Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada; Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montreal, Canada.
Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada; Department of Psychology, Université de Montréal, Montreal, Canada.
Sleep Med Rev. 2018 Dec;42:139-148. doi: 10.1016/j.smrv.2018.08.001. Epub 2018 Aug 13.
Epidemiologic and mechanistic evidence is increasingly supporting the notion that obstructive sleep apnea is a risk factor for dementia. Hence, the identification of patients at risk of cognitive decline due to obstructive sleep apnea may significantly improve preventive strategies and treatment decision-making. Cerebrospinal fluid and blood biomarkers obtained through genomic, proteomic and metabolomic approaches are improving the ability to predict incident dementia. Therefore, fluid biomarkers have the potential to predict vulnerability to neurodegeneration in individuals with obstructive sleep apnea, as well as deepen our understanding of pathophysiological processes linking obstructive sleep apnea and dementia. Many fluid biomarkers linked to Alzheimer's disease and vascular dementia show abnormal levels in individuals with obstructive sleep apnea, suggesting that these conditions share common underlying mechanisms, including amyloid and tau protein neuropathology, inflammation, oxidative stress, and metabolic disturbances. Markers of these processes include amyloid-β, tau proteins, inflammatory cytokines, acute-phase proteins, antioxydants and oxidized products, homocysteine and clusterin (apolipoprotein J). Thus, these biomarkers may have the ability to identify adults with obstructive sleep apnea at high risk of dementia and provide an opportunity for therapeutic intervention. Large cohort studies are necessary to establish a specific fluid biomarker panel linking obstructive sleep apnea to dementia risk.
越来越多的流行病学和机制证据支持阻塞性睡眠呼吸暂停是痴呆的危险因素这一观点。因此，识别因阻塞性睡眠呼吸暂停而导致认知能力下降的患者，可能会显著改善预防策略和治疗决策。通过基因组、蛋白质组和代谢组学方法获得的脑脊液和血液生物标志物提高了预测痴呆发生的能力。因此，这些生物标志物有可能预测阻塞性睡眠呼吸暂停患者的神经退行性变易感性，并加深我们对阻塞性睡眠呼吸暂停与痴呆之间病理生理过程的理解。许多与阿尔茨海默病和血管性痴呆相关的脑脊液生物标志物在阻塞性睡眠呼吸暂停患者中显示出异常水平，这表明这些疾病具有共同的潜在机制，包括淀粉样蛋白和tau 蛋白病理学、炎症、氧化应激和代谢紊乱。这些过程的标志物包括淀粉样蛋白-β、tau 蛋白、炎症细胞因子、急性期蛋白、抗氧化剂和氧化产物、同型半胱氨酸和载脂蛋白 J（簇蛋白）。因此，这些生物标志物可能有能力识别阻塞性睡眠呼吸暂停患者中痴呆风险较高的成年人，并为治疗干预提供机会。需要进行大型队列研究，以建立一个将阻塞性睡眠呼吸暂停与痴呆风险联系起来的特定的脑脊液生物标志物谱。
