Posts tagged sleep apnea
Articles and news from the latest research reports.
Sleep disorders widely undiagnosed in individuals with multiple sclerosis
In what may be the largest study of sleep problems among individuals with multiple sclerosis (MS), researchers at UC Davis have found that widely undiagnosed sleep disorders may be at the root of the most common and disabling symptom of the disease: fatigue.
Conducted in over 2,300 individuals in Northern California with multiple sclerosis, the large, population-based study found that, overall, more than 70 percent of participants screened positive for one or more sleep disorders.
The research highlights the importance of diagnosing the root causes of fatigue among individuals with MS, as sleep disorders may affect the course of the disease as well as the overall health and well-being of sufferers, the authors said.
The study “The Underdiagnosis of Sleep Disorders in Patients with Multiple Sclerosis,” is published online today in the Journal of Clinical Sleep Medicine.
“A large percentage of MS subjects in our study are sleep deprived and screened positive for one or more sleep disorders,” said Steven Brass, associate clinical professor and director of the Neurology Sleep Clinical Program and co-medical director of the UC Davis Sleep Medicine Laboratory.
“The vast majority of these sleep disorders are potentially undiagnosed and untreated,” he said. “This work suggests that patients with MS may have sleep disorders requiring independent diagnosis and management.”
Fatigue is the hallmark of multiple sclerosis, an inflammatory disease affecting the white matter and spinal cord of sufferers. MS symptoms include loss of vision, vertigo, weakness and numbness. Patients also may experience psychiatric symptoms. Disease onset generally is between the ages of 20 and 50 years. The cause of MS is not known, although it is believed to be an autoimmune condition.
Sleep disorders are known to occur more frequently among patients with MS. To gauge the extent of sleep disorders, such as obstructive sleep apnea and insomnia, Brass and his colleagues surveyed members of the Northern California Chapter of the National MS Society. Subjects were recruited in 2011.
More than 11,000 surveys were mailed to prospective participants. Of those, 2,375 met criteria and were included in the study. Consistent with the reported epidemiology of multiple sclerosis, the majority (81 percent) were female and Caucasian (88 percent). The mean age of the participants was 54.
Participants were asked to complete a 10-page survey, which included a detailed sleep history and questions assessing obstructive sleep apnea, daytime sleepiness, insomnia and restless legs syndrome.
Most of the participants - nearly 52 percent - said it took them more than one half hour to fall asleep at night, and nearly 11 percent reported taking a medication to fall asleep. Close to 38 percent of participants screened positive for obstructive sleep apnea. Nearly 32 percent had moderate to severe insomnia and nearly 37 percent had restless legs syndrome.
However, most of the participants had not been diagnosed with a sleep disorder by a physician. While nearly 38 percent reported having obstructive sleep apnea, only a little more than 4 percent reported being diagnosed by a physician with the condition. Similar statistics were seen for other sleep disorders.
“This study shows that sleep disorder frequency, sleep patterns and complaints of excessive daytime sleepiness suggest that sleep problems may be a hidden epidemic in the MS population, separate from MS fatigue,” Brass said.
(Source: ucdmc.ucdavis.edu)
Study provides more evidence that sleep apnea is hurting your brain
Employing a measure rarely used in sleep apnea studies, researchers at the UCLA School of Nursing have uncovered evidence of what may be damaging the brain in people with the sleep disorder — weaker brain blood flow.
(Image caption: This brain scan shows that the brain blood flow in a subject with obstructive sleep apnea (left) is markedly lower compared to a subject without the sleep disorder. Credit: UCLA)
In the study, published Aug. 28 in the peer-reviewed journal PLOS ONE, researchers measured blood flow in the brain using a non-invasive MRI procedure: the global blood volume and oxygen dependent (BOLD) signal. This method is usually used to observe brain activity. Because previous research showed that poor regulation of blood in the brain might be a problem for people with sleep apnea, the researchers used the whole-brain BOLD signal to look at blood flow in individuals with and without obstructive sleep apnea (OSA).
“We know there is injury to the brain from sleep apnea, and we also know that the heart has problems pumping blood to the body, and potentially also to the brain,” said Paul Macey, associate dean for Information Technology and Innovations at the UCLA School of Nursing and lead researcher for the study. “By using this method, we were able to show changes in the amount of oxygenated blood across the whole brain, which could be one cause of the damage we see in people with sleep apnea.”
