Ann Am Thorac Soc. 2022 Aug;19(8):1245-1256. doi: 10.1513/AnnalsATS.202205-380ST.
There is emerging evidence that obstructive sleep apnea (OSA) is a risk factor for preclinical Alzheimer's disease (AD). An American Thoracic Society workshop was convened that included clinicians, basic scientists, and epidemiologists with expertise in OSA, cognition, and dementia, with the overall objectives of summarizing the state of knowledge in the field, identifying important research gaps, and identifying potential directions for future research. Although currently available cognitive screening tests may allow for identification of cognitive impairment in patients with OSA, they should be interpreted with caution. Neuroimaging in OSA can provide surrogate measures of disease chronicity, but it has methodological limitations. Most data on the impact of OSA treatment on cognition are for continuous positive airway pressure (CPAP), with limited data for other treatments. The cognitive domains improving with CPAP show considerable heterogeneity across studies. OSA can negatively influence risk, manifestations, and possibly progression of AD and other forms of dementia. Sleep-dependent memory tasks need greater incorporation into OSA testing, with better delineation of sleep fragmentation versus intermittent hypoxia effects. Plasma biomarkers may prove to be sensitive, feasible, and scalable biomarkers for use in clinical trials. There is strong biological plausibility, but insufficient data, to prove bidirectional causality of the associations between OSA and aging pathology. Engaging, recruiting, and retaining diverse populations in health care and research may help to decrease racial and ethnic disparities in OSA and AD. Key recommendations from the workshop include research aimed at underlying mechanisms; longer-term longitudinal studies with objective assessment of OSA, sensitive cognitive markers, and sleep-dependent cognitive tasks; and pragmatic study designs for interventional studies that control for other factors that may impact cognitive outcomes and use novel biomarkers.
越来越多的证据表明阻塞性睡眠呼吸暂停（OSA）是临床前阿尔茨海默病（AD）的一个风险因素。美国胸科学会召开了一个研讨会，与会者包括在 OSA、认知和痴呆方面具有专业知识的临床医生、基础科学家和流行病学家，他们的总体目标是总结该领域的知识现状，确定重要的研究空白，并确定未来研究的潜在方向。尽管目前可用的认知筛查测试可能允许识别 OSA 患者的认知障碍，但应谨慎解释这些测试结果。OSA 中的神经影像学可以提供疾病慢性的替代测量，但它具有方法学上的局限性。关于 OSA 治疗对认知的影响的大多数数据都是针对持续气道正压通气（CPAP）的，其他治疗方法的数据有限。CPAP 改善的认知域在研究之间存在相当大的异质性。OSA 可对 AD 和其他形式的痴呆的风险、表现和可能的进展产生负面影响。睡眠依赖的记忆任务需要更大程度地纳入 OSA 测试，更好地区分睡眠片段化与间歇性低氧的影响。血浆生物标志物可能被证明是敏感、可行和可扩展的生物标志物，可用于临床试验。虽然有很强的生物学合理性，但数据不足，无法证明 OSA 和衰老病理之间的关联存在双向因果关系。吸引、招募和留住不同人群参与医疗保健和研究，可能有助于减少 OSA 和 AD 中的种族和民族差异。研讨会的主要建议包括针对潜在机制的研究；进行更长时间的纵向研究，客观评估 OSA、敏感的认知标志物和睡眠依赖的认知任务；以及对可能影响认知结果的其他因素进行控制的干预性研究的实用研究设计，并使用新型生物标志物。
