A recent study published in SLEEP Advances has revealed that obstructive sleep apnea (OSA) significantly raises the risk of dementia, particularly among older women. This underscores the urgent need for targeted interventions to improve sleep health and cognitive care for this vulnerable population.
Dementia, characterized by a progressive decline in cognitive function and behavioral changes due to neurodegenerative diseases, currently affects approximately seven million Americans. Given its prevalence, identifying modifiable risk factors is crucial for developing effective interventions. Research indicates that women are more likely to develop dementia than men, highlighting the importance of understanding the environmental and health-related factors that may contribute to this disparity.
Obstructive sleep apnea is defined by episodes of blocked breathing during sleep, leading to disrupted sleep and reduced oxygen levels. With its prevalence increasing with age, OSA is recognized as a significant risk factor for dementia. However, there is a need for more extensive, sex-specific studies to explore this relationship over time.
The study analyzed data from 18,815 American men and women aged 50 and older who participated in the Health and Retirement Study (HRS). The average age of participants was 60 for men and 61 for women, all of whom were free of dementia at the study’s outset. Researchers employed a validated algorithm to identify new dementia cases based on objective cognitive assessments.
Participants were classified as having known OSA if they reported a prior diagnosis. Given that approximately 80% of individuals with OSA remain undiagnosed, the study also utilized the STOP-Bang screening tool to identify suspected cases of OSA.
Over the ten-year study period, dementia was reported in 9% of women and 8% of men, with 48% of participants having known or suspected OSA. Notably, OSA was more prevalent in men (68%) compared to women (31%). Additionally, individuals with OSA tended to have lower educational attainment than those without the condition.
Among participants with a prior OSA diagnosis, 29% of men and 30% of women screened positive for OSA, while 10% of men and 7% of women had a diagnosis but screened negative.
The study found that the presence of OSA was associated with an increased risk of dementia for individuals aged 60 to 84. By age 80, women with OSA exhibited a 4-7% higher cumulative incidence of dementia compared to their non-OSA peers, while men showed a 2.5% increase. The risk for women continued to rise with age, whereas men’s risk stabilized after an initial increase.
The population-attributable risk percentage (PAR%) indicated that OSA accounted for 10.3% of dementia cases in women and 13.2% in men, reflecting a greater risk associated with OSA in men. Even after adjusting for age, the risk of dementia remained significantly higher for individuals with OSA compared to those without.
OSA may contribute to the progression of Alzheimer’s disease and cognitive decline through mechanisms such as the accumulation of tau and amyloid β42 proteins. Sleep disruption associated with OSA can lead to chronic inflammation, impairing microglial function and increasing the risk of atherosclerosis, which is linked to brain shrinkage in Alzheimer’s disease.
Women with OSA are more likely to experience reduced quality of life, poor sleep, fatigue, depression, and cardiovascular disease, all of which can exacerbate cognitive decline. The risk of OSA tends to increase after menopause, with later onset of menopause associated with a lower risk of dementia.
Conclusion
This longitudinal study highlights the significant relationship between obstructive sleep apnea and dementia risk in older adults, emphasizing that women face a higher risk than men. The findings call for greater awareness and treatment of OSA as a modifiable risk factor for dementia.
Previous research has suggested that positive airway pressure (PAP) therapy may help protect OSA patients from mild cognitive impairment and the progression of Alzheimer’s disease. Future studies with larger, more diverse populations and improved methodologies are necessary to further explore the evolving relationship between OSA and dementia, as well as to identify factors that could lead to targeted interventions for older adults at risk.
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