Obstructive sleep apnea is a serious disorder that occurs when a person’s breathing is repeatedly interrupted during sleep, hundreds of times a night. Each time breathing stops, the oxygen level in the blood drops, which damages many cells in the body. If left untreated, it can lead to high blood pressure, stroke, heart failure, diabetes, depression and other serious health problems. Approximately 10 percent of adults struggle with obstructive sleep apnea, which is accompanied by symptoms of brain dysfunction, including extreme daytime sleepiness, depression and anxiety, and memory problems.
In this study, men and women — both with and without obstructive sleep apnea had their BOLD signals measured during three physical tasks while they were awake:
- The Valsalva maneuver: participants forcefully breathe out through a very small tube, which raises the pressure in the chest.
- A hand-grip challenge: participants squeeze hard with their hand.
- A cold pressor challenge: A participants’s right foot is put in icy water for a minute.
“When we looked at the results, we didn’t see much difference between the participants with and without OSA in the Valsalva maneuver,” said Macey. “But for the hand-grip and cold-pressor challenges, people with OSA saw a much weaker brain blood flow response.”
The researchers believe that the reason there were differences in the sleep apnea patients during the hand-grip and cold pressor challenge was because the signals from the nerves in the arms and legs had to be processed through the high brain areas controlling sensation and muscle movement, which was slower due to the brain injury. On the other hand, the changes from the Valsalva are mainly driven by blood pressure signaling in the chest, and do not need the sensory or muscle-controlling parts of the brain.
“This study brings us closer to understanding what causes the problems in the brain of people with sleep apnea,” concluded Macey.
The study also found the problem is greater in women with sleep apnea, which may explain the worse apnea-related outcomes in females than males. Studies recently published by the UCLA School of Nursing have shown that brain injury from sleep apnea is much worse in women than men.
The researchers are now looking at whether treatment for obstructive sleep apnea can reverse the damaging effects.
(Source: newsroom.ucla.edu)
Brain damage caused by severe sleep apnea is reversible
A neuroimaging study is the first to show that white matter damage caused by severe obstructive sleep apnea can be reversed by continuous positive airway pressure therapy. The results underscore the importance of the “Stop the Snore” campaign of the National Healthy Sleep Awareness Project, a collaboration between the Centers for Disease Control and Prevention, American Academy of Sleep Medicine, Sleep Research Society and other partners.
Results show that participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas. This brain damage was accompanied by impairments to cognition, mood and daytime alertness. Although three months of CPAP therapy produced only limited improvements to damaged brain structures, 12 months of CPAP therapy led to an almost complete reversal of white matter abnormalities. Treatment also produced significant improvements in nearly all cognitive tests, mood, alertness and quality of life.
“Structural neural injury of the brain of obstructive sleep apnea patients is reversible with effective treatment,” said principal investigator and lead author Vincenza Castronovo, PhD, clinical psychologist at the Sleep Disorders Center at San Raffaele Hospital and Vita-Salute San Raffaele University in Milano, Italy. “Treatment with CPAP, if patients are adherent to therapy, is effective for normalizing the brain structure.”
The study results are published in the September issue of the journal Sleep.
“Obstructive sleep apnea is a destructive disease that can ruin your health and increase your risk of death,” said American Academy of Sleep Medicine President Dr. Timothy Morgenthaler, a national spokesperson for the Healthy Sleep Project. “Treatment of sleep apnea can be life-changing and potentially life-saving.”
The “Stop the Snore” campaign was launched recently to encourage people to talk to a doctor about the warning signs for sleep apnea, which afflicts at least 25 million adults in the U.S. Sleep apnea warning signs include snoring and choking, gasping or silent breathing pauses during sleep. Pledge to stop the snore at www.stopsnoringpledge.org.
The study involved 17 men with severe, untreated obstructive sleep apnea who had an average age of 43 years. They were evaluated at baseline and after both three months and 12 months of treatment with CPAP therapy. At each time point they underwent a neuropsychological evaluation and a diffusion tensor imaging examination. DTI is a form of magnetic resonance imaging that measures the flow of water through brain tissue. Participants were compared with 15 age-matched, healthy controls who were evaluated only at baseline.
A previous study by Castronovo’s research team found similar damage to gray matter volume in multiple brain regions of people with severe sleep apnea. Improvements in gray matter volume appeared after three months of CPAP therapy. According to the authors, the two studies suggest that the white matter of the brain takes longer to respond to treatment than the gray matter.
