Gribsholt Sigrid Bjerge, Horváth-Puhó Erzsébet, Elser Holly, Laugesen Kristina, Skajaa Nils, Fuglsang Cecilia Hvitfeldt, Henderson Victor, Sørensen Henrik Toft
Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
BMJ Neurol Open. 2025 Aug 4;7(2):e001174. doi: 10.1136/bmjno-2025-001174. eCollection 2025.
Obstructive sleep apnoea (OSA) is associated with adverse health outcomes. However, the association with dementia remains uncertain. Thus, we examined the association of OSA with all-cause dementia and Alzheimer's disease.
We conducted a Danish nationwide population-based cohort study using health registries. Patients with OSA were identified from 1995 to 2017. Furthermore, a propensity score-matched comparison cohort was defined. Propensity scores were computed based on age, sex, comorbidities and education. With follow-up until 2018, we computed incidence rates (IRs) and HRs for all-cause dementia and Alzheimer's disease. Subgroup analyses were conducted by sex, age, overweight/obesity, hypertension and continuous positive airway pressure (CPAP) treatment.
We identified 62 928 patients with OSA and 62 928 in the propensity score-matched comparison cohort (76% male, median age 52 years). The IR for all-cause dementia was 1.27 (95% CI 1.17 to 1.37) per 1000 person-years in patients with OSA and 1.15 (95% CI 1.05 to 1.25) in the propensity score-matched comparison cohort, yielding an HR of 1.10 (95% CI 0.98 to 1.24). The HR for Alzheimer's disease was 1.16 (95% CI 0.94 to 1.43). Among individuals with overweight/obesity, the HR for all-cause dementia was 0.71 (95% CI 0.51 to 0.99), while it was 1.17 (95% CI 1.03 to 1.33) in those without. CPAP treatment attenuated associations.
Our findings support a modest association between OSA and dementia, including Alzheimer's disease, motivating early clinical detection of OSA as a potentially modifiable risk factor for subsequent dementia. The finding that the dementia hazard was not increased in the setting of overweight or obesity requires further study and points to the need for research on mechanisms underlying the association between OSA and dementia.
阻塞性睡眠呼吸暂停（OSA）与不良健康后果相关。然而，其与痴呆症的关联仍不确定。因此，我们研究了OSA与全因性痴呆症和阿尔茨海默病之间的关联。
我们利用健康登记系统在丹麦全国范围内开展了一项基于人群的队列研究。确定了1995年至2017年期间的OSA患者。此外，定义了一个倾向评分匹配的对照队列。倾向评分根据年龄、性别、合并症和教育程度计算得出。随访至2018年，我们计算了全因性痴呆症和阿尔茨海默病的发病率（IRs）和风险比（HRs）。按性别、年龄、超重/肥胖、高血压和持续气道正压通气（CPAP）治疗进行亚组分析。
我们确定了62928例OSA患者以及倾向评分匹配对照队列中的62928例患者（76%为男性，中位年龄52岁）。OSA患者中全因性痴呆症的发病率为每1000人年1.27（95%置信区间1.17至1.37），倾向评分匹配对照队列中的发病率为1.15（95%置信区间1.05至1.25），风险比为1.10（95%置信区间0.98至1.24）。阿尔茨海默病的风险比为1.16（95%置信区间0.94至1.43）。在超重/肥胖个体中，全因性痴呆症的风险比为0.71（95%置信区间0.51至0.99），而在非超重/肥胖个体中为1.17（95%置信区间1.03至1.33）。CPAP治疗减弱了这种关联。
我们的研究结果支持OSA与痴呆症（包括阿尔茨海默病）之间存在适度关联，这促使早期临床检测OSA，将其作为后续痴呆症潜在的可改变风险因素。超重或肥胖情况下痴呆症风险未增加这一发现需要进一步研究，并指出有必要研究OSA与痴呆症关联的潜在机制。
