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Obstructive sleep apnea is associated with early but possibly modifiable Alzheimer's Disease changes.

Research paper by Claudio C Liguori, Nicola Biagio NB Mercuri, Francesca F Izzi, Andrea A Romigi, Alberto A Cordella, Giuseppe G Sancesario, Fabio F Placidi

Indexed on: 23 Mar '17Published on: 23 Mar '17Published in: Sleep



Abstract

Obstructive sleep apnea (OSA) is a common sleep disorder. Actually, literature lacks studies examining sleep, cognition, and Alzheimer's Disease (AD) cerebrospinal-fluid biomarkers in OSA patients. Therefore, we firstly studied cognitive performances, polysomnographic sleep, and CSF β-amyloid, tau proteins and lactate levels in patients affected by subjective cognitive impairment (SCI) divided in three groups: OSA patients (showing an Apnea-Hypopnea Index - AHI ≥15/h), controls (showing an AHI<15/h), and patients treating OSA by continuous positive airway pressure (CPAP).We compared results among 25 OSA, 10 OSA-CPAP and 15 controls, who underwent a protocol counting neuropsychological testing in the morning, 48-hour polysomnograhy followed by CSF analysis.OSA patients showed lower CSF Aβ42, higher CSF lactate levels, and higher t-tau/Aβ42 ratio compared to controls and OSA-CPAP patients. OSA patients also showed reduced sleep quality and continuity, and lower performances at memory, intelligence and executive tests than controls and OSA-CPAP patients. We found significant relationships among higher CSF tau proteins levels, sleep impairment and increased CSF lactate levels in the OSA group. Moreover, lower CSF Aβ42 levels correlate with memory impairment and nocturnal oxygen saturation parameters in OSA patients.We hypothesize that OSA reducing sleep quality and producing intermittent hypoxia lowers CSF Aβ42 levels, increases CSF lactate levels, and alters cognitive performances in SCI patients, thus inducing early AD clinical and neuropathological biomarker changes. Notably, controls as well as OSA-CPAP SCI patients did not show clinical and biochemical AD markers. Therefore, OSA may induce early but possibly CPAP-modifiable AD biomarkers changes.