Treatment of Obstructive Sleep Apnea with Positive Airway Pressure in Mild Cognitive Impairment
Suneja A, Skiba V, Novikova M, Schultz L, and McLellan B. Treatment of obstructive sleep apnea with positive airway pressure in mild cognitive impairment. Neurology 2018; 90(15)
Objective: To identify if treating Obstructive Sleep Apnea (OSA) with Positive Airway Pressure (PAP) therapy delays progression to dementia or improves cognitive outcomes in patients with Mild Cognitive Impairment (MCI). Background: OSA has been linked with decreased quality of life, cardiovascular complications and cognition dysfunction. However, there are few and conflicting studies on benefits of treating OSA in patients with Alzheimer's Dementia and MCI. We tested the hypothesis that treatment of OSA with PAP therapy in MCI patients improves cognitive outcomes and delays progression dementia. Design/Methods: We retrospectively examined 90 patients over 18 years old with OSA and MCI seen at our clinics between 1/1/2011 and 12/31/2015. We compared those who received PAP therapy and were compliant (used PAP for more than average of 4 hours a night) to those who were untreated for OSA or non-compliant with PAP therapy. A Clinical Dementia Rating score change from 0.5 to 1.0 was used to measure progression to dementia. Decline of cognitive function was measured using the Consortium to Establish a Registry for Alzheimer's Disease sub-scores. Results: The mean age was 70.5, 68% were male and 52% had non-amnestic MCI. 29 subjects had no PAP use, 24 were non-compliant and 37 were compliant with PAP therapy. There were 24 subjects who progressed to dementia during their follow-up. The median time to progression was 47.3 months for patients with no PAP use and 52.2 months for patients with non-compliant PAP use and not reached for patients with compliant PAP use; this difference was not significant (p=0.774). No significant trends were found among other CERAD sub-scores examined. Conclusions: The benefits of treating OSA with PAP therapy in MCI patients remains unclear. Likely, longer follow up and perhaps more regular PAP use is needed to assess the effectiveness of PAP therapy in this population..