Obstructive sleep apnea and cognitive impairment

Title [sv]

Abstract [sv]

BackgroundWorldwide around 50 million people are affected by dementia, characterized by progressive cognitive and functional decline. There is an urgent need of identifying new modifiable risk factors related to dementia. Previous studies suggest that obstructive sleep apnea (OSA) is associated with cognitive impairment and dementia but most studies are based on self-reports. One possible way that OSA may contribute to the development of cognitive impairment and dementia is by nondipping of blood pressure (BP) and small vessel disease. Subjects with nondipping BP score worse on cognitive tests than systolic BP dippers. In OSA the prevalence of nondipping of systolic blood pressure (BP) in the night is high, especially during rapid eye movement (REM) sleep. We have previously identified that OSA during REM sleep is more closely related to early signs of atherosclerosis and biomarkers than OSA during non-REM sleep.AimsThe primary aim is to determine the relationship between obstructive sleep apnea and cognitive impairment. Secondary aims: -To analyse whether such a relationship is mediated by reverse dippping of blood pressure-Identify the OSA phenotype that is most affected by cognitive decline.We hypothesize that OSA is associated with cerebral small vessel disease and thereby with impaired cognitive performance. Another hypothesis is that this association is mediated by reverse dipping of BP and that OSA during REM-sleep is most closely related to cognitive impairment. Project descriptionParticipants in the communitu-based studies Sleep and Health in Women (SHE) or Men in Uppsala; a Study of sleep, Apnoea and Cardiometabolic Health (MUSTACHE) are investigated with whole-night polysomnography (n=800) for assessment of OSA in total and by different sleep stages. In addition, 4,010 individuals from the Swedish Cardiopulmonary Bioimage Study (SCAPIS) study in Uppsala have performed whole-night polygraphy and twenty-four-hour ambulatory blood pressure monitoring. Cognitive function is assessed in all participants by trail making tests A and B. Anthropometrics have been measured at test centers and confounding factors assessed by questionnaires.Clinical significanceIf an association between OSA and cognitive impairment can be identified this is an important clinical finding that would have implications on present guidelines for OSA treatment as well as open a research field for a new modifiable risk factor for vascular dementia.

Abstract [en]

BackgroundWorldwide around 50 million people are affected by dementia, characterized by progressive cognitive and functional decline. There is an urgent need of identifying new modifiable risk factors related to dementia. Previous studies suggest that obstructive sleep apnea (OSA) is associated with cognitive impairment and dementia but most studies are based on self-reports. One possible way that OSA may contribute to the development of cognitive impairment and dementia is by nondipping of blood pressure (BP) and small vessel disease. Subjects with nondipping BP score worse on cognitive tests than systolic BP dippers. In OSA the prevalence of nondipping of systolic blood pressure (BP) in the night is high, especially during rapid eye movement (REM) sleep. We have previously identified that OSA during REM sleep is more closely related to early signs of atherosclerosis and biomarkers than OSA during non-REM sleep.AimsThe primary aim is to determine the relationship between obstructive sleep apnea and cognitive impairment. Secondary aims: -To analyse whether such a relationship is mediated by reverse dippping of blood pressure-Identify the OSA phenotype that is most affected by cognitive decline.We hypothesize that OSA is associated with cerebral small vessel disease and thereby with impaired cognitive performance. Another hypothesis is that this association is mediated by reverse dipping of BP and that OSA during REM-sleep is most closely related to cognitive impairment. Project descriptionParticipants in the communitu-based studies Sleep and Health in Women (SHE) or Men in Uppsala; a Study of sleep, Apnoea and Cardiometabolic Health (MUSTACHE) are investigated with whole-night polysomnography (n=800) for assessment of OSA in total and by different sleep stages. In addition, 4,010 individuals from the Swedish Cardiopulmonary Bioimage Study (SCAPIS) study in Uppsala have performed whole-night polygraphy and twenty-four-hour ambulatory blood pressure monitoring. Cognitive function is assessed in all participants by trail making tests A and B. Anthropometrics have been measured at test centers and confounding factors assessed by questionnaires.Clinical significanceIf an association between OSA and cognitive impairment can be identified this is an important clinical finding that would have implications on present guidelines for OSA treatment as well as open a research field for a new modifiable risk factor for vascular dementia.

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