched by time of completion of the initial study. A neuropsychological test battery and sleep/mood questionnaires were administered and effect sizes were calculated.
Even with a small sample size, sustained CPAP use resulted in moderate-to-large effect sizes. Compared to the CPAP- group, the CPAP+ group showed less cognitive decline with sustained CPAP use, stabilization of depressive symptoms and daytime somnolence, and significant improvement in subjective sleep quality. Caregivers of the CPAP+ group also reported that their own sleep was better when compared to the final RCT visit and that their patients psychopathological behavior was improved.
The results of this preliminary study raise the possibility that sustained, long-term CPAP treatment for patients with AD and OSA may result in lasting improvements in sleep and mood as well as a slowing of cognitive deterioration. Prospective randomized controlled research trials evaluating these hypotheses are needed.

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    • "Timely screening of patients at OSA risk, con¯rmation of diagnosis in sleep laboratory using polysomnography and providing the standard treatment with CPAP are proposed to improve patients' global cognitive functioning including executive dysfunction, delayed long-term verbal and visual memory, attention, learning and vigilance (Cooke et al., 2009; Berlowitz & Shafazand, 2013; Torabi-Nami et al., 2015). CPAP, as the treatment of choice for OSA, is shown to improve sleep breathing leading to a proper blood oxygen saturation, fewer fragmentations during sleep and a subsequently improved daytime functioning (Lamphere et al., 1989; Sanchez et al., 2009). "
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    ABSTRACT: The present review attempts to put together the available evidence and potential research paradigms at the interface of obstructive sleep apnea syndrome (OSAS), sleep micro- and macrostructure, cerebral vasoreactivity and cognitive neuroscience. Besides the significant health-related consequences of OSAS including hypertension, increased risk of cardio- and cerebrovascular events, notable neurocognitive lapses and excessive daytime somnolence are considered as potential burdens. The intermittent nocturnal hypoxia and hypercapnia which occur in OSAS are known to affect cerebral circulation and result in brain hypoperfusion. Arousal instability is then resulted from altered cyclic alternating patterns (CAPs) reflected in sleep EEG. In chronic state, some pathological loss of gray matter may be resulted from obstructive sleep apnea. This is proposed to be related to an upregulated proinflammatory state which may potentially result in apoptotic cell loss in the brain. On this basis, a pragmatic framework of the possible neural mechanisms which underpin obstructive sleep apnea-related neurcognitive decline has been discussed in this review. In addition, the impact of OSAS on cerebral autoregulation and sleep microstructure has been articulated.
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    • "Sleep interventions at this stage of AD may be difficult to both implement and achieve positive benefits. For example, the incidence of sleep disorders (e.g., sleep apnea) is increased in patients with AD and continuous positive airway pressure (CPAP) therapy may slow or improve cognitive functioning in patients with AD and sleep disordered breathing (SDB) (Ancoli- Israel et al., 2008; Cooke et al., 2009). However, both the diagnosis and treatment of sleep disorders (e.g., SDB) in patients with AD is challenging because of the patients' underlying cognitive dysfunction impeding both the diagnosis via polysomnography and treatment with CPAP. "
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    • "The most effective treatment of OSA is continuous positive airway pressure (CPAP). In a 6-week randomized placebo controlled clinical trial of CPAP in patients with mild-moderate AD and OSA, CPAP improved OSA, objective sleep parameters , and daytime sleepiness and resulted in modest improvements in measures of cognitive functioning [146] [147] [148] [149]. "
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