Effect of continuous positive airway pressure on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease combined with obstructive sleep apnea hypopnea syndrome_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Dongjie ¹ , HUO Jianmin ¹ , SANG Yulan ¹ , LUO Wen ¹ , XU Ziping ¹ , JIA Li ¹ ,  YANG Fan ²

1. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P. R. China;
2. Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P. R. China;

Corresponding author：

YANG Fan, Email: yangfan42001@163.com

Keywords：

Alzheimer’s disease; Obstructive sleep apnea hypopnea syndrome; Continuous positive airway pressure; Neuropsychology

DOI：

10.7507/1671-6205.202106068

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Objective To investigate the effect of continuous positive airway pressure (CPAP) on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease (AD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of forty-two early AD patients with OSAHS were randomly divided into a CPAP combined treatment group (20 cases) and a simple medicine treatment group (22 cases). The changes of neurocognitive function were assessed by Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE) and Hopkins Verbal Learning Test-revised (HVLT). Patient Health Questionnaire-9 (PHQ9) was used to evaluate the depression mood changes. The sleep characteristics and respiratory parameters were evaluated by polysomnography. The changes of the patients’ sleep status were assessed by Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). The changes of sleep status, cognitive function and mood in the CPAP combined treatment group were compared before and three months after CPAP treatment, and with the simple medicine treatment group. Results After three months of CPAP treatment, the ESS, PSQI and PHQ9 scores in the CPAP combined treatment group were significantly decreased compared with those before treatment, whereas MoCA, MMSE and HVLT (total scores and recall ) in the CPAP combined treatment group were increased compared with those before treatment (P<0.05). After CPAP treatment, the respiratory parameters apnea hypopnea index in the CPAP combined treatment group was significantly lower than that before treatment (P<0.05), and the minimum blood oxygen saturation was significantly higher than that before treatment (P<0.05). However, the sleep characteristics and parameters did not show statistically significant changes compared with those before treatment (P>0.05). The ESS, PSQI and PHQ9 scores were significantly reduced in the CPAP combined treatment group compared with the simple medicine treatment group (P<0.05), while there was no statistically significant changes of cognitive scores between the two groups (P>0.05). Conclusions The degree of low ventilation and hypoxia is alleviated, and the daytime sleepiness and depression is improved in early AD patients with OSAHS after three-month continuous CPAP treatment. Cognitive function is significantly improved, whereas there is no significant change in sleep structure disorder.

Citation： WANG Dongjie, HUO Jianmin, SANG Yulan, LUO Wen, XU Ziping, JIA Li, YANG Fan. Effect of continuous positive airway pressure on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease combined with obstructive sleep apnea hypopnea syndrome. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(11): 784-788. doi: 10.7507/1671-6205.202106068 Copy

1.	Ballard C, Gauthier S, Corbett A, et al. Alzheimer’s disease. Lancet, 2011, 377: 1019-1031.
2.	Joe E, Ringman JM. Cognitive symptoms of Alzheimer’s disease: clinical management and prevention. BMJ, 2019, 367: I6217.
3.	Sivathamboo S, Perucca P, Velakoulis D, et al. Sleep disordered breathing in epilepsy: epidemiology, mechanisms and treatment. Sleep, 2018, 41(4): 1-15.
4.	中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南. 中华医学杂志, 2018, 98(24): 1902-1914.
5.	Siachpazidou DI, Stavrou VT, Astara K, et al. Alzheimer’s disease in patients with obstructive sleep apnea syndrome. Tanaffos, 2020, 19(3): 176-185.
6.	Joseph S, Zuriqat M, Husari A. Sustained improvement in cognitive and emotional status of apneic patients after prolonged treatment with positive airway pressure. South Med J, 2009, 102(6): 589-594.
7.	Dubois B, Feldman H H, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurology, 2007, 6(8): 734-746.
8.	中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.
9.	Ju YES, Finn MB, Sutphen CL, et al. Obstructive sleep apnea decreases central nervous system-derived proteins in the cerebrospinal fluid. Ann Neurol, 2016, 80(1): 154-159.
10.	Liguori C, Agostino Chiaravalloti A, Izzi F, et al. Sleep apnoeas may represent a reversible risk factor for amyloid-β pathology. Brain, 2017, 140(12): e75.
11.	Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res, 2015, 93(12): 1778-1794.
12.	Xie LL, Kang HY, Xu QW, et al. Sleep drives metabolite clearance from the adult brain. Science, 2013, 342(6156): 373-377.
13.	张立芳, 李博, 刘煜, 等. 一夜持续正压呼吸道通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构的影响. 医学综述, 2013, 19(8): 1496-1498.
14.	Bero AW, Bauer AQ, Stewart FR, et al. Bidirectional relationship between functional connectivity and amyloid-β deposition in mouse brain. J Neurosci, 2012, 32(13): 4334.
15.	White KG, Ruske AC. Memory deficits in Alzheimer's disease: the encoding hypothesis and cholinergic function. Psychon Bull Rev, 2002, 9(3): 426-437.
16.	Richards KC, Gooneratne N, Barry Dicicco B, et al. CPAP adherence may slow 1-year cognitive decline in older adults with mild cognitive impairment and apnea. J Am Geriatr Soc, 2019, 67(3): 558-564.
17.	Berlowitz DJ, Shafazand S. CPAP and cognition OSA (APPLES). J Clin Sleep Med, 2013, 9(5): 515-516.
18.	Kahya M, Vidoni E, Burns JM, et al. The relationship between apolipoprotein ε4 carrier status and sleep characteristics in cognitively normal older adults. J Geriatr Psychiatry Neurol, 2017, 30(5): 273-279.