“We are seeing a consistent message that the brain can improve with treatment,” said co-principal investigator Mark Aloia, PhD, Associate Professor of Medicine at National Jewish Health in Denver, Colorado, and Senior Director of Global Clinical Research for Philips Respironics, Inc. “We know that PAP therapy keeps people breathing at night; but demonstrating effects on secondary outcomes is critical, and brain function and structure are strong secondary outcomes.”
FDA approves first-of-a-kind sleep apnea implant
Sleep-deprived Americans have a new option to address hard-to-treat nighttime breathing problems: a first-of-kind device that keeps airways open by zapping them with an electrical current.
The Food and Drug Administration approved the pacemaker-like device from Inspire Medical Systems for sleep apnea patients who have trouble with the current standard of care: machines that blow air through a bedtime mask.
Tired all the time: Could undiagnosed sleep problems be making MS patients’ fatigue worse?
People with multiple sclerosis (MS) might assume that the fatigue they often feel just comes with the territory of their chronic neurological condition.
But a new University of Michigan study suggests that a large proportion of MS patients may have an undiagnosed sleep disorder that is also known to cause fatigue. And that disorder – obstructive sleep apnea – is a treatable condition.
In the latest issue of the Journal of Clinical Sleep Medicine, researchers from the U-M Health System’s Sleep Disorders Center report the results of a study involving 195 patients of the U-M Multiple Sclerosis Center.
In all, 56 percent of the MS patients were found to be at increased risk for obstructive sleep apnea, based on a method of screening for the condition known as the STOP-Bang questionnaire. But most had never received a formal diagnosis of sleep apnea, and less than half of those who had been told they had sleep apnea were using the standard treatment for it.
The authors also found that patients who were more fatigued were more likely to also be at elevated risk for sleep apnea – even after taking into account other factors that might have contributed to feelings of fatigue, such as age, gender, body mass index (BMI), sleep duration, depression, and other nighttime symptoms.
The research is based on patients’ answers from a sleep questionnaire designed by the authors, and four validated instruments designed to assess daytime sleepiness, fatigue severity, insomnia severity and obstructive sleep apnea risk. Medical records also were accessed with patients’ permission, to examine clinical characteristics that may predict fatigue or obstructive sleep apnea risk.
“We were particularly surprised by the difference between the proportion of patients who carried an established diagnosis of obstructive sleep apnea – 21 percent — and the proportion at risk for obstructive sleep apnea based on their STOP-Bang scores, which was 56 percent,” says the study’s lead author, Tiffany Braley, M.D., M.S. “These findings suggest that OSA may be a highly prevalent and yet under-recognized contributor to fatigue in persons with MS.”
Braley, an assistant professor of Neurology and multiple sclerosis specialist at the U-M Medical School, conducted the study in collaboration with professors Ronald Chervin, M.D., M.S., and Benjamin Segal, M.D. Chervin is the Director of U-M Sleep Disorders Center, and Segal directs the U-M MS Center.
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system that causes inflammation and damage of the brain and spinal cord. In addition to neurological disability, MS patients suffer from a number of chronic symptoms, the most common of which is fatigue. Fatigue is also one of the most disabling symptoms experienced by MS patients.
Braley cautions that the design of this new study does not allow for demonstration of cause and effect – that is, the researchers can’t prove based on survey results that the patients felt more fatigued because they had a high score on a sleep apnea risk survey. But, she says, “the findings should prompt doctors who treat MS patients to consider sleep apnea as a possible contributor to their patients’ fatigue, and recommend appropriate testing and treatment.”
The standard treatment for obstructive sleep apnea, called continuous positive airway pressure, or CPAP, involves a machine and mask device that applies a stream of air to the upper airway to keep it open during sleep.
The patients in the study had an average age of 47 and had lived with MS for an average of 10 years. Two-thirds were female, consistent with the prevalence of MS in the U.S., and two-thirds were taking a medication to treat their MS. Three-quarters had the relapsing-remitting form of the disease.
Sleep Better, Look Better? New Research Says Yes
First scientific look at how sleep apnea treatment affects appearance — alertness, youthfulness & attractiveness — may help patients stick with care
Getting treatment for a common sleep problem may do more than help you sleep better – it may help you look better over the long term, too, according to a new research study from the University of Michigan Health System and Michigan Technological University.
