Original ArticleContinuous positive airway pressure deepens sleep in patients with Alzheimer’s disease and obstructive sleep apnea☆
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
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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.