Obstructive Sleep Apnea and Cognition in Parkinson's disease

Alexandrea L Harmell; Ariel B Neikrug; Barton W Palmer; Julie A Avanzino; Lianqi Liu; Jeanne E Maglione; Loki Natarajan; Jody Corey-Bloom; Jose S Loredo; Sonia Ancoli-Israel

doi:10.1016/j.sleep.2016.01.001

Obstructive Sleep Apnea and Cognition in Parkinson's disease

Sleep Med. 2016 May:21:28-34. doi: 10.1016/j.sleep.2016.01.001. Epub 2016 Feb 10.

Authors

Affiliations

¹ Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA.
² Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.
³ Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA.
⁴ Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA.
⁵ Department of Psychiatry, University of California, San Diego, CA, USA.
⁶ Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA.
⁷ Department of Family and Preventative Medicine, University of California, San Diego, CA, USA.
⁸ Department of Neurosciences, University of California, San Diego, CA, USA.
⁹ Veterans Administration Healthcare System, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA.
¹⁰ Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Department of Medicine, University of California, San Diego, CA, USA. Electronic address: sancoliisrael@ucsd.edu.

Abstract

Objective: Obstructive sleep apnea (OSA) is very common in Parkinson's disease (PD). OSA is known to affect patients' cognition. The present study assessed whether PD patients with OSA (PD + OSA) score lower on cognitive measures than those without OSA (PD - OSA). In addition, this study evaluated whether treating the OSA with continuous positive airway pressure (CPAP) in PD + OSA patients results in an improved cognitive functioning.

Methods: Eighty-six patients with PD underwent an overnight polysomnography screen for OSA and were administered the Mini-Mental Status Exam (MMSE) and the Montreal Cognitive Assessment (MoCA). This resulted in 38 patients with PD + OSA who were randomly assigned to receive either therapeutic CPAP for 6 weeks (n = 19) or placebo CPAP for three weeks followed by therapeutic CPAP for three weeks (n = 19). Intervention participants completed a neurocognitive battery at baseline and 3- and 6-week time-points.

Results: Patients with PD + OSA scored significantly lower than PD - OSA on the MMSE and MoCA after controlling for age, education, and PD severity. OSA was a significant predictor of cognition (MMSE p <0.01; MoCA p = 0.028).There were no significant changes between groups in cognition when comparing three weeks of therapeutic CPAP with 3 weeks of placebo CPAP. Comparisons between pre-treatment and 3-week post-therapeutic CPAP for the entire sample also revealed no significant changes on overall neuropsychological (NP) scores.

Conclusions: Findings suggest that PD patients with OSA show worse cognitive functioning on cognitive screening measures than those without OSA. However, OSA treatment after three or six weeks of CPAP may not result in overall cognitive improvement in patients with PD.

Trial registration: ClinicalTrials.gov NCT00492115.

Keywords: Cognition; Continuous positive airway pressure; Intervention; Neuropsychology; Obstructive sleep apnea; Parkinson's disease.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Cognition*
Continuous Positive Airway Pressure / methods
Female
Humans
Male
Neuropsychological Tests / statistics & numerical data
Parkinson Disease / complications*
Polysomnography
Sleep Apnea, Obstructive / psychology
Sleep Apnea, Obstructive / therapy*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT00492115

Abstract

Publication types

MeSH terms

Associated data

Grants and funding