Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms

Kerner, Nancy Allison; Roose, Steven P.

doi:10.1016/j.jagp.2016.01.134

Cited by 218 publications

(137 citation statements)

References 118 publications

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“…The main finding is consistent with studies reporting an increased incidence of OSA symptoms in patients with depression, building a long-standing co-occurrence of mood and sleep disorders (11,24). The results are also consistent with studies indicating that untreated OSA patients might show higher depressive symptoms (38)(39)(40). Several studies have shown that existence of treatment resistant symptoms in patients with OSA might be due to depression and not due to OSA per se (41)(42)(43).…”

Section: Discussionsupporting

confidence: 90%

Higher Risk for Obstructive Sleep Apnea in Chronic Treatment-Resistant Depression

Khazaie

Alavi-Mehr

Younesi

et al. 2018

Iran J Psychiatry Behav Sci

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Objectives: Studies have reported a higher risk for obstructive sleep apnea (OSA) in major depressive disorder (MDD). However, the risk of OSA in patients with chronic treatment-resistant depressive symptoms is not well documented worldwide. Hence, the current study assessed the risk of OSA and associated factors in patients with chronic treatment resistant depression (cTRD). Methods: The study recruited 140 Iranian patients with cTRD. All patients completed the Berlin questionnaire, which evaluates the risk of OSA. Additionally, demographic data and history of cardiovascular or metabolic diseases were collected. Pearson's Chi-square test, Fisher's exact test, and independent T-test were used to assess group differences, when appropriate. Results: The study found that 89 of 140 cTRD patients (64%) were at high risk for OSA. Group comparison between cTRD patients (high vs. low risk for OSA) demonstrated that at high risk OSA-cTRD patients had an elevated rate of hypertension, diabetes mellitus, and obesity. Also, age, duration of depression, and duration of treatment were significantly higher in cTRD patients with higher risk compared to those with lower risk for OSA. Conclusions:The results suggest that a noticeable number of patients with cTRD are at high risk for OSA, which is higher than the reported magnitude in the general population. Moreover, hypertension, diabetes mellitus, and obesity are associated with a higher risk for OSA. Also, age, treatment duration, and depression duration could be considered as possible comorbid factors for OSA in patients with cTRD.

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Section: Discussionsupporting

confidence: 90%

Higher Risk for Obstructive Sleep Apnea in Chronic Treatment-Resistant Depression

Khazaie

Alavi-Mehr

Younesi

et al. 2018

Iran J Psychiatry Behav Sci

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“…These alterations caused cognitive impairments in many domains, such as attention, memory, executive function, psychomotor function and visuospatial function [53], which can lead to mild cognitive impairment (MCI) and dementia in the aging population [58].…”

Section: Obstructive Sleep Apnea Syndromementioning

confidence: 99%

Is Sleep Disruption a Cause or Consequence of Alzheimer’s Disease? Reviewing Its Possible Role as a Biomarker

Lloret

Cervera‐Ferri

Nepomuceno

et al. 2020

IJMS

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In recent years, the idea that sleep is critical for cognitive processing has gained strength. Alzheimer's disease (AD) is the most common form of dementia worldwide and presents a high prevalence of sleep disturbances. However, it is difficult to establish causal relations, since a vicious circle emerges between different aspects of the disease. Nowadays, we know that sleep is crucial to consolidate memory and to remove the excess of beta-amyloid and hyperphosphorilated tau accumulated in AD patients' brains. In this review, we discuss how sleep disturbances often precede in years some pathological traits, as well as cognitive decline, in AD. We describe the relevance of sleep to memory consolidation, focusing on changes in sleep patterns in AD in contrast to normal aging. We also analyze whether sleep alterations could be useful biomarkers to predict the risk of developing AD and we compile some sleep-related proposed biomarkers. The relevance of the analysis of the sleep microstructure is highlighted to detect specific oscillatory patterns that could be useful as AD biomarkers.the risk of developing AD [9]. Similarly, Bubu and colleagues estimated in a meta-analysis that the risk of dementia in patients with sleep disorders was 1.68 times greater [10]. Moreover, in a recent multi-center study, both midlife and late-life terminal insomnia were associated with a higher risk of dementia [11].It is interesting to note that affected brain structures in people with disturbed sleep coincide with vulnerable areas in AD. Lower gray matter volume in hippocampus, precuneus, amygdala, and cingulate gyrus [12][13][14][15][16][17][18][19], and a higher degree of cortical atrophy have been described in cognitively-unimpaired insomnia patients [14,20]. A recent study performed in cognitively unimpaired adults aged between 45 and 75, found that insomnia patients presented decreases in grey matter volume in AD-related areas, that concur with other studies. Furthermore, they found greater volume in the left caudate in these subjects, which can also be seen in presymptomatic carriers of an AD genetic mutation [21]. Finally, a very recent study in middle-aged, cognitively unimpaired adults found lower grey matter volumes in the left angular gyrus, the bilateral superior frontal gyri, the thalami, and the right hippocampus in insomniac APOE-ε4 carriers (AD's main risk factor) when compared to non-carriers with or without insomnia [21].This temporal and anatomical relationship could suggest that sleep disturbances may influence or exacerbate AD pathology and that improving sleep may help slow down its progression [22,23]. Additionally, sleep alterations could be used to predict the risk of developing dementia and could also serve as early indicators of the disease. If sleep disorders constitute a risk factor to initiate or to accelerate the clinical course of AD, they could be used to develop disease biomarkers. Furthermore, a sleep biomarker with high sensitivity and specificity would be extremely useful, as electrophysiological re...

