The relationship between obstructive sleep apnea and Parkinson’s disease: a systematic review and meta-analysis

Sun, Aping; Liu, Na; Zhang, Ying-shuang; Zhao, Hanqing; Liu, Xiaolu

doi:10.1007/s10072-019-04211-9

Cited by 30 publications

(24 citation statements)

References 42 publications

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“…Overall, recent studies reported associations between OSA and grey and white matter alterations [3, 10-12, 20, 22-24], and changes in brain diffusion [13,25,26], as well as impaired cognition, specifically regarding memory [5,6,26,32], attention [5,7,8,30,31], and executive control [7,8]. Furthermore, subjects with OSA were found to have a higher risk of developing mild cognitive impairment (MCI) [5,27], Alzheimer's dementia [16,17,[39][40][41], and Parkinson's disease [47], and show shorter progression times between cognitively normal and MCI or MCI and Alzheimer's dementia [17]. But while these studies have added further insights, there are some discrepancies in their results and large gaps remain to get a comprehensive overview of the exact mechanism at play here.…”

Section: Discussionmentioning

confidence: 99%

“…There are indications that OSA may act as a risk factor before the onset of PD. In a recent meta-analysis performed by Sun et al (2020), subjects with OSA were 1.56 times more likely to develop PD than controls [47]. The exact mechanisms at play are still not fully understood, but, similar to AD, OSA, although not causing the disorder, likely plays a role in promoting or enhancing PD-associated pre-clinical pathological processes.…”

Section: Sleep Apnoea and Parkinson's Diseasementioning

confidence: 99%

“…With the onset of PD, the relationship between OSA and PD becomes more complex. While there is no evidence that the incidence of OSA is higher in the PD than that in the non-PD population, OSA has an impact on the disorder when present [47]. A meta-analysis performed by Elfi et al (2020) found that subjects with PD and OSA showed greater cognitive and motor deficits than subjects with PD but without OSA [49].…”

Section: Sleep Apnoea and Parkinson's Diseasementioning

confidence: 99%

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The Link Between Obstructive Sleep Apnoea and Neurodegeneration and Cognition

Weihs

Frenzel

Grabe

2021

Curr Sleep Medicine Rep

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Purpose of Review Obstructive sleep apnoea (OSA) is increasingly found to have an impact on neurodegeneration. In this review, we summarise recent findings on the association between OSA and brain morphology, cognition, and processes related to Alzheimer’s dementia (AD) and Parkinson’s disease (PD). Recent Findings Associations between OSA and alterations in grey and white matter, brain diffusivity, and deficits in memory, attention, and executive control were reported. Furthermore, OSA was correlated with higher risks of developing AD and PD and associated pathophysiology. Treatment was found to alleviate but not reverse some of the damage. Summary There are strong indications that OSA plays a major role in neurodegenerative processes. The broad picture however remains elusive, likely due to insufficient sample sizes, heterogeneous outcomes, and OSA definitions failing to quantify the disorder’s sub-processes. While studies resolving these issues are required, the available evidence shows OSA to be a promising target to slow neurodegeneration and delay the onset of related disorders.

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Section: Discussionmentioning

confidence: 99%

Section: Sleep Apnoea and Parkinson's Diseasementioning

confidence: 99%

Section: Sleep Apnoea and Parkinson's Diseasementioning

confidence: 99%

See 1 more Smart Citation

The Link Between Obstructive Sleep Apnoea and Neurodegeneration and Cognition

Weihs

Frenzel

Grabe

2021

Curr Sleep Medicine Rep

View full text Add to dashboard Cite

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“…Limited by the participants included in our study, the association was not stable enough and future studies still need to explore the potential correlations in female patients with larger sample size and high-quality study design. Besides, Sun et al [47] only analyzed gender in their subgroup to explore the correlations between OSA and PD, in our study, we performed gender and sample size in our subgroup analysis in order to produce more convincing evidence.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to previous meta-analysis [47], our current meta-analysis has several strengths. First, our study further confirmed the association between OSA and PD incidence in a larger sample and covered a wider range of people including Asia and North America.…”

Section: Discussionmentioning

confidence: 99%

Does Obstructive sleep apnea increase the risk of Parkinson Disease? A systematic review and meta-analysis

Zhao

Xuan

Sun

et al. 2020

Preprint

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Objectives: The evidence of whether the obstructive sleep apnea (OSA) could increase the risk of Parkinson disease (PD) remains controversial. This meta-analysis was conducted in hopes of providing evidence of associations between the OSA and the risk of PD incidence. Methods: Relevant studies published until 7 September, 2020 were retrieved from 6 databases. 6 studies were finally included based on our selection criteria. Hazard Ratios (HRs) and their 95%CI of each study were collected to evaluate the relationship between obstructive sleep apnea and Parkinson disease risk. Subgroup analysis was performed based on gender and sample size. Results: We find a positive association between obstructive sleep apnea and Parkinson disease risk (HR=1.64, 95%CI:1.56-1.73, I2=23.8%). OSA patients have a higher risk of Parkinson disease than subjects without OSA, especially in male patients (HR=1.56, 95%CI: 1.30-1.87, I2=0.0%). Based on results of sensitivity analysis, our study results were quite stable. Conclusions: Our results provided evidence of a modest positive association between obstructive sleep apnea and Parkinson disease. It is a certain degree of significance to improve our understanding of obstructive sleep apnea and take measures to prevent and treat it. Moreover, additional studies are recommended to explore this topic in more detail. This study was registered in PROSPERO (CRD42020207528).

