TY - JOUR
T1 - The Link between Obstructive Sleep Apnea and Neurocognitive Impairment An Official American Thoracic Society Workshop Report
AU - American Thoracic Society Assembly on Sleep and Respiratory Neurobiology
AU - Lal, Chitra
AU - Varga, Andrew W.
AU - Ayappa, Indu
AU - Ayas, Najib
AU - Beaudin, Andrew E.
AU - Hoyos, Camilla
AU - Kaminska, Marta
AU - Kushida, Clete A.
AU - Mullins, Anna
AU - Naismith, Sharon L.
AU - Osorio, Ricardo S.
AU - Parekh, Ankit
AU - Phillips, Craig L.
AU - Stone, Katie L.
AU - Turner, Arlener D.
N1 - Funding Information:
consultant and speaker for Chest/ GlaxoSmithKline and Jazz Pharmaceuticals; served on a data safety and monitoring board for Jazz Pharmaceuticals; received research support from NIH Sleep smart, NIH LOFT HF study. I.A. served as a grant reviewer for AASM Foundation; received royalties from Fisher & Paykel for patent on CPAP algorithm; received research support from Fisher & Paykel. N.A. received research support from Signifier Medical. C.H. received research support from Advance Brain Monitoring, Fisher & Paykel, Sante Group. C.A.K. served as a consultant for Merck Sharp & Dohme and M^3 Public Benefit Corporation; served as a speaker for Itamar Medical and ResMed; holds stock options for M^3 Public Benefit Corp, Restful Robotics, Vivos Therapeutics. M.K. served on an advisory committee for Biron Soins du Sommeil; received research support from Fisher & Paykel, Philips, Signifier, VitalAire. S.L.N. served as a consultant for Brain Protection Company and University of Sunshine Coast; served as a speaker for AASBI, Nutricia, Roche; served on a data safety and monitoring board for Alzheimer’s Australia Research Foundation; serves in a leadership role for Australian Dementia Network; received research support from NHMRC, MRFF, US Alzheimer’s Drug Discovery Foundation, St Vincent’s Clinic Foundation, Cardiovascular Research Capacity Grants. A.P. served as a speaker for Health Advances; received research support from Itamar Medical. K.L.S. received research support from Merck. A.D.T. received research support from National Institute on Aging, National Institutes of Health. A.E.B., A.M., R.S.O., C.L.P., and A.W.V. reported no commercial or relevant non-commercial interests from ineligible companies.
Publisher Copyright:
Copyright © 2022 by the American Thoracic Society.
PY - 2022/8
Y1 - 2022/8
N2 - There is emerging evidence that obstructive sleep apnea (OSA) is a risk factor for preclinical Alzheimer’s disease (AD). An American Thoracic Society workshop was convened that included clinicians, basic scientists, and epidemiologists with expertise in OSA, cognition, and dementia, with the overall objectives of summarizing the state of knowledge in the field, identifying important research gaps, and identifying potential directions for future research. Although currently available cognitive screening tests may allow for identification of cognitive impairment in patients with OSA, they should be interpreted with caution. Neuroimaging in OSA can provide surrogate measures of disease chronicity, but it has methodological limitations. Most data on the impact of OSA treatment on cognition are for continuous positive airway pressure (CPAP), with limited data for other treatments. The cognitive domains improving with CPAP show considerable heterogeneity across studies. OSA can negatively influence risk, manifestations, and possibly progression of AD and other forms of dementia. Sleep-dependent memory tasks need greater incorporation into OSA testing, with better delineation of sleep fragmentation versus intermittent hypoxia effects. Plasma biomarkers may prove to be sensitive, feasible, and scalable biomarkers for use in clinical trials. There is strong biological plausibility, but insufficient data, to prove bidirectional causality of the associations between OSA and aging pathology. Engaging, recruiting, and retaining diverse populations in health care and research may help to decrease racial and ethnic disparities in OSA and AD. Key recommendations from the workshop include research aimed at underlying mechanisms; longer-term longitudinal studies with objective assessment of OSA, sensitive cognitive markers, and sleep-dependent cognitive tasks; and pragmatic study designs for interventional studies that control for other factors that may impact cognitive outcomes and use novel biomarkers.
AB - There is emerging evidence that obstructive sleep apnea (OSA) is a risk factor for preclinical Alzheimer’s disease (AD). An American Thoracic Society workshop was convened that included clinicians, basic scientists, and epidemiologists with expertise in OSA, cognition, and dementia, with the overall objectives of summarizing the state of knowledge in the field, identifying important research gaps, and identifying potential directions for future research. Although currently available cognitive screening tests may allow for identification of cognitive impairment in patients with OSA, they should be interpreted with caution. Neuroimaging in OSA can provide surrogate measures of disease chronicity, but it has methodological limitations. Most data on the impact of OSA treatment on cognition are for continuous positive airway pressure (CPAP), with limited data for other treatments. The cognitive domains improving with CPAP show considerable heterogeneity across studies. OSA can negatively influence risk, manifestations, and possibly progression of AD and other forms of dementia. Sleep-dependent memory tasks need greater incorporation into OSA testing, with better delineation of sleep fragmentation versus intermittent hypoxia effects. Plasma biomarkers may prove to be sensitive, feasible, and scalable biomarkers for use in clinical trials. There is strong biological plausibility, but insufficient data, to prove bidirectional causality of the associations between OSA and aging pathology. Engaging, recruiting, and retaining diverse populations in health care and research may help to decrease racial and ethnic disparities in OSA and AD. Key recommendations from the workshop include research aimed at underlying mechanisms; longer-term longitudinal studies with objective assessment of OSA, sensitive cognitive markers, and sleep-dependent cognitive tasks; and pragmatic study designs for interventional studies that control for other factors that may impact cognitive outcomes and use novel biomarkers.
KW - Alzheimer’s disease
KW - neurocognitive dysfunction
KW - obstructive sleep apnea
UR - http://www.scopus.com/inward/record.url?scp=85135501931&partnerID=8YFLogxK
U2 - 10.1513/AnnalsATS.202205-380ST
DO - 10.1513/AnnalsATS.202205-380ST
M3 - Article
C2 - 35913462
AN - SCOPUS:85135501931
SN - 2325-6621
VL - 19
SP - 1245
EP - 1256
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 8
ER -