1. Ballard C, Gauthier S, Corbett A, et al. Alzheimer’s disease. Lancet, 2011, 377: 1019-1031.
2. Joe E, Ringman JM. Cognitive symptoms of Alzheimer’s disease: clinical management and prevention. BMJ, 2019, 367: I6217.
3. Sivathamboo S, Perucca P, Velakoulis D, et al. Sleep disordered breathing in epilepsy: epidemiology, mechanisms and treatment. Sleep, 2018, 41(4): 1-15.
4. 中国医师协会睡眠医学专业委员会. 成人阻塞性睡眠呼吸暂停多学科诊疗指南. 中华医学杂志, 2018, 98(24): 1902-1914.
5. Siachpazidou DI, Stavrou VT, Astara K, et al. Alzheimer’s disease in patients with obstructive sleep apnea syndrome. Tanaffos, 2020, 19(3): 176-185.
6. Joseph S, Zuriqat M, Husari A. Sustained improvement in cognitive and emotional status of apneic patients after prolonged treatment with positive airway pressure. South Med J, 2009, 102(6): 589-594.
7. Dubois B, Feldman H H, Jacova C, et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurology, 2007, 6(8): 734-746.
8. 中华医学会呼吸病学分会睡眠呼吸障碍学组. 阻塞性睡眠呼吸暂停低通气综合征诊治指南(2011修订版). 中华结核和呼吸杂志, 2012, 35(1): 9-12.
9. Ju YES, Finn MB, Sutphen CL, et al. Obstructive sleep apnea decreases central nervous system-derived proteins in the cerebrospinal fluid. Ann Neurol, 2016, 80(1): 154-159.
10. Liguori C, Agostino Chiaravalloti A, Izzi F, et al. Sleep apnoeas may represent a reversible risk factor for amyloid-β pathology. Brain, 2017, 140(12): e75.
11. Daulatzai MA. Evidence of neurodegeneration in obstructive sleep apnea: relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. J Neurosci Res, 2015, 93(12): 1778-1794.
12. Xie LL, Kang HY, Xu QW, et al. Sleep drives metabolite clearance from the adult brain. Science, 2013, 342(6156): 373-377.
13. 张立芳, 李博, 刘煜, 等. 一夜持续正压呼吸道通气治疗对阻塞性睡眠呼吸暂停低通气综合征患者睡眠结构的影响. 医学综述, 2013, 19(8): 1496-1498.
14. Bero AW, Bauer AQ, Stewart FR, et al. Bidirectional relationship between functional connectivity and amyloid-β deposition in mouse brain. J Neurosci, 2012, 32(13): 4334.
15. White KG, Ruske AC. Memory deficits in Alzheimer's disease: the encoding hypothesis and cholinergic function. Psychon Bull Rev, 2002, 9(3): 426-437.
16. Richards KC, Gooneratne N, Barry Dicicco B, et al. CPAP adherence may slow 1-year cognitive decline in older adults with mild cognitive impairment and apnea. J Am Geriatr Soc, 2019, 67(3): 558-564.
17. Berlowitz DJ, Shafazand S. CPAP and cognition OSA (APPLES). J Clin Sleep Med, 2013, 9(5): 515-516.
18. Kahya M, Vidoni E, Burns JM, et al. The relationship between apolipoprotein ε4 carrier status and sleep characteristics in cognitively normal older adults. J Geriatr Psychiatry Neurol, 2017, 30(5): 273-279.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of continuous positive airway pressure on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease combined with obstructive sleep apnea hypopnea syndrome

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