Treating sleep apnea in Parkinson's disease with C-PAP: feasibility concerns and effects on cognition and alertness

Michele Terzaghi; Laura Spelta; Brigida Minafra; Valter Rustioni; Roberta Zangaglia; Claudio Pacchetti; Raffaele Manni

doi:10.1016/j.sleep.2017.01.009

Treating sleep apnea in Parkinson's disease with C-PAP: feasibility concerns and effects on cognition and alertness

Sleep Med. 2017 May:33:114-118. doi: 10.1016/j.sleep.2017.01.009. Epub 2017 Jan 27.

Authors

Michele Terzaghi¹, Laura Spelta², Brigida Minafra³, Valter Rustioni², Roberta Zangaglia³, Claudio Pacchetti³, Raffaele Manni²

Affiliations

¹ Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy. Electronic address: michele.terzaghi@mondino.it.
² Unit of Sleep Medicine and Epilepsy, C. Mondino National Neurological Institute, Pavia, Italy.
³ Parkinson's Disease and Movement Disorders Unit, C. Mondino National Neurological Institute, Pavia, Italy.

PMID: 28449889
DOI: 10.1016/j.sleep.2017.01.009

Abstract

Background: Obstructive sleep apnea (OSA) is highly prevalent in Parkinson disease (PD) and is known to contribute to cognitive impairment and daytime sleepiness. We investigated feasibility of continuous positive airway pressure treatment (CPAP) and its effects on subjective daytime sleepiness and cognitive profile in PD plus OSA subjects in a longitudinal three months follow up study.

Methods: Seventy (age 71.7 ± 7.6, disease duration 9.9 ± 12.3, UPDRS-III 33.7 ± 12.5, MMSE 25.3 ± 3.6; years of education 7.7 ± 3.2) out of 228 consecutive PD patients undergoing in-lab video-polysomnography were found to have obstructive sleep apnea. Thirty-six subjects accepted to titrate therapeutic CPAP. Video-polysomnography, neuropsychological battery evaluating different cognitive domains and subjective scales for daytime sleepiness were scheduled at baseline and after three months. All the patients were given educational informations relative to diagnosis of OSA and benefits of OSA treatment, and an individualized training with CPAP.

Results: Twenty-seven (75%) subjects dropped out of the study due to CPAP intolerance. No demographic or disease-related variables (in particular, severity of OSA), could be found between subjects who completed the study versus those who dropped out. Nine subjects completed the three-month follow up, and there were no significant changes in subjective sleepiness, neuropsychological scores and sleep structure (except for reduction in apnea/hypopnea index and a trend toward increase in stage N3 sleep).

Conclusion: Our data show that feasibility of CPAP treatment can be significantly threatened by overall attrition rates. Further studies should consider well-structured adherence promoting interventions. The actual role of OSA as a determinant of the profile of subjective daytime sleepiness and cognition in PD, and the effects of CPAP in PD need to be further studied.

Keywords: Cognition; Continuous positive airway pressure; Parkinson's disease; Sleep apnea; Sleepiness.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Attention / physiology*
Cognition / physiology*
Cognitive Dysfunction / complications*
Cognitive Dysfunction / epidemiology
Cognitive Dysfunction / physiopathology
Continuous Positive Airway Pressure / methods*
Feasibility Studies*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neuropsychological Tests / standards
Parkinson Disease / complications*
Parkinson Disease / epidemiology
Parkinson Disease / therapy
Patient Compliance
Polysomnography / methods
Sleep Apnea Syndromes / complications
Sleep Apnea Syndromes / physiopathology
Sleep Apnea Syndromes / therapy*
Sleep Apnea, Obstructive / complications
Sleep Apnea, Obstructive / epidemiology
Sleep Apnea, Obstructive / physiopathology
Sleep Apnea, Obstructive / therapy*
Sleep Stages / physiology
Treatment Outcome