Wang Jingya, Subramanian Anuradhaa, Cockburn Neil, Xiao Jingyi, Nirantharakumar Krishnarajah, Haroon Shamil
School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK
School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, UK.
Thorax. 2025 Feb 17;80(3):167-174. doi: 10.1136/thorax-2024-221810.
Obstructive sleep apnoea syndrome (OSAS) has been recognised as a potential risk factor for cognitive decline, yet its precise relationship with dementia remains uncertain. This study aimed to determine the risk of dementia among individuals with and without OSAS.
Data derived from 2.3 million adults (aged ≥18 years) were extracted from the Clinical Practice Research Datalink (2000-2022), a nationally representative primary care electronic health records database in the UK. 193 600 individuals with OSAS were propensity score-matched to 536 701 individuals without OSAS. Cox proportional hazard regression models were applied to quantify the risk of developing all-cause dementia, vascular dementia and Alzheimer's disease between individuals with and without OSAS.
With a median follow-up of 4.0 (IQR 1.8-7.5) years, 2802 and 6211 individuals developed all-cause dementia in those with and without OSAS, corresponding to crude incidence rates of 2.47 and 2.34 per 1000 person-years, respectively. The presence of OSAS was associated with higher risks of all-cause dementia (adjusted HR (aHR) 1.12, 95% CI 1.07 to 1.17), vascular dementia (1.29, 95% CI 1.19 to 1.41) and unchanged risk of Alzheimer's disease (1.07, 95% CI 0.99 to 1.16). Individuals with OSAS who had received continuous positive airway pressure (CPAP) treatment exhibited a similar risk of all-cause dementia as their matched counterparts (0.99, 95% CI 0.74 to 1.32).
OSAS is associated with higher risks of all-cause dementia and some of its subtypes. Further investigation is needed to investigate the clinical benefits of screening for cognitive impairment in people with OSAS and to further evaluate the impact of CPAP on cognitive decline and dementia risk.
阻塞性睡眠呼吸暂停综合征（OSAS）已被认为是认知功能下降的一个潜在风险因素，但其与痴呆症的确切关系仍不确定。本研究旨在确定患有和未患有OSAS的个体患痴呆症的风险。
从临床实践研究数据链（2000 - 2022年）中提取了来自230万成年人（年龄≥18岁）的数据，该数据库是英国一个具有全国代表性的初级保健电子健康记录数据库。193600名患有OSAS的个体与536701名未患有OSAS的个体进行了倾向得分匹配。应用Cox比例风险回归模型来量化患有和未患有OSAS的个体发生全因性痴呆、血管性痴呆和阿尔茨海默病的风险。
中位随访时间为4.0（四分位间距1.8 - 7.5）年，患有和未患有OSAS的个体中分别有2802人和6211人发生了全因性痴呆，相应的粗发病率分别为每1000人年2.47例和2.34例。OSAS的存在与全因性痴呆（调整后风险比（aHR）1.12，95%置信区间1.07至1.17）、血管性痴呆（1.29，95%置信区间1.19至1.41）的较高风险相关，而阿尔茨海默病的风险未改变（1.07，95%置信区间0.99至1.16）。接受持续气道正压通气（CPAP）治疗的OSAS个体发生全因性痴呆的风险与其匹配的对照个体相似（0.99，95%置信区间0.74至1.32）。
OSAS与全因性痴呆及其某些亚型的较高风险相关。需要进一步研究以探讨对OSAS患者进行认知障碍筛查的临床益处，并进一步评估CPAP对认知功能下降和痴呆风险的影响。
