Increased Risk of Parkinson's Disease in Patients With Obstructive Sleep Apnea

Abstract

Obstructive sleep apnea (OSA), characterized by repetitive episodes of apnea/hypopnea and hypoxia, is associated with systemic inflammation and induces metabolic, endocrine, and cardiovascular diseases. Inflammation might have an impact on neurodegenerative diseases. This study investigates the possible association between OSA and Parkinson's disease (PD). Random samples out of 1 million individuals were collected from Taiwan's National Health Insurance database. A total of 16,730 patients with newly diagnosed OSA from 2002 to 2008 were recruited and compared with a cohort of 16,730 patients without OSA matched for age, gender, and comorbidities using propensity scoring. All patients were tracked until a diagnosis of PD, death, or the end of 2011.During the mean 5.6-year follow-up period, the incidence rates of PD were 2.30 per 1000 person-years in the OSA cohort and 1.71per 1000 person-years in the comparison group. The incidence rate ratio (IRR) for PD was greater in older patients (≧ 65 years) and male patients with OSA than the controls, respective IRRs being 1.34 and 1.47. After adjustment for the comorbidities, patients with OSA were 1.37 times more likely to have PD than patients without (95% CI = 1.12–1.68, P < 0.05). Subgroup analysis showed that older patients and patients with coronary artery disease, stroke, or chronic kidney disease had a higher risk for PD than their counter parts. Log-rank analysis revealed that patients with OSA had significantly higher cumulative incidence rates of PD than the comparison group (P = 0.0048). Patients with OSA are at an increased risk for subsequent PD, especially elderly male patients.

Obstructive sleep apnea, CPAP therapy and Parkinson's disease motor function: A longitudinal study

“…OSA and PD often coincide with one another, whether due to the high general prevalence of OSA, the higher incidence of OSA in PD, or OSA predisposing to PD. In large-scale population studies with long follow-up periods, OSA has been suggested to increase the incidence of PD [5]. Our group has found an association between OSA and PD nonmotor symptoms [6], which improved with OSA treatment [7].…”

“…However, OSA may also, in turn, have adverse effects on PD. In support of this, large population studies have suggested that pre-existing OSA predisposes to PD [5]. Conversely, a multicenter study from the International RBD Study Group found OSA not to be a risk factor for subsequent development of PD among idiopathic RBD patients, although OSA scoring criteria were not standardized or defined and likely differed between centres, making conclusions on OSA less reliable [19].…”

Sleep and Circadian Rhythm Disorders in Parkinson’s Disease

“…Several recent studies that employed well-selected controls revealed similar prevalence of OSA in PD and general population (82, 83). Interestingly, three studies have suggested an increased risk of PD among patients with OSA with hazard ratios (HR) of 1.37, 1.84 and 2.26, respectively (84–86). Although the risks are higher, the absolute numbers remain low, and thus OSA might overall provide a minor risk for subsequent development of PD (84).…”

Sleep apnoea and the neurologist

“…The adjusted HR for developing Parkinson's disease in people with OSA was 1.37 (95% CI 1.12 to 1.68, p<0.05). The absolute incidence of Parkinson's disease in the OSA group was 2.30/1000 person-years, compared with 1.71 in controls 49. The authors speculate on the possible mechanisms for this association: there is evidence that OSA induces systemic inflammatory responses as well as brain hypoperfusion that, by increasing oxidative stress, could lead to various pathogenic effects, including accelerated degeneration of dopaminergic neurones in the substantia nigra.…”