Sleep Apnea and Dementia | Ten Points to Remember

Rosenzweig I, Glasser M, Polsek D, Leschziner GD, Williams SC, Morrell MJ.
Sleep Apnea and the Brain: A Complex Relationship. Lancet Respir Med 2015;Apr 14:[Epub ahead of print].

The following are 10 points to remember from this review article about sleep apnea and the brain:

  1. Obstructive sleep apnea (OSA) is a commonly prevalent, chronic multisystem disease with a high socioeconomic burden, which appears to be underdiagnosed in the general population.
  2. Intermittent hypoxia, reoxygenation, and hypercapnia or hypocapnia occur in both adults and children during untreated apnea and hypopnea, along with changes in cerebral blood flow and sleep fragmentation.
  3. Disruption of sleep physiology by OSA is an underappreciated factor, which, together with hypoxemia and other already recognized factors, might further aggravate age-related memory deficits.
  4. OSA is increasingly recognized as one of the potentially modifiable risk factors for dementia; its multiple effects on the central nervous system are acknowledged, although their nature and prognosis are not fully understood.
  5. Persistent deficits, even after long-term treatment with continuous positive airway pressure in some patients, suggest that early detection of the central nervous system sequelae in OSA is essential so that appropriate treatment is given before irreversible atrophic and metabolic changes occur.
  6. Both maladaptive and adaptive pathways are likely initiated in the central nervous system during nocturnal apneic and hypopneic episodes and ensuing sleep fragmentation, the net result of which will depend on the chronicity of process and idiosyncratic characteristics of each patient.
  7. Tapping into the therapeutic potential of ischemic preconditioning, while working on mitigating the acute and chronic effects of neuroinflammation, could offer new therapeutic targets in OSA.
  8. Clinical approaches that target the sleep disturbance arm of this intricate equation advocate substantial potential for future treatment.
  9. In the future, multimodal investigative approaches should help elucidate more reliable referencing for the acuity of the pathological process, as well as its reversibility following the treatment.
  10. Given the associations between OSA, various cognitive and emotional deficits, and dementia, there is a need to detect and target those at highest risk for cognitive decline.

Clinical Topics: Heart Failure and Cardiomyopathies, Sleep Apnea

Keywords: Anoxia, Apnea, Cognition, Cost of Illness, Dementia, Hypercapnia, Hypocapnia, Ischemic Preconditioning, Memory Disorders, Prognosis, Risk Factors, Sleep Apnea Syndromes, Sleep Apnea, Obstructive, Sleep Deprivation

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