Monica Moon Shieu1, Afsara Zaheed2, Carol Shannon3, Ronald David Chervin4, Alan Conceicao4, Henry Lauris Paulson5, Tiffany Joy Braley4,6, Galit Levi Dunietz4. 1. University of Michigan, Department of Neurology, Division of Sleep Medicine mshie@med.umich.edu. 2. University of Michigan, Department of Psychology. 3. University of Michigan, Taubman Health Sciences Library. 4. University of Michigan, Department of Neurology, Division of Sleep Medicine. 5. University of Michigan, Department of Neurology, Division of Cognitive Disorders. 6. University of Michigan, Department of Neurology, Division of Neuroimmunology & Division of Sleep Medicine.
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.
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.
Authors: Jonathan A C Sterne; Jelena Savović; Matthew J Page; Roy G Elbers; Natalie S Blencowe; Isabelle Boutron; Christopher J Cates; Hung-Yuan Cheng; Mark S Corbett; Sandra M Eldridge; Jonathan R Emberson; Miguel A Hernán; Sally Hopewell; Asbjørn Hróbjartsson; Daniela R Junqueira; Peter Jüni; Jamie J Kirkham; Toby Lasserson; Tianjing Li; Alexandra McAleenan; Barnaby C Reeves; Sasha Shepperd; Ian Shrier; Lesley A Stewart; Kate Tilling; Ian R White; Penny F Whiting; Julian P T Higgins Journal: BMJ Date: 2019-08-28
Authors: Vincenza Castronovo; Paola Scifo; Antonella Castellano; Mark S Aloia; Antonella Iadanza; Sara Marelli; Stefano F Cappa; Luigi Ferini Strambi; Andrea Falini Journal: Sleep Date: 2014-09-01 Impact factor: 5.849
Authors: Monica M Shieu; Galit Levi Dunietz; Henry L Paulson; Ronald D Chervin; Tiffany J Braley Journal: J Clin Sleep Med Date: 2022-04-01 Impact factor: 4.062
Authors: Jana R Cooke; Liat Ayalon; Barton W Palmer; Jose S Loredo; Jody Corey-Bloom; Loki Natarajan; Lianqi Liu; Sonia Ancoli-Israel Journal: J Clin Sleep Med Date: 2009-08-15 Impact factor: 4.062
Authors: Ina E Djonlagic; Meng Guo; Moroke Igue; Divya Kishore; Robert Stickgold; Atul Malhotra Journal: Am J Respir Crit Care Med Date: 2021-05-01 Impact factor: 21.405
Authors: Ivana Rosenzweig; Martin Glasser; William R Crum; Matthew J Kempton; Milan Milosevic; Alison McMillan; Guy D Leschziner; Veena Kumari; Peter Goadsby; Anita K Simonds; Steve C R Williams; Mary J Morrell Journal: EBioMedicine Date: 2016-03-25 Impact factor: 8.143
Authors: Maria Salsone; Maria Eugenia Caligiuri; Vincenza Castronovo; Nicola Canessa; Sara Marelli; Andrea Quattrone; Aldo Quattrone; Luigi Ferini-Strambi Journal: J Neurosci Res Date: 2021-07-01 Impact factor: 4.164