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Garcia A, Reljic T, Pogoda TK, Kenney K, Agyemang A, Troyanskaya M, Belanger HG, Wilde EA, Walker WC, Nakase-Richardson R. Obstructive Sleep Apnea Risk Is Associated with Cognitive Impairment after Controlling for Mild Traumatic Brain Injury History: A Chronic Effects of Neurotrauma Consortium Study. J Neurotrauma 2020; 37:2517-2527. [PMID: 32709212 PMCID: PMC7698980 DOI: 10.1089/neu.2019.6916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
The contribution of sleep disturbance to persistent cognitive symptoms following a mild traumatic brain injury (mTBI) remains unclear. Obstructive sleep apnea (OSA) is very common, yet its relationship between risk factors for developing OSA and cognitive performance in those with history of mTBI has not been investigated. The current study examined OSA risk levels and its association with cognitive performance in 391 combat-exposed, post-911 veterans and service members (median age = 37 years) enrolled in the Chronic Effects of Neurotrauma Consortium (CENC) prospective multi-center study. Participants included those with and without mTBI (n = 326 and 65, respectively). When using clinical cut-offs, those with history of mTBI were more likely to be categorized as high risk for OSA (mTBI positive = 65% vs. mTBI negative = 51%). After adjustment for TBI status and demographic variables, increased OSA risk was significantly associated with worse performance on measures of complex processing speed and executive functioning (Wechsler Adult Intelligence Scale Fourth Edition Coding, Trail Making Test, part B) and greater symptom burden (Neurobehavioral Symptom Inventory). Thus, OSA, a modifiable behavioral health factor, likely contributes to cognitive performance following mTBI. Accordingly, OSA serves as a potential point of intervention to improve clinical and cognitive outcomes after injury.
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Affiliation(s)
- Amanda Garcia
- Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Mental Health and Behavioral Sciences and Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
| | - Tea Reljic
- Morsani College of Medicine, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kimbra Kenney
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- Department of Neurology, Uniformed Services University, Bethesda, Maryland, USA
| | - Amma Agyemang
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Maya Troyanskaya
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Heather G. Belanger
- United States Special Operations Command, Tampa, Florida, USA
- Department of Psychology and Psychiatry and Behavioral Neurosciences, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
| | - Elisabeth A. Wilde
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
- George E. Wahlen VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
- Department of Neurology, TBI and Concussion Center, University of Utah, Salt Lake City, Utah, USA
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Risa Nakase-Richardson
- Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Mental Health and Behavioral Sciences and Defense and Veterans Brain Injury Center, James A. Haley VA Hospital, Tampa, Florida, USA
- Department of Internal Medicine, Sleep and Pulmonary Division, University of South Florida, Tampa, Florida, USA
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Gronewold J, Haensel R, Kleinschnitz C, Frohnhofen H, Hermann DM. Sleep-Disordered Breathing in Hospitalized Geriatric Patients with Mild Dementia and Its Association with Cognition, Emotion and Mobility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050863. [PMID: 30857293 PMCID: PMC6427687 DOI: 10.3390/ijerph16050863] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/18/2019] [Accepted: 03/05/2019] [Indexed: 01/10/2023]
Abstract
Sleep-disordered breathing (SDB) is an emerging dementia risk factor. Data on the prevalence of SDB in dementia patients and its association with cognitive impairment is so far only based on patients with severe dementia. In 101 geriatric patients mostly with mild dementia recruited on German geriatric wards, SDB was assessed during overnight polygraphy in the patient room with a portable sleep apnea examination device and associations of SDB severity with severity of impairment in cognitive and emotional function as well as mobility were investigated. We also elucidated which factors influence compliance of SDB diagnostics. In 82 of the 101 dementia patients (81.2%), SDB could be assessed. Of those, only 12.2% had an apnea-hypopnea index (AHI) < 5/h demonstrating the absence of SDB. 40.2% exhibited 5/h ≤ AHI < 15/h representing mild SDB, and 47.6% revealed an AHI ≥ 15/h representing moderate/severe SDB. Patients in these three AHI categories did not significant differ from each other in demographical and clinical characteristics. Patients with an AHI ≥ 15/h particularly often presented with heart failure and vitamin D deficiency. We observed a low to moderate association between severity of SDB and severity of dementia. Tolerance of the nasal airflow sensor of at least 6 h was present in less than one third of all patients. The tolerant group exhibited more symptoms of depression and higher physical fitness compared to the non-tolerant group. We observed a high prevalence of SDB also in geriatric patients with mild dementia underlining the importance of SDB screening in the elderly.
