Abstract
BackgroundSleep apnea leads to cognitive impairment in older patients, but its association with neurodegeneration remains controversial, and most studies do not distinguish between the more common obstructive form (OSAS) and the rarer central form (CSAS).ObjectiveThe purpose of this study was to assess the prevalence of the different forms of sleep apnea in a cohort of cognitively impaired elderly patients (>70 years) and to investigate their associations with cognitive deficit, weighted against known risk factors for neurodegeneration.MethodsOvernight polygraphy was performed for 76 consecutive patients admitted to our geriatric unit. Their cognitive function was assessed using the Mini Mental-State Exam (MMSE), Mattis Dementia Rating Scale (MDRS) and Stroop test. Multivariable analyses were performed to determine associations between cognitive function and independent variables describing demographics, sleep apnea measures, and cardiovascular risk factors.ResultsThe cohort comprised 58 women and 18 men aged a mean of 84 years (range, 73–96). Sleep apnea syndrome (SAS) was diagnosed in 48 patients (63%), of which 31 (41%) with OSAS and 17 (22%) with CSAS. Multivariable regression analysis revealed that MDRS was lower in patients with OSAS (β = −10.03, p = 0.018), that Stroop Colors and Words delays increased with AHI (β = 0.17, p = 0.030 and β = 0.31, p = 0.047) and that that Stroop Interference delay was higher in patients with CSAS (β = 24.45, p = 0.002).ConclusionSleep apnea is thus highly prevalent in elderly patients with cognitive impairment. OSAS was associated with lower general cognitive function, while CSAS was only associated with increased Stroop Interference delays. Elderly patients with cognitive deficit could benefit from sleep apnea screening and treatment.
Highlights
MATERIALS AND METHODSSleep apnea syndrome (SAS) is a disorder characterized by repeated pauses in breathing during sleep (Young et al, 1993)
SAS was diagnosed in 48 patients (63%), of which 31 (41%) with OSAS and 17 (22%) with CSAS
The prevalence of SAS in elderly patients admitted to our geriatric unit was 63% (OSAS in 41% and CSAS in 22%), which is considerably higher than that reported in the general population, between 24 and 40% (Peppard et al, 2013; Heinzer et al, 2015)
Summary
MATERIALS AND METHODSSleep apnea syndrome (SAS) is a disorder characterized by repeated pauses in breathing during sleep (Young et al, 1993). The association between SAS and neurodegenerative diseases remains controversial (Somers et al, 2008; Rosenzweig et al, 2015) and the pathophysiological consequences of SAS are still unclear (Yaffe et al, 2011; Zimmerman and Aloia, 2012; Martin et al, 2015; Bubu et al, 2019) This is further complicated by the fact that most studies do not distinguish between the more common obstructive form (OSAS), characterized by recurrent collapse of the upper respiratory tract, and the rarer central form (CSAS), characterized by repetitive pauses in breathing without respiratory effort. Sleep apnea leads to cognitive impairment in older patients, but its association with neurodegeneration remains controversial, and most studies do not distinguish between the more common obstructive form (OSAS) and the rarer central form (CSAS)
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