The findings aren’t just about “looking sleepy” after a late night, or being bright-eyed after a good night’s rest.
It’s the first time researchers have shown specific improvement in facial appearance after at-home treatment for sleep apnea, a condition marked by snoring and breathing interruptions. Sleep apnea affects millions of adults – most undiagnosed — and puts them at higher risk for heart-related problems and daytime accidents.
Using a sensitive “face mapping” technique usually used by surgeons, and a panel of independent appearance raters, the researchers detected changes in 20 middle-aged apnea patients just a few months after they began using a system called CPAP to help them breathe better during sleep and overcome chronic sleepiness.
While the research needs to be confirmed by larger studies, the findings may eventually give apnea patients even more reason to stick with CPAP treatment – a challenge for some because they must wear a breathing mask in bed. CPAP is known to stop snoring, improve daytime alertness and reduce blood pressure.
Sleep neurologist Ronald Chervin, M.D., M.S., director of the U-M Sleep Disorders Center, led the study, which was funded by the Covault Memorial Foundation for Sleep Disorders Research and published in the Journal of Clinical Sleep Medicine.
Putting anecdote to the test
Chervin says the study grew out of the anecdotal evidence that sleep center staff often saw in sleep apnea patients when they came for follow-up visits after using CPAP. The team, including research program manager Deborah Ruzicka, R.N., Ph.D., sought a more scientific way to assess appearance before and after sleep treatment.
“The common lore, that people ‘look sleepy’ because they are sleepy, and that they have puffy eyes with dark circles under them, drives people to spend untold dollars on home remedies,” notes Chervin, the Michael S. Aldrich Collegiate Professor of Sleep Medicine and professor of Neurology at the U-M Medical School. “We perceived that our CPAP patients often looked better, or reported that they’d been told they looked better, after treatment. But no one has ever actually studied this.”
They teamed with U-M plastic and reconstructive surgeon Steven Buchman, M.D., to use a precise face-measuring system called photogrammetry to take an array of images of the patients under identical conditions before CPAP and a few months after. Capable of measuring tiny differences in facial contours, the system helps surgeons plan operations and assess their impact.
“One of the breakthroughs in plastic surgery over the last decade has been our aim to get more objective in our outcomes,” says Buchman. “The technology used in this study demonstrates the real relationship between how you look and how you really are doing, from a health perspective.”
The research team also included longtime collaborators at the Michigan Tech Research Institute, led by signal analysis expert and engineer Joseph W. Burns, Ph.D., who developed a way to precisely map the colors of patients’ facial skin before and after CPAP treatment.
The researchers also used a subjective test of appearance: 22 independent raters were asked to look at the photos, without knowing which were the “before” pictures and which the “after” pictures of each patient. The raters were asked to rank attractiveness, alertness and youthfulness – and to pick which picture they thought showed the patient after sleep apnea treatment.
Results show improvement
About two-thirds of the time, the raters stated that the patients in the post-treatment photos looked more alert, more youthful and more attractive. The raters also correctly identified the post-treatment photo two-thirds of the time.
Meanwhile, the objective measures of facial appearance showed that patients’ foreheads were less puffy, and their faces were less red, after CPAP treatment. The redness reduction was especially visible in 16 patients who are Caucasian, and was associated with the independent raters’ tendency to say a patient looked more alert in the post-treatment photo. The researchers also perceived, but did not have a way to measure, a reduction in forehead wrinkles after treatment.
However, the researchers note, they didn’t see a big change in facial characteristics that popular lore associates with sleepiness. “We were surprised that our approach could not document any improvement, after treatment, in tendency to have dark blue circles or puffiness under the eyes,” says Chervin. “Further research is needed, to assess facial changes in more patients, and over a longer period of CPAP treatment.”
He notes that this initial study wouldn’t have been possible without the generosity of donors who have supported U-M sleep research as a way of honoring the memory of Jonathan Covault, a promising attorney who died young, and whose undertreated sleep apnea may have contributed to his premature death. The Covault family was aware of the research study, and of the importance of research that might encourage others to seek and stay with apnea treatment.
Chervin and his colleagues hope to continue to study the effect of sleep apnea treatment on many aspects of a person’s life, including further research on appearance. “We want sleep to be on people’s minds, and to educate them about the importance of getting enough sleep and getting attention for sleep disorders,” he says.