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“…sometimes including cognitive impairment), explore heterogenous populations and stipulate various mechanisms by which recurrent obstructive episodes might cause changes in mental status . Although postoperative delirium may be reflective of a neuro‐inflammatory process that is caused by catabolic surgical insults, it shares some of the pathophysiology thought to underlie endothelial and vasomotor changes in the brain of patients with OSA that may result from hypoxia and changes in perfusion due to the effects of repeated airway obstructions on cardiovascular function .…”

Section: The Outcomes Of Pain and Deliriummentioning

confidence: 99%

The association between obstructive sleep apnoea, delirium and pain: does it exist or is it just in our heads?

Memtsoudis

2019

Anaesthesia

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The topic of obstructive sleep apnoea (OSA) in the perioperative period has received an increasing amount of attention in recent years. With growing acceptance of the notion that OSA is associated with increased peri-operative risk for a variety of adverse outcomes [1], focus has shifted to providing guidance on the identification and treatment of this patient population in the context of surgery [2, 3]. Despite numerous publications and the release of various guidelines by specialty societies, to date, information on the topic remains incomplete. Consequently, it is widely debated among researchers which peri-operative OSA phenotypes are prone to what type of complications and if these adverse outcomes are preventable through pre-operative identification and adjusted peri-operative management. This information is of major importance in order to help clinicians allocate scarce resources appropriately [4]. It is in this context that the study by Strutz et al. provides valuable information. In their retrospective analysis of data collected for three parent studies, the authors specifically sought to investigate the association between OSA and the occurrence of postoperative delirium as well as increased pain perception. After devising a thorough analysis protocol and employing state of the art methodology, the authors concluded that no such associations exist, at least within the framework of their analysis. They therefore suggested that screening for OSA may not be an effective tool to reduce the burden of these particular events, which are linked to further medical complications and higher resource utilisation. However, they do point out that the rate of delirium among patients with OSA is very high and therefore represents a considerable problem [5]. This publication adds to our knowledge on the subject of delirium and pain in OSA patients for which there is a paucity of literature [5]. The authors based their hypothesis on a relatively small number of previous studies suggesting OSA to be a risk factor for postoperative delirium and increased pain perception. Comparatively though, the data published in this edition of Anaesthesia represent the largest cohort in which these questions have been studied thus far [6, 7]. Qualitative assessment of the study and its design There are several points to be discussed about this remarkable publication. Strutz et al. present an example of how complex analyses of observational data can be conducted in a transparent way that increases confidence in the robustness of results.In an era where observational analyses of secondary data have become the source of much excitement but also significant criticism, it is important to note that in order to maintain the highest level of integrity, the authors have not only formulated and published their analysis plan a priori but also have opened it up to peer review [8]. This allowed for outside input and improvement of their protocol and goes beyond calls for registration of such investigations as suggested previously [9]. Although the c...

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Obstructive Sleep Apnea is Linked to Depression and Cognitive Impairment: Evidence and Potential Mechanisms

Cited by 218 publications

References 118 publications

Higher Risk for Obstructive Sleep Apnea in Chronic Treatment-Resistant Depression

Higher Risk for Obstructive Sleep Apnea in Chronic Treatment-Resistant Depression

Is Sleep Disruption a Cause or Consequence of Alzheimer’s Disease? Reviewing Its Possible Role as a Biomarker

The association between obstructive sleep apnoea, delirium and pain: does it exist or is it just in our heads?

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