Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Neurology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy.
Sleep Med Rev. 2021 Feb;55:101375. doi: 10.1016/j.smrv.2020.101375. Epub 2020 Sep 6.
Sleep-disordered breathing is highly prevalent in the elderly population. Obstructive sleep apnea (OSA) represents the most common sleep disorder among the adult and elderly population. Recently, OSA diagnosis has been associated with an increased risk of developing cognitive decline and dementia, including vascular dementia and Alzheimer's disease (AD). Subsequently, there have been studies on AD biomarkers investigating cerebrospinal fluid, blood, neuroimaging, and nuclear medicine biomarkers in patients with OSA. Furthermore, studies have attempted to assess the possible effects of continuous positive airway pressure (CPAP) treatment on the cognitive trajectory and AD biomarkers in patients with OSA. This review summarizes the findings of studies on each AD biomarker (cognitive, biofluid, neuroimaging, and nuclear medicine imaging) in patients with OSA, also accounting for the related effects of CPAP treatment. In addition, the hypothetical model connecting OSA to AD in a bi-directional interplay is analyzed. Finally, the sex-based differences in prevalence and clinical symptoms of OSA between men and women have been investigated in relation to AD risk. Further studies investigating AD biomarkers changes in patients with OSA and the effect of CPAP treatment should be auspicated in future for identifying strategies to prevent the development of AD.
睡眠障碍性呼吸在老年人群中非常普遍。阻塞性睡眠呼吸暂停（OSA）是成人和老年人群中最常见的睡眠障碍。最近，OSA 诊断与认知能力下降和痴呆的风险增加有关，包括血管性痴呆和阿尔茨海默病（AD）。随后，针对 OSA 患者，开展了有关 AD 生物标志物的研究，包括脑脊液、血液、神经影像学和核医学生物标志物。此外，研究还试图评估 CPAP 治疗对 OSA 患者认知轨迹和 AD 生物标志物的可能影响。本综述总结了关于 OSA 患者每个 AD 生物标志物（认知、生物流体、神经影像学和核医学成像）的研究结果，同时还考虑了 CPAP 治疗的相关影响。此外，还分析了 OSA 与 AD 之间双向相互作用的假设模型。最后，研究了男性和女性 OSA 患病率和临床症状的性别差异与 AD 风险的关系。未来应该开展更多研究，调查 OSA 患者 AD 生物标志物的变化以及 CPAP 治疗的效果，以确定预防 AD 发展的策略。