![Study finds that sleep apnea and Alzheimer’s are linked
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer’s disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
But this latest study also poses an interesting question: Could AD in its “preclinical stages” also lead to SDB and explain the increased prevalence of SDB in the elderly?
The study will be presented at the ATS 2013 International Conference.
"It’s really a chicken and egg story," said Ricardo S. Osorio, MD, a research assistant professor at NYU School of Medicine who led the study. "Our study did not determine the direction of the causality, and, in fact, didn’t uncover a significant association between the two, until we broke out the data on lean and obese patients."
When the researchers did consider body mass, they found that lean patients (defined as having a body mass index <25) with SDB did possess several specific and non-specific biomarkers of AD risk (increased P-Tau and T-Tau in CSF, hippocampal atrophy using structural MRI, and glucose hypometabolism using FDG-PET in several AD-vulnerable regions). Among obese patients (BMI >25), glucose hypometabolism was also found in the medial temporal lobe, but was not significant in other AD-vulnerable regions.
"We know that about 10 to 20 percent of middle-aged adults in the United States have SDB [defined as an apnea-hypopnea index greater than 5] and that the number jumps dramatically in those over the age of 65," said Dr. Osorio, noting that studies put the percentage of people over the age of 65 with SDB between 30 and 60 percent. "We don’t know why it becomes so prevalent, but one factor may be that some of these patients are in the earliest preclinical stages of AD."
According to Dr. Osorio, the biochemical harbingers of AD are present 15 to 20 years before any of its currently recognized symptoms become apparent.
The NYU study enrolled 68 cognitively normal elderly patients (mean age 71.4±5.6, range 64-87) who underwent two nights of home monitoring for SDB and were tested for at least one diagnostic indicator of AD. The researchers looked at P-Tau, T-Tau and Aβ42 in CSF, FDG-PET (to measure glucose metabolism), Pittsburgh compound B (PiB) PET to measure amyloid load, and/or structural MRI to measure hippocampal volume. Reduced glucose metabolism in AD-vulnerable regions, decreased hippocampal volume, changes in P-Tau, T-Tau and Aβ42, and increased binding of PiB-PET are recognized as markers of risk for AD and have been reported to be abnormal in healthy subjects before the disease onset.
Biomarkers for AD risk were found only among lean study participants with SDB. These patients showed a linear association between the severity of SDB and CSF levels of the biomarker P-Tau (F = 5.83, t=2.41, β=0.47; p< 0.05) and between SDB and glucose hypometabolism using FDG-PET, in the medial temporal lobe (F=6.34, t=-2.52, β=-0.57,p<0.05), the posterior cingulate cortex/precuneus (F=11.62, t=-3.41, β=-0.69, p<0.01) and a composite score of all AD-vulnerable regions (F=4.48, t=-2.11, β=-0.51, p<0.05). Lean SDB patients also showed smaller hippocampi when compared to lean controls (F=4.2, p<0.05), but no differences were found in measures of amyloid burden such as decreased Aβ42 in CSF or PiB positive scans.
Dr. Osorio and his colleagues are planning to test their hypothesis that very early stage preclinical AD brain injury that associates with these biomarkers can lead to SDB. They have proposed a two-year longitudinal study that would enroll 200 cognitively normal subjects, include AD biomarkers and treat those patients with moderate to severe SDB with continuous positive airway pressure, or CPAP, over time.
The purpose of the new study would be to determine the “direction” of causality between SDB and preclinical AD in elderly patients. After an initial assessment, the patients would be given CPAP to treat their sleep apnea. After six months, they would be evaluated again for biomarker evidence of AD.
"If the biomarkers change, it may indicate that SDB is causing AD," explained Dr. Osorio. "If they don’t change, the probable conclusion is that these patients are going to develop AD with or without CPAP, and that AD may either be causing the apneas or may simply coexist with SDB as part of aging."
Either way, Dr. Osorio believes the relationship between SDB and AD deserves further study.
"Sleep apnea skyrockets in the elderly, and this fact hasn’t been given the attention it deserves by the sleep world or the Alzheimer’s world," Dr. Osorio said. "Sleep particularly suffers from an outmoded perception that it is an inactive physiological process, when, in reality, it is a very active part of the day for the brain."](http://41.media.tumblr.com/6a53931d85c0688a19f1b1a50fac7dc1/tumblr_mn3hqygKfJ1rog5d1o1_500.jpg)
Study finds that sleep apnea and Alzheimer’s are linked
A new study looking at sleep-disordered breathing (SDB) and markers for Alzheimer’s disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.
