Treatment of obstructive sleep apnea with positive airway pressure to improve cognitive function in mild cognitive impairment
McLellan B, Skiba V, Novikova M, Schultz L, and Suneja A. Treatment of obstructive sleep apnea with positive airway pressure to improve cognitive function in mild cognitive impairment. Sleep 2019; 42:A383.
Introduction: Obstructive Sleep Apnea (OSA) is felt to be a risk factor for developing cognitive impairment, including Mild Cognitive Impairment (MCI). Limited evidence demonstrates that Positive Airway Pressure therapy (PAP) may improve cognitive function in this population. The purpose of this study was to determine if treatment of OSA with PAP in patients with MCI delays progression to dementia. Methods: This was a retrospective chart review of subjects diagnosed with MCI and OSA (with PAP recommended) who and had attended clinic between 01/2011 and 12/2017. Charts were reviewed for Clinical Dementia Rating (CERAD) scores, sleep study results and PAP compliance. Results: Analyses were performed on 99 subjects. The mean age at MCI diagnosis was 70.5 years, more were male and Caucasian. 27% patients did not use PAP, 30% were non-complaint and 42% were compliant (used PAP for average of more than 4 hours a night). 28 patients progressed to dementia. Although the median time to dementia progression was longer for patients with no PAP use (47.3 months) and PAP non-compliant use (52.1 months) than for patients with CPAP use (77.3 months), there was no statically significant difference from progression to dementia with the use of PAP therapy. Regression models did not show a difference between the groups for Trails A and B and CDR sum of boxes. The progression to dementia in MCI subjects was significant, with patients with amnestic MCI having shorter progression time and that the subjects with amnestic MCI had higher rates of CPAP use. None of the analyses done within the amnestic and non-amnestic groups to assess the relationship between CPAP use and progression to dementia were significant. Conclusion: The use of PAP therapy showed a trend in slowed progression to dementia, but was not significant in improving cognitive function in this patient population. The study is limited by small number of compliant patients.