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Affiliation(s)
- Janine Gronewold
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
| | - Robert Haensel
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
- Department of Nephrology, Geriatric and Internal Medicine, Alfried Krupp Hospital Ruettenscheid-Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany.
| | - Christoph Kleinschnitz
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
| | - Helmut Frohnhofen
- Department of Nephrology, Geriatric and Internal Medicine, Alfried Krupp Hospital Ruettenscheid-Essen, Alfried-Krupp-Straße 21, 45131 Essen, Germany.
- Faculty of Health, Department of Medicine, University Witten-Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
| | - Dirk M Hermann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.
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Simpson R, Oyekan AA, Ehsan Z, Ingram DG. Obstructive sleep apnea in patients with Down syndrome: current perspectives. Nat Sci Sleep 2018; 10:287-293. [PMID: 30254502 PMCID: PMC6143127 DOI: 10.2147/nss.s154723] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
For individuals with Down syndrome (DS), obstructive sleep apnea (OSA) is a complex disorder with significant clinical consequences. OSA is seen frequently in DS, and when present, it tends to be more severe. This increased prevalence is likely related to common anatomic abnormalities and a greater risk of additional comorbidities such as hypotonia and obesity. Because signs and symptoms do not often correlate with disease, all children and adults with DS should receive routine screening for OSA. Similar to the general population, polysomnography remains the gold standard for diagnosis. Because individuals with DS may be more susceptible to cardiovascular and neurocognitive sequelae, early diagnosis and treatment of OSA is becoming increasingly important. Treatment options generally involve upper airway surgery (primarily adenotonsillectomy) and continuous positive airway pressure (CPAP); however, various adjunctive therapies including intranasal steroids, palatal expansion, and oropharyngeal exercises are also available. Residual disease status post adenotonsillectomy is common, and further evaluation (eg, drug-induced sleep endoscopy [DISE]) is often needed. More advanced and directed airway surgery can be performed if additional sites of obstruction are observed. Novel therapies including hypoglossal nerve stimulation are emerging as effective treatments for refractory OSA. Due to the diversity among individuals with DS, personalized treatment plans should be developed. Within this arena, opportunities for research remain abundant and should include areas involving patient risk factors, alternative diagnostic methods, and outcome analysis.
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Affiliation(s)
- Ryne Simpson
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA,
| | - Anthony A Oyekan
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA,
| | - Zarmina Ehsan
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA, .,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA,
| | - David G Ingram
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA, .,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA,
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Abstract
Key points Educational aims Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is characterised by repeated cycles of upper airway obstruction during sleep, leading to diurnal symptoms. Individuals with Down syndrome are predisposed to OSAHS due to overlap between the Down syndrome phenotype and OSAHS risk factors. Recent large studies using subjective and objective measures estimate that OSAHS affects around 40% of adults with Down syndrome, in contrast to 2–4% of the general adult population. The “double-hit” of comorbid Down syndrome and OSAHS may accelerate cognitive decline in adults with Down syndrome. However, with the appropriate care and support, OSAHS can be treated effectively in this group using continuous positive airway pressure (CPAP) therapy, improving daytime function and behaviour. Symptoms of OSAHS should be routinely monitored in this population, with testing and treatment available to all adults with Down syndrome; however, this is not currently commonplace, and health inequalities are evident. Obstructive sleep apnoea/hypopnoea syndrome affects ∼40% of adults with Down syndrome cut can be treated effectivelyhttp://ow.ly/Jdco3062xP5
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Affiliation(s)
- Elizabeth A Hill
- Dept of Paediatric Cardiac, Respiratory & Sleep Physiology, Royal Hospital for Sick Children, Edinburgh, UK; Sleep Research Unit, The University of Edinburgh, Edinburgh, UK
