Cognitive Effects of Treating Obstructive Sleep Apnea in Alzheimer's Disease: A Randomized Controlled Study

Authors

  • Sonia Ancoli-Israel PhD,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Barton W. Palmer PhD,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Jana R. Cooke MD,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Jody Corey-Bloom MD, PhD,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Lavinia Fiorentino PhD,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Loki Natarajan PhD,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Lianqi Liu MD,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Liat Ayalon PhD,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Feng He MS,

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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  • Jose S. Loredo MD

    1. From the Departments of *Psychiatry, Medicine, §Neurosciences, and #Family and Preventative Medicine, University of California, San Diego, La Jolla, CaliforniaVeterans Affairs San Diego Healthcare System, San Diego, CaliforniaSan Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California.
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Address correspondence to Sonia Ancoli-Israel, PhD, Department of Psychiatry 0603. 9500 Gilman Drive, University of California San Diego, La Jolla, CA 92093-0603. E-mail: sancoliisrael@ucsd.edu

Abstract

OBJECTIVES: To examine whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) in patients with Alzheimer's disease (AD) results in better cognitive function.

DESIGN: Randomized double-blind placebo-controlled trial. Participants were randomized to therapeutic CPAP for 6 weeks or placebo CPAP for 3 weeks followed by therapeutic CPAP for 3 weeks.

SETTING: General clinical research center.

PARTICIPANTS: Fifty-two men and women with mild to moderate AD and OSA.

INTERVENTION: CPAP.

MEASUREMENTS: A complete neuropsychological test battery was administered before treatment and at 3 and at 6 weeks.

RESULTS: A comparison of subjects randomized to 3 weeks of therapeutic versus placebo CPAP suggested no significant improvements in cognition. A comparison of pre- and posttreatment neuropsychological test scores after 3 weeks of therapeutic CPAP in both groups showed a significant improvement in cognition. The study was underpowered to make definitive statements about improvements within specific cognitive constructs, although exploratory post hoc examination of change scores for individual tests suggested improvements in episodic verbal learning and memory and some aspects of executive functioning such as cognitive flexibility and mental processing speed.

CONCLUSION: OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in patients with AD. OSA treatment seems to improve some cognitive functioning. Clinicians who care for patients with AD should consider implementing CPAP treatment when OSA is present.

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