In the JournalsPerspective

Consistent CPAP use may improve cognitive function in older patients

Older patients with obstructive sleep apnea who used continuous positive airway pressure therapy for at least 4 hours nightly for 1 year had improved cognitive function, according to findings recently published in the Journal of the American Geriatrics Society.

Obstructive sleep apnea has been linked to an increased risk for Alzheimer’s disease, but little prospective evidence exists on the effects of [obstructive sleep apnea] treatment in preclinical [Alzheimer’s disease],” Kathy C. Richards, PhD, of the School of Nursing at the University of Texas at Austin and colleagues wrote.

Researchers divided patients with mild cognitive impairment and obstructive sleep apnea into two groups: those who used their CPAP for at least 4 hours a night (n = 29; mean age, 67.4 years) and those who did not (n = 25; mean age, 73.2 years).

Richards and colleagues found that after 1 year, those adhering to their CPAP therapy had statistically significant improvements in psychomotor/cognitive processing speed (parameter estimate = 1.68; standard error = 0.47; 95% CI, 0.73-2.62) vs. those who did not. Those adhering to their CPAP therapy also had small to moderate positive changes in daytime sleepiness, everyday function and memory.

“The mild cognitive impairment plus CPAP [compliant] group reported an over fivefold increased odds of perceiving that they had improved, as compared with the mild cognitive impairment and [noncompliant] CPAP group, and this is important from a clinical perspective because it represents an outcome that matters to individuals. Clinicians should screen for obstructive sleep apnea in older adults with mild cognitive impairment and treat it,” Richards and colleagues concluded. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.

Older patients with obstructive sleep apnea who used continuous positive airway pressure therapy for at least 4 hours nightly for 1 year had improved cognitive function, according to findings recently published in the Journal of the American Geriatrics Society.

Obstructive sleep apnea has been linked to an increased risk for Alzheimer’s disease, but little prospective evidence exists on the effects of [obstructive sleep apnea] treatment in preclinical [Alzheimer’s disease],” Kathy C. Richards, PhD, of the School of Nursing at the University of Texas at Austin and colleagues wrote.

Researchers divided patients with mild cognitive impairment and obstructive sleep apnea into two groups: those who used their CPAP for at least 4 hours a night (n = 29; mean age, 67.4 years) and those who did not (n = 25; mean age, 73.2 years).

Richards and colleagues found that after 1 year, those adhering to their CPAP therapy had statistically significant improvements in psychomotor/cognitive processing speed (parameter estimate = 1.68; standard error = 0.47; 95% CI, 0.73-2.62) vs. those who did not. Those adhering to their CPAP therapy also had small to moderate positive changes in daytime sleepiness, everyday function and memory.

“The mild cognitive impairment plus CPAP [compliant] group reported an over fivefold increased odds of perceiving that they had improved, as compared with the mild cognitive impairment and [noncompliant] CPAP group, and this is important from a clinical perspective because it represents an outcome that matters to individuals. Clinicians should screen for obstructive sleep apnea in older adults with mild cognitive impairment and treat it,” Richards and colleagues concluded. – by Janel Miller

Disclosure: The authors report no relevant financial disclosures.

    Perspective
    Heather M. Snyder

    Heather M. Snyder

    Interventions like the one Richards et al, studied are interesting in that they look downstream in how a person’s behavior now could impact his or her cognition later. While these researchers’ findings are encouraging, it is a small study, so it is premature to consider changing clinical practice or guidance based on their results. That said, studies such as those conducted by Richards and colleagues, but with larger populations, are definitely in the direction we should be taking as we try to understand what causes and how to potentially reduce risk of cognitive decline.

    Primary care physicians should take note of a number of presentations made at the Alzheimer’s Association International Conference during the past few years involving the link between sleep and cognition; these studies have suggested it may be the quality of sleep that is more important than the quantity of sleep to achieving better brain health.

    In addition, sleep is one of the “10 Ways to Love your Brain” listed on the Alzheimer’s Association’s website. These are tips that PCPs can recommend that facilitate good brain health and overall good health in their patients as they age.

    • Heather M. Snyder, PhD
    • Senior director of medical and scientific operations
      Alzheimer's Association

    Disclosures: Snyder reports no relevant financial disclosures.

    Perspective
    Joseph M. Dzierzewski

    Joseph M. Dzierzewski

    Older adults are often concerned with negative changes in their thinking and memory abilities, and frequently seek recommendations to discourage age-related declines. While there many researchers who study sleep and cognition via observational methods, Richards et al’s study is innovative in that it examined changes in cognition throughout the course of treatment for sleep apnea, a very common sleep disorder. The results, suggesting a possible association between adherence to sleep apnea treatment, specifically CPAP, and slowed cognitive decline, are very promising and an encouraging first step in identifying the potential cognitive benefits of regular CPAP to slow down cognitive decline in older adults who are already experiencing some mild cognitive complaints.

    Given the preliminary nature of the study, it might be a bit premature to assess all older adults with memory complaints for sleep apnea with the hope of prescribing CPAP to slow the progression of negative cognitive changes; however, as CPAP is the gold-standard treatment for sleep apnea, the potential for regular use to slow cognitive decline could be discussed with patients who are lacking the motivation needed to make behavioral changes associated with CPAP adherence. The results of Richards and colleague’s study should also be considered by the following specialty providers: pulmonologists, sleep specialists, geriatricians, neurologists, and geropsychologists, all of whom regularly interact with patients who may benefit from a discussion of potential cognitive benefits of consistent CPAP use.

    While the present study is promising, larger randomized clinical trials replicating and extending the results are needed. The preliminary nature notwithstanding, I am in strong favor of nonmedication treatments for common sleep disorders. Treatments like cognitive behavioral therapy for insomnia and CPAP for sleep apnea offer many potential advantages with low risk for unexpected negative consequences. Even if Richards and colleagues’ findings do not hold up in a large-scale randomized trial, it is important to remember that consistent use of CPAP can still help many people get a good night sleep. Time and again we have seen how better sleep has so many benefits to a person’s mental and physical health. Mounting evidence now suggests that potential benefits on late-life cognition may need to be added to the list of possible benefits of good sleep.

    • Joseph M. Dzierzewski, PhD
    • Assistant professor, department of psychology
      Virginia Commonwealth University

    Disclosures: Dzierzewski reports no relevant financial disclosures.