Elsevier

Sleep Medicine

Volume 10, Issue 10, December 2009, Pages 1101-1106
Sleep Medicine

Original Article
Continuous positive airway pressure deepens sleep in patients with Alzheimer’s disease and obstructive sleep apnea

https://doi.org/10.1016/j.sleep.2008.12.016Get rights and content

Abstract

Objective

Patients with Alzheimer’s disease (AD) and obstructive sleep apnea (OSA) experience disrupted sleep. This study examined the effect of continuous positive airway pressure (CPAP) on sleep parameters in AD patients with OSA.

Methods

A randomized placebo-controlled trial of 3 weeks of therapeutic CPAP (tCPAP) vs. 3 weeks placebo CPAP (pCPAP) followed by 3 weeks tCPAP in patients with AD and OSA. Polysomnography data from screening after one night and after 3 weeks of treatment were analyzed. Records were scored for percent of each sleep stage, total sleep time (TST), sleep efficiency (SE), sleep period (SP), time in bed (TIB), sleep onset (SO), wake time after sleep onset (WASO), and arousals. A randomized design comparing one night of pCPAP to tCPAP and a paired analysis combining 3 weeks of tCPAP were performed.

Results

Fifty-two participants (mean age = 77.8 years, SD = 7.3) with AD and OSA were included. After one treatment night, the tCPAP group had significantly less % Stage 1 (p = 0.04) and more % Stage 2 sleep (p = 0.02) when compared to the pCPAP group. In the paired analysis, 3 weeks of tCPAP resulted in significant decreases in WASO (p = 0.005), % Stage 1 (p = 0.001), arousals (p = 0.005), and an increase in % Stage 3 (p = 0.006).

Conclusion

In mild to moderate AD patients with OSA, the use of tCPAP resulted in deeper sleep after just one night, with improvements maintained for 3 weeks.

Introduction

Alzheimer’s disease (AD) patients have disrupted sleep relative to aged controls [1], [2], with less slow wave sleep (SWS) and more frequent awakenings and wake time after sleep onset (WASO) [1]. Some have hypothesized that there is an important association between the severity of these sleep disruptions and worsening cognitive function in AD [3], [1].

In addition to the sleep disruptions associated with AD, patients with AD also have a reported increased incidence of obstructive sleep apnea (OSA) [4], [5], [6], [7], [8]. Our laboratory has previously shown that the sleep of AD patients with OSA is characterized by less rapid eye movement (REM) sleep compared to AD patients without OSA [9]. Continuous positive airway pressure (CPAP) is the most effective treatment for OSA and its effect on restoring consolidated sleep in patients without dementia is characterized by an increase in SWS and REM [10], [11], [12], [13].

As part of a larger study exploring the effect of CPAP on cognitive functioning in patients with mild to moderate AD and OSA [14], this study examined the effect of CPAP on sleep parameters in this population of patients. Although patients with AD without OSA have sleep disturbances, we hypothesized that treatment with CPAP would result in deeper, less disrupted sleep (manifested by increases in SWS and REM sleep and decreases in Stage 1 sleep, WASO, and arousals).

Section snippets

Participants

Four hundred and twenty persons with AD were screened for this study from several sources including the University of California San Diego (UCSD) Alzheimer’s Disease Research Center, the UCSD Seniors Only Care Program, advertisements, referrals from neurologists at UCSD and in the general San Diego community, and from word of mouth. Ninety-eight participants were ultimately enrolled and 52 were eventually randomized (see Fig. 1). All participants were assessed for decision making capacity.

Results

Demographics: Table 1 lists the participants’ baseline demographics characteristics. There were 52 participants (39 men, 13 women) initially randomized. Mean age was 77.8 years (SD = 7.3, range = 53–91), and participants on average were mildly overweight, had mild to moderate dementia (mean MMSE = 25.3, SD = 2.9, range = 18–30), and had 14 or more years of education. Although most participants completed the study, a total of 13 participants (25%) dropped out before the 6-week time point. Attrition rates

Discussion

This study demonstrated that in mild to moderate AD patients with OSA, a single night of treatment with therapeutic CPAP, when compared to placebo CPAP, resulted in an immediate deepening of sleep with less time spent in Stage 1 and more time spent in Stage 2 sleep. These improvements in sleep were maintained following 3 weeks of therapeutic CPAP. In addition, 3 weeks of therapeutic CPAP resulted in more consolidated sleep with less time spent awake during the night, less arousals from sleep, and

References (42)

  • J.M. Parish et al.

    Compliance with CPAP in elderly patients with OSA

    Sleep Med

    (2000)
  • L. Ayalon et al.

    Adherence to continuous positive airway pressure treatment in patients with Alzheimer’s disease and obstructive sleep apnea

    Am J Geriatr Psychiatry

    (2006)
  • P.N. Prinz et al.

    Sleep in Alzheimer’s disease

  • P.N. Prinz et al.

    Changes in the sleep and waking EEGs of nondemented and demented elderly subjects

    J Am Geriatr Soc

    (1982)
  • C.C. Hoch et al.

    Sleep-disordered breathing in normal and pathologic aging

    J Clin Psychiatry

    (1986)
  • C.F.I. Reynolds et al.

    Sleep apnea in Alzheimer’s dementia: correlation with mental deterioration

    J Clin Psychiatry

    (1985)
  • Smirne S, Franceschi M, Bareggi SR, Comi G, Mariani E, Mastrangelo M. Sleep apneas in Alzheimer’s disease. In: Sleep...
  • S. Ancoli-Israel et al.

    Dementia in institutionalized elderly: relation to sleep apnea

    J Am Geriatr Soc

    (1991)
  • J.R. Cooke et al.

    The effect of sleep disordered breathing on sleep stages in patients with Alzheimer’s disease

    Behav Sleep Med

    (2006)
  • M. Aldrich et al.

    Effects of continuous positive airway pressure on phasic events of REM sleep in patients with obstructive sleep apnea

    Sleep

    (1989)
  • J.S. Loredo et al.

    Effect of continuous positive airway pressure versus supplemental oxygen on sleep quality in obstructive sleep apnea: a placebo-CPAP controlled study

    Sleep

    (2006)
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    Supported by NIA AG08415, GCRC M01 RR00827, P50 AG05131, and the Research Service of the Veterans Affairs San Diego Healthcare System.

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