OBJECTIVE: To examine whether treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) in patients with Alzheimer's disease (AD) would result in improved cognitive function. DESIGN: Randomized double-blind placebo-controlled trial. Participants were randomized to either therapeutic CPAP for six weeks or placebo CPAP for three weeks followed by therapeutic CPAP for three weeks. SETTING: General clinical research center PARTICIPANTS: 52 men and women with mild-moderate AD and OSA INTERVENTION: Continuous positive airway pressure MEASUREMENTS: A complete neuropsychological test battery was administered before treatment, at three and at six-weeks. RESULTS: A comparison of subjects randomized to 3 weeks of therapeutic versus placebo CPAP suggested no significant improvements in cognition. A comparison of pre- versus post-treatment neuropsychological test scores after 3 weeks of therapeutic CPAP in both groups showed a significant improvement in cognition. The study was underpowered to make definitive statements about improvements within specific cognitive constructs. However, exploratory post-hoc examination of change scores for individual tests suggested improvements in episodic verbal learning and memory and some aspects of executive functioning such as cognitive flexibility, and mental processing speed. CONCLUSIONS: OSA may aggravate cognitive dysfunction in dementia and thus may be a reversible cause of cognitive loss in AD patients. OSA treatment seems to improve some of the cognitive functioning. Clinicians who care for AD patients should consider implementing CPAP treatment when OSA is present.

Rationale: Hispanic/Latino populations have a high prevalence of cardiovascular risk factors and may be at risk for sleep-disordered breathing (SDB). An understanding of SDB among these populations is needed given evidence that SDB increases cardiovascular risk.Objectives: To quantify SDB prevalence in the U.S. Hispanic/Latino population and its association with symptoms, risk factors, diabetes, and hypertension; and to explore variation by sex and Hispanic/ Latino background.Methods: Cross-sectional analysis from the baseline examination of the Hispanic Community Health Study/Study of Latinos. Measurements and Main Results:The apnea-hypopnea index (AHI) was derived from standardized sleep tests; diabetes and hypertension were based on measurement and history. The sample of 14,440 individuals had an age-adjusted prevalence of minimal SDB (AHI > 5), moderate SDB (AHI > 15), and severe SDB (AHI > 30) of 25.8, 9.8, and 3.9%, respectively. Only 1.3% of participants reported a sleep apnea diagnosis. Moderate SDB was associated with being male (adjusted odds ratio, 2.7; 95% confidence interval, 2.3-3.1), obese (16.8; 11.6-24.4), and older. SDB was associated with an increased adjusted odds of impaired glucose tolerance (1.7; 1.3-2.1), diabetes (2.3; 1.8-2.9), and hypertension. The association with hypertension varied across background groups with the strongest associations among individuals of Puerto Rican and Central American background.Conclusions: SDB is prevalent in U.S. Latinos but rarely associated with a clinical diagnosis. Associations with diabetes and hypertension suggest a large burden of disease may be attributed to untreated SDB, supporting the development and evaluation of culturally relevant detection and treatment approaches. had full access to the study data and take responsibility for the integrity of the data and accuracy of analyses.Correspondence and requests for reprints should be addressed to Susan Redline, M.D., M. 11,12). Baseline data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were analyzed to estimate the prevalence of SDB and SDB symptoms, to describe associations with risk factors and diabetes and hypertension, and to explore variation in SDB by sex and Hispanic/Latino background. We hypothesized that SDB would be more prevalent in Hispanic/Latino groups with higher rates of obesity, and associated with an increased prevalence of hypertension and diabetes. Some of the results of these studies have been previously reported in the form of abstracts (13-15). MethodsThe online supplement provides detailed methods and additional results. SampleThe HCHS/SOL is a community-based cohort study of 16,415 self-identified Hispanic/Latino persons 18-74 years old recruited from randomly selected households in four U.S. field centers (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA). The multistage sampling design and cohort selection procedures have been described (16,17). Briefly, participants were recruited between 2008 and 2011 from defined geographic areas selecte...

Most studies of sleep and health outcomes rely on self-reported sleep duration, although correlation with objective measures is poor. In this study, we defined sociodemographic and sleep characteristics associated with misreporting and assessed whether accounting for these factors better explains variation in objective sleep duration among 2,086 participants in the Hispanic Community Health Study/Study of Latinos who completed more than 5 nights of wrist actigraphy and reported habitual bed/wake times from 2010 to 2013. Using linear regression, we examined self-report as a predictor of actigraphy-assessed sleep duration. Mean amount of time spent asleep was 7.85 (standard deviation, 1.12) hours by self-report and 6.74 (standard deviation, 1.02) hours by actigraphy; correlation between them was 0.43. For each additional hour of self-reported sleep, actigraphy time spent asleep increased by 20 minutes (95% confidence interval: 19, 22). Correlations between self-reported and actigraphy-assessed time spent asleep were lower with male sex, younger age, sleep efficiency <85%, and night-to-night variability in sleep duration ≥1.5 hours. Adding sociodemographic and sleep factors to self-reports increased the proportion of variance explained in actigraphy-assessed sleep slightly (18%-32%). In this large validation study including Hispanics/Latinos, we demonstrated a moderate correlation between self-reported and actigraphy-assessed time spent asleep. The performance of self-reports varied by demographic and sleep measures but not by Hispanic subgroup.

