Is obstructive sleep apnea a risk factor for cognitive impairment and dementia?

Title [sv]

Abstract [sv]

BackgroundThere is an urgent need of identifying new modifiable risk factors related to dementia. There are several possible pathways by which obstructive sleep apnea (OSA) with intermittent hypoxia could give rise to small vessel disease in the brain. Previous studies also suggest that OSA is associated with cognitive impairment and dementia but most studies are based on self-reports and not by objectively measured sleep apnea.AimsThe primary aim of the present study is to in a longitudinal study determine the relationship between OSA and changes in cognitive function over time. Secondary aims: -Identify if OSA patients have an increased incidence of dementia and in that case, what kind of dementia.-Identify the OSA phenotype that is most affected by cognitive decline.-If we find an association between OSA and incidence of dementia we will further analyze whether treatment with CPAP have a protective effect. Project descriptionParticipants in the community-based study SCAPIS in Uppsala were investigated with whole-night polygraphy for assessment of OSA and their cognitive function was tested by the trail making test B (TMT-B) in 2015-2018 (SCAPIS I, baseline). Both tests are repeated during an ongoing follow-up during 2024-2025 (SCAPIS II, follow-up). Changes in TMT-B score between baseline and follow-up will be used as the main outcome and severity of OSA as the main exposure. Anthropometrics are measured at test centers and confounding factors assessed by questionnaires. For incidence of dementia we will use the DISCOVERY database that includes patients starting CPAP for OSA in Sweden reported to the Swedish National Respiratory Failure Registry, Swedevox (n=109,000), and cross-linked data with several national quality and governmental registries including the Swedish National Patient Registry. Data on treatment adherence are available for 42,000 patients. Incidence of dementia will be analysed in the OSA patient group and compared with a population-based control group from the Statistics Sweden. Incidence of dementia will also be compared between patients using their prescribed CPAP treatment for >4 h/night and <4 hours/night, respectively. 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]

BackgroundThere is an urgent need of identifying new modifiable risk factors related to dementia. There are several possible pathways by which obstructive sleep apnea (OSA) with intermittent hypoxia could give rise to small vessel disease in the brain. Previous studies also suggest that OSA is associated with cognitive impairment and dementia but most studies are based on self-reports and not by objectively measured sleep apnea.AimsThe primary aim of the present study is to in a longitudinal study determine the relationship between OSA and changes in cognitive function over time. Secondary aims: -Identify if OSA patients have an increased incidence of dementia and in that case, what kind of dementia.-Identify the OSA phenotype that is most affected by cognitive decline.-If we find an association between OSA and incidence of dementia we will further analyze whether treatment with CPAP have a protective effect. Project descriptionParticipants in the community-based study SCAPIS in Uppsala were investigated with whole-night polygraphy for assessment of OSA and their cognitive function was tested by the trail making test B (TMT-B) in 2015-2018 (SCAPIS I, baseline). Both tests are repeated during an ongoing follow-up during 2024-2025 (SCAPIS II, follow-up). Changes in TMT-B score between baseline and follow-up will be used as the main outcome and severity of OSA as the main exposure. Anthropometrics are measured at test centers and confounding factors assessed by questionnaires. For incidence of dementia we will use the DISCOVERY database that includes patients starting CPAP for OSA in Sweden reported to the Swedish National Respiratory Failure Registry, Swedevox (n=109,000), and cross-linked data with several national quality and governmental registries including the Swedish National Patient Registry. Data on treatment adherence are available for 42,000 patients. Incidence of dementia will be analysed in the OSA patient group and compared with a population-based control group from the Statistics Sweden. Incidence of dementia will also be compared between patients using their prescribed CPAP treatment for >4 h/night and <4 hours/night, respectively. 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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