A Pilot Study: The Effect of CPAP Intervention on Sleep Architecture and Cognition in Alzheimer's Disease Patients with Obstructive Sleep Apnea.

IF 3 Q2 CLINICAL NEUROLOGY
Carmen L Frias, Marta Almeria, Judith Castejon, Cristina Artero, Giovanni Caruana, Andrea Elias-Mas, Karol Uscamaita, Virginia Hawkins, Nicola J Ray, Mariateresa Buongiorno, Natalia Cullell, Jerzy Krupinski
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引用次数: 0

Abstract

Background: Obstructive sleep apnea (OSA) is highly prevalent in the early stages of Alzheimer's disease (AD), and its hallmark, sleep fragmentation, may accelerate cognitive decline. Continuous positive airway pressure (CPAP) improves OSA-related hypoxia during slow-wave sleep, but its cognitive benefits in AD remain unclear.

Methods: We performed a 12-month sub-analysis of a prospective, longitudinal pilot study that enrolled 21 adults (median age = 77 yr; 71% women) with Mild Cognitive Impairment (MCI) with AD confirmed biomarkers and polysomnography-diagnosed OSA. All participants underwent baseline overnight polysomnography (PSG) and neuropsychological testing (Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)) that were repeated after 12 months. Twelve participants were CPAP-compliant (moderate/severe OSA) and nine were non-users (mild OSA/intolerance). Cognitive change scores (Δ = 12 months -baseline) were compared with Generalized Linear Models (GLM) adjusted for baseline cognition and Apnea-Hypopnea Index (AHI); associations between baseline sleep parameters and cognitive trajectories were examined. And the association of sleep variables with the use of CPAP was also evaluated.

Results: Compared with non-users, CPAP users showed significantly slower global decline (Δ MMSE: p = 0.016) and improvements in overall cognition (Δ RBANS Total: p = 0.028) and RBANS sub-domains (Δ RBANS FC: p = 0.010; Δ RBANS SF: p = 0.045). Longer baseline non-rapid eye movement (NREM) stage 3 and rapid eye movement (REM) sleep, greater total sleep time and sleep efficiency, and right-side sleeping were each linked to better cognitive outcomes, whereas extended NREM stage 2, wakefulness, and supine sleeping were associated with poorer trajectories.

Conclusions: Twelve months of CPAP use was associated with attenuated cognitive decline and domain-specific gains in AD-related MCI with OSA. Sleep architecture and body position during sleep predicted cognitive outcomes, underscoring the therapeutic relevance of optimizing breathing and sleep quality. Larger, longer-term trials are warranted to confirm CPAP's disease-modifying potential and to clarify the mechanistic role of sleep in AD progression.

一项初步研究:CPAP干预对阿尔茨海默病伴阻塞性睡眠呼吸暂停患者睡眠结构和认知的影响。
背景:阻塞性睡眠呼吸暂停(OSA)在阿尔茨海默病(AD)的早期阶段非常普遍,其标志睡眠片段化可能加速认知能力下降。持续气道正压通气(CPAP)可改善慢波睡眠期间osa相关的缺氧,但其对AD的认知益处尚不清楚。方法:我们对一项前瞻性纵向先导研究进行了为期12个月的亚分析,该研究招募了21名患有轻度认知障碍(MCI)的成年人(中位年龄= 77岁;71%为女性),患有AD确诊的生物标志物和多导睡眠图诊断的OSA。所有参与者在12个月后重复进行基线夜间多导睡眠图(PSG)和神经心理测试(临床痴呆评分(CDR),迷你精神状态检查(MMSE),神经心理状态评估可重复电池(rban))。12名受试者符合cpap(中度/重度OSA), 9名受试者不使用cpap(轻度OSA/不耐受)。将认知变化评分(Δ = 12个月基线)与基线认知和呼吸暂停-低通气指数(AHI)调整后的广义线性模型(GLM)进行比较;研究了基线睡眠参数和认知轨迹之间的关系。并对睡眠变量与CPAP使用的关系进行了评估。结果:与非CPAP使用者相比,CPAP使用者的整体认知能力下降(Δ MMSE: p = 0.016)和整体认知能力(Δ RBANS Total: p = 0.028)和RBANS子域(Δ RBANS FC: p = 0.010; Δ RBANS SF: p = 0.045)均有显著改善。较长的基线非快速眼动(NREM)第3阶段和快速眼动(REM)睡眠,较长的总睡眠时间和睡眠效率,以及右侧睡眠都与更好的认知结果有关,而延长的非快速眼动(NREM)第2阶段,清醒和仰卧睡眠与较差的轨迹有关。结论:CPAP使用12个月与ad相关MCI合并OSA的认知能力下降和领域特异性增益有关。睡眠结构和睡眠时的体位预测了认知结果,强调了优化呼吸和睡眠质量的治疗相关性。需要更大规模、更长期的试验来证实CPAP的疾病改善潜力,并阐明睡眠在AD进展中的机制作用。
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来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
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