Treatment of OSA: What (else) can it accomplish?

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Applied Evidence

Treatment of OSA: What (else) can it accomplish?

J Fam Pract. 2019 December;68(10):557-563

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References

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Findings of more recent studies remain mixed. A 3-month Spanish trial of PAP in older adults with severe OSA showed improvement in 2 of 4 neuropsychological tests of cognitive function; this was a secondary outcome measure.²⁰ The PREDICT trial in the United Kingdom demonstrated a reduction in daytime sleepiness but no improvement in cognitive function in PAP-treated older adults with OSA but without dementia over a 1-year period.²¹

The prevalence of OSA in patients with dementia is high, and more severe dementia is associated with more severe OSA.

In contrast, a French long-term study of adults ages ≥ 65 years with severe (but not necessarily symptomatic) OSA showed better maintenance of memory performance; these results must be interpreted with caution, however, because the study was not randomized, controlled, or blinded, and the results were not adjusted for potential confounders.²² The severity of OSA may influence the impact of PAP treatment on cognitive function.

The prevalence of OSA in patients with dementia is high, and more severe dementia is associated with more severe OSA.²³ Although it is intuitive that disrupted sleep may worsen cognitive function, and that treatment could improve it, minimal benefit on cognitive function was shown by neuropsychological testing in patients with Alzheimer’s disease and OSA treated with continuous positive airway pressure (CPAP) vs sham CPAP in 1 small short-term randomized trial.²³

In another study of patients with Alzheimer’s disease, this time an observational (nonrandomized, non-controlled, single-blind) study of patients who also had severe symptomatic OSA, researchers followed the patients for 3 years and found a significant delay in median annual cognitive decline of 1.5 points per year on the Mini-Mental Status Examination in patients treated with PAP compared with those who did not receive PAP treatment.²⁴

Hypertension: Small but positive results

A meta-analysis of PAP use in patients with OSA and resistant hypertension (defined as inadequate control while taking at least 3 antihypertensive agents or control requiring at least 4 agents) documented significant blood pressure (BP) lowering, with a pooled estimate of -7.21 mm Hg systolic and -4.99 mm Hg diastolic.²⁵ The decrease in BP was demonstrated in both sleepy and non-sleepy subjects.

Continue to: Multiple studies have...