Abstract-This study examined the effect of continuous positive airway pressure (CPAP) treatment on blood pressure in patients with obstructive sleep apnea. Thirty-nine patients with sleep apnea were studied. Ambulatory blood pressure monitoring was obtained before and after patients were randomized to receive either 1 week of CPAP or placebo CPAP (CPAP administered at ineffective pressure). Blood pressure was examined over daytime hours (6 AM to 10 PM) and during nighttime hours (10 PM to 6 AM). Daytime mean arterial blood pressure decreased significantly but equally in both the active treatment group and the placebo treatment group (Pϭ0.001). Nighttime mean arterial pressure levels decreased to a much greater extent over time in the patients who received active CPAP treatment (Pϭ0.032). CPAP does appear to decrease nighttime blood pressure. However, the decrease in daytime blood pressure may reflect a nonspecific response (ie, placebo), since both the active treatment group and the placebo treatment group developed comparable decreases in blood pressure. Treatments for OSA are multiple, but, after weight loss, the most commonly used treatment is nocturnal continuous positive airway pressure (CPAP). The great majority of OSA patients can have their apnea successfully treated with this methodology. 5 Because of the comorbidity of hypertension and OSA, many investigators have examined how CPAP affects BP levels. 6 -19 Table 1 summarizes these endeavors. As the table suggests, many of the studies report a beneficial effect of CPAP on BP. The studies suggest that CPAP acutely decreases nighttime BP in hypertensive OSA patients but not in normotensive patients and that longer-term use of CPAP decreases both nocturnal and diurnal BP. However, certain design aspects are striking. The studies generally have a small sample size (average of 14 patients per study), and most of them use neither randomization nor a control group. Most studies combined normotensives and hypertensives, and many hypertensives were studied while they were receiving antihypertensive treatment. Few studies examined patients in the absence of antihypertensive medication. Most studies did not describe how they dealt with data from patients who were noncompliant with the CPAP treatment.Only half of the studies used ambulatory blood pressure monitoring (ABPM). ABPM techniques acquire a more complete and representative sample of BP readings than would be obtained by casual BP measurement in the physician's office. In addition, ABPM allows examination of BP patterns in awake and in sleeping patients.Most notably, only 1 study used a placebo control (an oral placebo) for CPAP, and that study found no effect of CPAP on 24-hour ambulatory BP. 8 BP is notoriously influenced by nonspecific effects. The CPAP apparatus itself could be a very powerful stimulus for placebo responses. For this reason, we performed a double-blind placebo trial of CPAP versus placebo CPAP on BP as gauged by ABPM. MethodsPatients were located by public advertisements and word-of-m...

Rationale: When obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) coexist in the so-called "overlap" syndrome, a high risk for mortality and morbidity has been reported. There is controversy about the prevalence of OSA in people affected by COPD.Objectives: The purpose of this study was to investigate objective meaures of sleep-disordered breathing in patients with moderate to severe COPD to test the hypothesis that COPD is associated with an increased prevalence of OSA.Methods: Fifty-four patients (54% men) with moderate to severe COPD were enrolled prospectively (mean 6 SD, FEV 1 = 42.8 6 19.8% predicted, and FEV 1 /FVC = 42.3 6 13.1). Twenty patients (37%) were on supplemental oxygen at baseline. Exercise tolerance; questionnaires related to symptoms, sleep, and quality of life; and home polysomnography were obtained.Measurements and Main Results: Forty-four patients had full polysomnography suitable for analysis. OSA (apnea-hypopnea index . 5/h) was present in 29 subjects (65.9%). Sleep efficiency was poor in 45% of subjects.Conclusions: OSA is highly prevalent in patients with moderate to severe COPD referred to pulmonary rehabilitation. Sleep quality is also poor among this selected group. These patients have greaterthan-expected sleep-disordered breathing, which could be an important contributory factor to morbidity and mortality. Pulmonary rehabilitation programs should consider including a sleep assessment in patients with moderate to severe COPD and interventions when indicated to help reduce the impact of OSA in COPD.

With use of a standardized algorithm to set rest intervals, scoring of actigraphy for the purpose of generating a wide array of sleep variables is highly reproducible.

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