Sleep-Disordered Breathing in Hospitalized Geriatric Patients with Mild Dementia and Its Association with Cognition, Emotion and Mobility.

Janine Gronewold,Helmut Frohnhofen,Dirk Hermann,Christoph Kleinschnitz,Robert Haensel

doi:10.3390/ijerph16050863

Abstract

Sleep-disordered breathing (SDB) is an emerging dementia risk factor. Data on the prevalence of SDB in dementia patients and its association with cognitive impairment is so far only based on patients with severe dementia. In 101 geriatric patients mostly with mild dementia recruited on German geriatric wards, SDB was assessed during overnight polygraphy in the patient room with a portable sleep apnea examination device and associations of SDB severity with severity of impairment in cognitive and emotional function as well as mobility were investigated. We also elucidated which factors influence compliance of SDB diagnostics. In 82 of the 101 dementia patients (81.2%), SDB could be assessed. Of those, only 12.2% had an apnea-hypopnea index (AHI) < 5/h demonstrating the absence of SDB. 40.2% exhibited 5/h ≤ AHI < 15/h representing mild SDB, and 47.6% revealed an AHI ≥ 15/h representing moderate/severe SDB. Patients in these three AHI categories did not significant differ from each other in demographical and clinical characteristics. Patients with an AHI ≥ 15/h particularly often presented with heart failure and vitamin D deficiency. We observed a low to moderate association between severity of SDB and severity of dementia. Tolerance of the nasal airflow sensor of at least 6 h was present in less than one third of all patients. The tolerant group exhibited more symptoms of depression and higher physical fitness compared to the non-tolerant group. We observed a high prevalence of SDB also in geriatric patients with mild dementia underlining the importance of SDB screening in the elderly.

Highlights

Sleep-disordered breathing (SDB) is an emerging dementia risk factor [1] but often remains undetected because patients report no subjective complaints like daytime sleepiness [2]
Even though nearly half of our cohort had at least moderate SDB, levels of daytime sleepiness were rather low with no significant differences between
With most patients in the study cohort exhibiting mild dementia, there were no significant differences between apnea-hypopnea index (AHI) categories in neuropsychological tests (Table 3)

Summary

Introduction

Sleep-disordered breathing (SDB) is an emerging dementia risk factor [1] but often remains undetected because patients report no subjective complaints like daytime sleepiness [2]. A causal relationship between SDB and dementia is not yet established, SDB is known to induce neurodegenerative changes as a consequence of sleep fragmentation and intermittent hypoxia [3]. In prospective population-based studies SDB was associated with increased risk for cognitive decline and dementia [4,5]. Positive airway pressure therapy, the gold standard for the treatment of obstructive sleep apnea, improved cognitive performance in dementia patients. Res. Public Health 2019, 16, 863; doi:10.3390/ijerph16050863 www.mdpi.com/journal/ijerph

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