While sleep apnea is common it remains an underdiagnosed sleep disorder that contributes to the development of dementia, particularly in women according to a study recently published in SLEEP Advances from Michigan Medicine.
Investigating sleep apnea and dementia
The study utilized data from the ongoing nationally representative Health and Retirement Study to find that women with known or suspected sleep apnea were more likely than men to have symptoms or a diagnosis of dementia at every age level. For adults aged 50+ having known obstructive sleep apnea or its symptoms was associated with a higher chance of developing signs or receiving a diagnosis of dementia in the coming years. Interestingly, the rate of dementia was found to decrease as men aged while increasing as women aged.
“Our findings offer new insight into the role of a treatable sleep disorder on long-term cognitive health at the population level for both women and men,” said first author Tiffany J. Braley, M.D., M.S., neurologist, director of the Multiple Sclerosis/Neuroimmunology Division and co-founder of the Multidisciplinary MS Fatigue and Sleep Clinic at the University of Michigan Health.
Sex-specific difference
The reason for the sex-specific difference in dementia diagnosis by sleep apnea status is not fully understood, but the researchers pose several possible explanations such as women with moderate sleep apnea may have a greater risk of cardiovascular disease and are more likely to have insomnia, both of which can negatively impact cognitive function.
“Estrogen starts to decline as women transition to menopause, which can impact their brains,” said co-author Galit Levi Dunietz, Ph.D., M.P.H., an associate professor in the University of Michigan Department of Neurology and Division of Sleep Medicine.
“During that time, they are more prone to memory, sleep, and mood changes that may lead to cognitive decline. Sleep apnea increases significantly post-menopause yet remains underdiagnosed. We need more epidemiologic studies to better understand how sleep disorders in women impact their cognitive health.”
Modifiable risk factors
Approximately 6 million Americans have been diagnosed with sleep apnea, however, it is estimated to be affecting closer to 30 million people. A report published in the Lancet Commission identified several modifiable risk factors such as mental health problems and cardiovascular disease, that when taken together account for 40% of global dementia.
While sleep was not listed as an official risk factor, the report noted that sleep apnea “might be associated with dementia” and suggested adding screening questions about dementia for people with the sleep disorder.
Potential harms
“These potential harms caused by sleep apnea, many of which threaten cognitive performance and decline, highlight the importance of early diagnosis and treatment,” Braley said. “Obstructive sleep apnea and resultant sleep deprivation and fragmentation are also associated with inflammatory changes in the brain that may contribute to cognitive impairment.”
“This study design cannot fully prove that sleep apnea causes dementia — that would likely require a randomized trial, over many years, to compare effects of sleep apnea treatment to the effects of no treatment,” said co-author Ronald D. Chervin, M.D., M.S., director of the Division of Sleep Medicine in the Department of Neurology at U-M Health.
“As it may be a long time if ever until such a trial occurs, backward-looking analyses such as ours, within large databases, may be among the most informative for years to come. In the meantime, the results provide new evidence that clinicians and patients, when making decisions about testing for sleep apnea and treating it, should consider the possibility that untreated sleep apnea causes or exacerbates dementia.”
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References/Sources/Materials provided by:
http://dx.doi.org/10.1093/sleepadvances/zpae077
https://worldhealth.net/news/40-of-dementia-cases-could-have-been-delayed-or-prevented/