But this latest study also poses an interesting question: Could AD in its “preclinical stages” also lead to SDB and explain the increased prevalence of SDB in the elderly?
The study will be presented at the ATS 2013 International Conference.
"It’s really a chicken and egg story," said Ricardo S. Osorio, MD, a research assistant professor at NYU School of Medicine who led the study. "Our study did not determine the direction of the causality, and, in fact, didn’t uncover a significant association between the two, until we broke out the data on lean and obese patients."
When the researchers did consider body mass, they found that lean patients (defined as having a body mass index <25) with SDB did possess several specific and non-specific biomarkers of AD risk (increased P-Tau and T-Tau in CSF, hippocampal atrophy using structural MRI, and glucose hypometabolism using FDG-PET in several AD-vulnerable regions). Among obese patients (BMI >25), glucose hypometabolism was also found in the medial temporal lobe, but was not significant in other AD-vulnerable regions.
"We know that about 10 to 20 percent of middle-aged adults in the United States have SDB [defined as an apnea-hypopnea index greater than 5] and that the number jumps dramatically in those over the age of 65," said Dr. Osorio, noting that studies put the percentage of people over the age of 65 with SDB between 30 and 60 percent. "We don’t know why it becomes so prevalent, but one factor may be that some of these patients are in the earliest preclinical stages of AD."
According to Dr. Osorio, the biochemical harbingers of AD are present 15 to 20 years before any of its currently recognized symptoms become apparent.
The NYU study enrolled 68 cognitively normal elderly patients (mean age 71.4±5.6, range 64-87) who underwent two nights of home monitoring for SDB and were tested for at least one diagnostic indicator of AD. The researchers looked at P-Tau, T-Tau and Aβ42 in CSF, FDG-PET (to measure glucose metabolism), Pittsburgh compound B (PiB) PET to measure amyloid load, and/or structural MRI to measure hippocampal volume. Reduced glucose metabolism in AD-vulnerable regions, decreased hippocampal volume, changes in P-Tau, T-Tau and Aβ42, and increased binding of PiB-PET are recognized as markers of risk for AD and have been reported to be abnormal in healthy subjects before the disease onset.
Biomarkers for AD risk were found only among lean study participants with SDB. These patients showed a linear association between the severity of SDB and CSF levels of the biomarker P-Tau (F = 5.83, t=2.41, β=0.47; p< 0.05) and between SDB and glucose hypometabolism using FDG-PET, in the medial temporal lobe (F=6.34, t=-2.52, β=-0.57,p<0.05), the posterior cingulate cortex/precuneus (F=11.62, t=-3.41, β=-0.69, p<0.01) and a composite score of all AD-vulnerable regions (F=4.48, t=-2.11, β=-0.51, p<0.05). Lean SDB patients also showed smaller hippocampi when compared to lean controls (F=4.2, p<0.05), but no differences were found in measures of amyloid burden such as decreased Aβ42 in CSF or PiB positive scans.
Dr. Osorio and his colleagues are planning to test their hypothesis that very early stage preclinical AD brain injury that associates with these biomarkers can lead to SDB. They have proposed a two-year longitudinal study that would enroll 200 cognitively normal subjects, include AD biomarkers and treat those patients with moderate to severe SDB with continuous positive airway pressure, or CPAP, over time.
The purpose of the new study would be to determine the “direction” of causality between SDB and preclinical AD in elderly patients. After an initial assessment, the patients would be given CPAP to treat their sleep apnea. After six months, they would be evaluated again for biomarker evidence of AD.
"If the biomarkers change, it may indicate that SDB is causing AD," explained Dr. Osorio. "If they don’t change, the probable conclusion is that these patients are going to develop AD with or without CPAP, and that AD may either be causing the apneas or may simply coexist with SDB as part of aging."
Either way, Dr. Osorio believes the relationship between SDB and AD deserves further study.
"Sleep apnea skyrockets in the elderly, and this fact hasn’t been given the attention it deserves by the sleep world or the Alzheimer’s world," Dr. Osorio said. "Sleep particularly suffers from an outmoded perception that it is an inactive physiological process, when, in reality, it is a very active part of the day for the brain."