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Emamian F, Khazaie H, Tahmasian M, Leschziner GD, Morrell MJ, Hsiung GYR, Rosenzweig I, Sepehry AA. The Association Between Obstructive Sleep Apnea and Alzheimer's Disease: A Meta-Analysis Perspective. Front Aging Neurosci 2016. [PMID: 27148046 DOI: 10.3389/fnagi.2016.00078.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease (AD) and obstructive sleep apnea (OSA) are highly prevalent, chronic conditions with intriguing, yet poorly understood epidemiological overlap. To date, the amount of OSA syndrome present in patients with AD across literature remains unknown. To address this question, we collected all available published clinical data and analyzed them through a quantitative meta-analytical approach. The results of our quantitative meta-analysis suggest that the aggregate odds ratio for OSA in AD vs. healthy control was 5.05 and homogeneous. This reflects that patients with AD have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. Moreover, these data suggest that around half of patients with AD have experienced OSA at some point after their initial diagnosis. The additive impact of progressive changes in sleep quality and structure, changes in cerebral blood flow and the cellular redox status in OSA patients may all be contributing factors to cognitive decline and may further aggravate AD progression. It is hoped that the high OSA rate in AD patients, as suggested by the findings of our meta-analysis, might provide a sufficient clinical incentive to alert clinicians the importance of screening patients for OSA in AD, and stimulate further research in this area.
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Affiliation(s)
- Farnoosh Emamian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS)Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation SciencesTehran, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Guy D Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College and Imperial CollegeLondon, UK
| | - Mary J Morrell
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial CollegeLondon, UK
| | - Ging-Yuek R Hsiung
- Division of Neurology, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College and Imperial CollegeLondon, UK
| | - Amir A Sepehry
- Division of Neurology, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
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Emamian F, Khazaie H, Tahmasian M, Leschziner GD, Morrell MJ, Hsiung GYR, Rosenzweig I, Sepehry AA. The Association Between Obstructive Sleep Apnea and Alzheimer's Disease: A Meta-Analysis Perspective. Front Aging Neurosci 2016; 8:78. [PMID: 27148046 PMCID: PMC4828426 DOI: 10.3389/fnagi.2016.00078] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022] Open
Abstract
Alzheimer's disease (AD) and obstructive sleep apnea (OSA) are highly prevalent, chronic conditions with intriguing, yet poorly understood epidemiological overlap. To date, the amount of OSA syndrome present in patients with AD across literature remains unknown. To address this question, we collected all available published clinical data and analyzed them through a quantitative meta-analytical approach. The results of our quantitative meta-analysis suggest that the aggregate odds ratio for OSA in AD vs. healthy control was 5.05 and homogeneous. This reflects that patients with AD have a five times higher chance of presenting with OSA than cognitively non-impaired individuals of similar age. Moreover, these data suggest that around half of patients with AD have experienced OSA at some point after their initial diagnosis. The additive impact of progressive changes in sleep quality and structure, changes in cerebral blood flow and the cellular redox status in OSA patients may all be contributing factors to cognitive decline and may further aggravate AD progression. It is hoped that the high OSA rate in AD patients, as suggested by the findings of our meta-analysis, might provide a sufficient clinical incentive to alert clinicians the importance of screening patients for OSA in AD, and stimulate further research in this area.
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Affiliation(s)
- Farnoosh Emamian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS)Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation SciencesTehran, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS) Kermanshah, Iran
| | - Guy D Leschziner
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College and Imperial CollegeLondon, UK
| | - Mary J Morrell
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial CollegeLondon, UK
| | - Ging-Yuek R Hsiung
- Division of Neurology, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy's and St Thomas' HospitalLondon, UK; Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience (IOPPN), King's College and Imperial CollegeLondon, UK
| | - Amir A Sepehry
- Division of Neurology, Faculty of Medicine, University of British Columbia Vancouver, BC, Canada
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