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Widening the Spectrum of Risk Factors, Comorbidities, and Prodromal Features of Parkinson Disease

Schrag

Bohlken

Dammertz³

et al. 2023

JAMA Neurol

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ImportanceThe prodromal phase of Parkinson disease (PD) may last for more than 10 years. Recognition of the spectrum and occurrence of risk factors, comorbidities, and prodromal features of PD can increase understanding of the causes and development of the disease and help identify individuals at risk.ObjectiveTo identify the association of a subsequent diagnosis of PD with a range of risk factors and prodromal features, including lifestyle factors, comorbidities, and potential extracerebral manifestations of PD.Design, Setting, and ParticipantsThis was a case-control study using insurance claims of outpatient consultations of patients with German statutory health insurance between January 1, 2011, and December 31, 2020. Included were patients with incident diagnosis of PD without a previous diagnosis of parkinsonism or dementia and controls matched 1:2 for age, sex, region, and earliest year of outpatient encounter.ExposuresExposures were selected based on previous systematic reviews, case-control and cohort studies reporting on risk factors, comorbidities, and prodromal features of PD.Main Outcomes and MeasuresPreviously postulated risk factors and prodromal features of PD, using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) coding.ResultsA total of 138 345 patients with incident PD (mean [SD] age, 75.1 [9.8] years; 73 720 male [53.3%]) and 276 690 matched controls (mean [SD] age, 75.1 (9.8) years; 147 440 male [53.3%]) were identified. Study participants were followed up for a mean (SD) of 6.0 (2.0) years. Consistent with previous reports, risk factors and prodromal features associated with PD included traumatic brain injury, odds ratio (OR), 1.62; 95% CI, 1.36-1.92; alcohol misuse, OR, 1.32; 95% CI, 1.21-1.44; hypertension, OR, 1.29; 95% CI, 1.26-1.31; anosmia, OR, 2.16; 95% CI, 1.59-2.93; and parasomnias (including RBD), OR, 1.62; 95% CI, 1.42-1.84. In addition, there were associations with restless legs syndrome (OR, 4.19; 95% CI, 3.91-4.50), sleep apnea (OR, 1.45; 95% CI, 1.37-1.54), epilepsy (OR, 2.26; 95% CI, 2.07-2.46), migraine (OR, 1.21; 95% CI, 1.12-1.29), bipolar disorder (OR, 3.81; 95% CI, 3.11-4.67), and schizophrenia (OR, 4.48; 95% CI, 3.82-5.25). The following diagnoses were also found to be associated with PD: sensory impairments beyond anosmia, such as hearing loss (OR, 1.14; 95% CI, 1.09-1.20) and changes of skin sensation (OR, 1.31; 95% CI, 1.21-1.43). There were also positive associations with skin disorders (eg, seborrheic dermatitis, OR, 1.30; 95% CI, 1.15-1.46; psoriasis, OR, 1.13; 95% CI, 1.05-1.21), gastrointestinal disorders (eg, gastroesophageal reflux, OR, 1.29; 95% CI, 1.25-1.33; gastritis, OR, 1.28; 95% CI, 1.24-1.33), conditions with a potential inflammatory component (eg, seronegative osteoarthritis, OR, 1.21; 95% CI, 1.03-1.43), and diabetes types 1 (OR, 1.32; 95% CI, 1.21-1.43) and 2 (OR, 1.24; 95% CI, 1.20-1.27). Associations even 5 to 10 years before diagnosis included tremor (odds ratio [OR], 4.49; 95% CI, 3.98-5.06), restless legs syndrome (OR, 3.73; 95% CI, 3.39-4.09), bipolar disorder (OR, 3.80; 95% CI, 2.82-5.14), and schizophrenia (OR, 4.00; 95% CI, 3.31-4.85).Conclusions and RelevanceResults of this case-control study suggest that the associations found between PD and certain risk factors, comorbidities, and prodromal symptoms in a representative population may reflect possible early extrastriatal and extracerebral pathology of PD. This may be due to shared genetic risk with PD, medication exposure, or direct causation, or represent pathophysiologically relevant factors contributing to the pathogenesis of PD.

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The relationship between obstructive sleep apnea and Parkinson’s disease: a systematic review and meta-analysis

Cited by 30 publications

References 42 publications

The Link Between Obstructive Sleep Apnoea and Neurodegeneration and Cognition

The Link Between Obstructive Sleep Apnoea and Neurodegeneration and Cognition

Does Obstructive sleep apnea increase the risk of Parkinson Disease? A systematic review and meta-analysis

Widening the Spectrum of Risk Factors, Comorbidities, and Prodromal Features of Parkinson Disease

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