Sleep apnea treatment and risk for cognitive decline and Alzheimers disease

睡眠呼吸暂停治疗与认知能力下降和阿尔茨海默病的风险

• 批准号: 10525760
• 负责人: Christopher Norfleet Kaufmann
• 金额: $ 63.4万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10525760
• 关键词: Address; Adherence; African American population; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Attention; Cardiovascular Diseases; Caucasians; Clinical; Clinical Trials; Cognition; Cognitive; Cohort Studies; Continuous Positive Airway Pressure; Data; Data Set; Dementia; Diagnosis; Disease; Elderly; Ethnic Origin; Exhibits; Female; Funding; Gender; Health; Health and Retirement Study; Impaired cognition; Individual; Investigational Therapies; Link; Measures; Medicare claim; Methods; Minority; Observational Study; Obstructive Sleep Apnea; Outcome; Participant; Performance; Persons; Population; Prevalence; Prevention; Preventive measure; Program Development; Race; Resources; Risk; Risk Factors; Risk Reduction; Running; Sampling; Sleep Apnea Syndromes; Subgroup; Time; Visuospatial; Vulnerable Populations; Woman; administrative database; age group; base; cardiovascular risk factor; cognitive development; cognitive function; cognitive performance; cognitive testing; cohort; data harmonization; dementia risk; disorder risk; effective therapy; ethnic minority; follow-up; health equity; high risk; high risk population; improved; innovation; men; performance tests; physical inactivity; preservation; prevent; processing speed; protective effect; racial and ethnic; tool; treatment disparity; treatment risk; trend

ABSTRACT The prevalence of Alzheimer’s disease and related dementias (ADRD) is expected to increase four-fold by 2050. Consequently, there are efforts to identify “actionable” risk factors, that if identified and addressed early, have the potential to prevent cognitive decline and onset of ADRD. Obstructive sleep apnea (OSA) is associated with risk of cognitive decline and ADRD, particularly among older adults. As effective treatments are available for the condition (e.g., Continuous Positive Airway Pressure [CPAP]) that are demonstrated to be highly efficacious when used adherently, OSA may be an ideal target for ADRD risk reduction. In this study, we propose to characterize associations between OSA treatment (specifically CPAP) and cognitive decline and ADRD over up to 14 years of follow-up (2010-2024) in two nationally representative NIA-funded cohorts of U.S. older adults: the Health and Retirement Study (HRS), and National Health and Aging Trends Study (NHATS). We also intend to determine whether the effects of OSA treatment on cognition differ in those at higher risk for ADRD (e.g., minority race/ethnicity, advanced age, cardiovascular risk factors/disease, etc.) in order to identify populations among whom treatment is most likely to yield effects and ways OSA treatments could be optimized in groups not benefiting. Both HRS and NHATS include nationally representative samples, have repeated performance- based cognitive measures to characterize cognitive performance trajectories and ADRD, and linkages to Medicare claims for ascertainment of OSA diagnosis and treatment. The study will use innovative methods to harmonize datasets and will address three specific aims. Aim 1 will be to determine the association of OSA with cognitive trajectories and incident ADRD from 2010-2024, and examine whether OSA interacts with other ADRD risk factors with regard to cognitive decline and ADRD risk. Aim 2 will be to determine, among individuals with OSA, whether CPAP is associated with better cognitive outcomes from 2010-2024. Specifically, we will examine whether a) receipt of CPAP (compared to no treatment) is associated with slower cognitive decline and lower risk for ADRD, b) among those treated whether initiation of CPAP is associated with a slowing of cognitive decline and lower risk for ADRD before and after initiation, and c) whether these associations vary across levels of CPAP adherence. Finally, Aim 3 will examine whether associations found in Aim 2 will differ across known ADRD risk factors. If we find that addressing OSA is particularly effective in slowing cognitive decline/preventing ADRD, especially in high-risk groups, then our study’s results will help us understand the means by which OSA can be treated in the population and contribute to development of programs to treat OSA in these populations at greatest risk. Further, it will inform efforts to curb the burden of ADRD in the U.S. and contribute substantially to dementia prevention efforts.

抽象的 到2050年，阿尔茨海默氏病和相关痴呆症（ADRD）的患病率预计将增加四倍。 因此，有一些努力来确定“可行的”风险因素，如果早点确定和解决， 预防ADRD认知能力下降和发作的潜力。阻塞性睡眠呼吸暂停（OSA）与 认知能力下降和ADRD的风险，尤其是在老年人中。因为有效治疗可用于 条件（例如，连续的正气道压力[CPAP]）被证明高效 当使用更好时，OSA可能是降低ADRD风险的理想目标。在这项研究中，我们建议 表征OSA治疗（特别是CPAP）与认知能力下降与ADRD之间的关联 到14年的随访（2010-2024），在全国两名代表NIA资助的美国老年人中： 健康与退休研究（HRS）以及国家健康与老化趋势研究（NHATS）。我们也打算 确定OSA治疗对ADRD风险较高的认知的影响是否不同（例如， 少数民族种族/民族，高年龄，心血管危险因素/疾病等）以确定人口 其中最有可能产生效果的治疗方法，以及可以分组优化OSA治疗的方法 没有受益。 HRS和NHAT都包括全国代表性样本，都重复了性能 - 基于认知性能轨迹和ADRD的基于认知措施，并与 Medicare确定OSA诊断和治疗的主张。该研究将使用创新方法 协调数据集并将解决三个特定目标。目标1将是确定OSA与 从2010 - 2024年开始认知轨迹和事件ADRD，并检查OSA是否与其他ADRD相互作用 关于认知能力下降和ADRD风险的风险因素。目标2将是确定有 OSA，CPAP是否与2010年至2024年更好的认知结果相关。具体来说，我们将检查 a）CPAP的收到（与没有治疗相比）是否与认知能力较慢和较低有关 ADRD的风险，b）在接受CPAP主动性的治疗的人中 并在主动行动前后降低ADRD的风险，c）这些关联是否在CPAP级别上有所不同 坚持。最后，AIM 3将检查AIM 2中发现的关联是否会在已知的ADRD风险中有所不同 因素。如果我们发现解决OSA在减慢认知能力下降/防止ADRD方面特别有效， 尤其是在高风险团体中，然后我们的研究结果将有助于我们了解OSA可以使用的方法 在人群中接受治疗，并为这些人群中的OSA的制定做出贡献 风险。此外，它将努力遏制美国ADRD的负担，并为痴呆症做出重大贡献 预防努力。