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J Am Geriatr Soc. 2019 Mar;67(3):558-564. doi: 10.1111/jgs.15758. Epub 2019 Feb 6.

CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea.

Author information

1
School of Nursing, University of Texas at Austin, Texas, Austin.
2
Division of Sleep Medicine, Center for Sleep and Circadian Neurobiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
3
School of Medicine, Virginia Commonwealth University & Pulmonary and Critical Care Specialists of Northern Virginia, Richmond, Virginia.
4
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
5
Department of Psychology, University of the Sciences in Philadelphia, Philadelphia, Pennsylvania.
6
Department of Geriatrics, CHU Bichat Claude Bernard, APHP, Paris, France.
7
INSERM 1178 & CESP, University of Paris Sud, Chatenay-Malabry, France.
8
National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
9
Corporal Michael J Crescenz VA Medical Center, Philadelphia, Pennsylvania.
10
Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago, Chicago, Illinois.
11
Division of Pulmonary, Critical Care and Sleep, Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.
12
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

BACKGROUND/OBJECTIVES:

Obstructive sleep apnea (OSA) has been linked to an increased risk for Alzheimer's disease (AD), but little prospective evidence exists on the effects of OSA treatment in preclinical AD. The objective was to determine if continuous positive airway pressure (CPAP) treatment adherence, controlling for baseline differences, predicts cognitive and everyday function after 1 year in older adults with mild cognitive impairment (MCI) and to determine effect sizes for a larger trial.

DESIGN:

Quasi-experimental pilot clinical trial with CPAP adherence defined as CPAP use 4 hours or more per night over 1 year.

SETTING:

Sleep and geriatric clinics and community.

PARTICIPANTS:

Older adults, aged 55 to 89 years, with an apnea-hypopnea index of 10 or higher participated: (1) MCI, OSA, and CPAP adherent (MCI +CPAP), n = 29; and (2) MCI, OSA, CPAP nonadherent (MCI -CPAP), n = 25.

INTERVENTION:

CPAP.

MEASUREMENTS:

The primary cognitive outcome was memory (Hopkins Verbal Learning Test-Revised), and the secondary cognitive outcome was psychomotor/cognitive processing speed (Digit Symbol subtest from the Wechsler Adult Intelligence Scale Substitution Test). Secondary function and progression measures were the Everyday Cognition, Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale, and Clinical Dementia Rating.

RESULTS:

Statistically significant improvements in psychomotor/cognitive processing speed in the MCI +CPAP group vs the MCI -CPAP group were observed at 1 year after adjustment for age, race, and marital status (parameter estimate = 1.68; standard error = 0.47; 95% confidence interval = 0.73-2.62), with a 6-month effect size (ES) of 0.46 and a 1-year ES of 1.25. There were small to moderate ESs for memory (ES 0.20, 6 mo), attention (ES 0.25, 1 y), daytime sleepiness (ES 0.33, 6 mo and ES 0.22, 1 y), and everyday function (ES 0.50, 6 mo) favoring the MCI +CPAP group vs the MCI -CPAP group.

CONCLUSION:

Controlling for baseline differences, 1 year of CPAP adherence in MCI +OSA significantly improved cognition, compared with a nonadherent control group, and may slow the trajectory of cognitive decline.

TRIAL REGISTRATION NUMBER:

Memories; NCT01482351; https://clinicaltrials.gov/ct2/show/NCT01482351?cond=MCI+and+OSA&rank=1 J Am Geriatr Soc 67:558-564, 2019.

KEYWORDS:

CPAP; memories; mild cognitive impairment; neurocognitive outcome; obstructive sleep apnea

PMID:
30724333
PMCID:
PMC6402995
[Available on 2020-03-01]
DOI:
10.1111/jgs.15758

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