Pathways between OSA and cognitive decline in older women and men: a longitudinal population-based study

摘要 大约有570万美国人患有痴呆症。老年痴呆症占大多数病例。 在美国，痴呆症的患病率和影响不断上升，加上缺乏有效的治疗方法来预防， 治愈或减缓痴呆症的进展，迫切需要确定可改变的风险因素。一 阻塞性睡眠呼吸暂停（OSA）这种高度未被诊断和后果性的睡眠障碍影响着 至少有24%的美国老年人虽然新的证据表明OSA与认知障碍有关， 痴呆的发病率，现有的报告没有充分检查潜在的关键混杂因素，以及 生物学相关的生物标志物，可能会影响这种关系。此外，很少有研究关注 气道正压通气治疗（PAP）对OSA发生风险的影响 痴呆研究人员最近的数据表明，老年痴呆症的发病率较低， 与非PAP使用者相比，接受PAP治疗的OSA医疗保险受益人。这表明 PAP对OSA影响的老年人痴呆风险的保护作用。调查人员的数据还显示， 在OSA治疗中显示出性别差异。女性对阿尔茨海默氏痴呆症和OSA的脆弱性 治疗不足进一步突出了OSA是否是阿尔茨海默氏痴呆症的危险因素的问题。 因此，本项目的总体目标是评估OSA和PAP对以下方面的纵向影响： 老年妇女和男子的认知结果，并解构未探索的途径之间 病理性睡眠和痴呆症。这将通过利用客观的认知，睡眠，健康， 以及每两年从健康和退休研究中收集的生物标志物数据。数据从该 具有全国代表性的多种族老年人纵向队列将与医疗保险协调一致 声称数据可以创建一个大型数据集，该数据集非常适合解决不可行的关键问题 以前瞻性的方式进行调查是昂贵的。这项研究的结果将为睡眠提供新的见解- 基于目标，以减少老年妇女和男子的认知发病率;为更有针对性的随机临床 试验;并促进努力确定最有可能从评估和治疗中受益的老年人， 睡眠障碍

ABSTRACT Approximately 5.7 million Americans have dementia. Alzheimer’s dementia accounts for the majority of cases. The rising prevalence and impact of dementia in the US, coupled with a lack of effective treatments to prevent, cure, or slow dementia progression, have galvanized an urgent need to identify modifiable risk factors. One may be obstructive sleep apnea (OSA). This highly underdiagnosed and consequential sleep disorder affects at least 24% of older Americans. Although emerging evidence has linked OSA to cognitive impairment and dementia incidence, existing reports have insufficiently examined potential key confounders as well as biologically relevant biomarkers that may influence this relationship. Furthermore, little research has focused on the effects of OSA treatment with positive airway pressure therapy (PAP) on risk for development of dementia. Recent data from the investigators demonstrate a lower incidence of Alzheimer’s dementia among Medicare beneficiaries with OSA who are treated with PAP, compared to non-PAP users. This suggests a protective role for PAP use on dementia risk in OSA-affected older adults. Data from the investigators also has shown sex disparities in OSA treatment. The vulnerability of women to both Alzheimer’s dementia and OSA under-treatment further highlights the question of whether OSA is a risk factor for Alzheimer’s dementia. Therefore, the overarching goal of this project is to assess the longitudinal impact of OSA and PAP on cognitive outcomes among older women and men, and to deconstruct unexplored pathways between pathological sleep and dementia. This will be accomplished by leveraging objective cognitive, sleep, health, and biomarker data that are collected biennially from the Health and Retirement Study. Data from this nationally representative, multi-ethnic longitudinal cohort of older adults will be harmonized with Medicare claims data to create a large dataset uniquely suited to address critical questions that would be unfeasibly expensive to investigate in a prospective manner. Findings from this study will provide new insight into sleep- based targets to reduce cognitive morbidity of older women and men; inform more targeted randomized clinical trials; and foster efforts to identify older individuals most likely to benefit from evaluation and treatment for sleep disorders.