Treating sleep apnea in Parkinson's disease with C-PAP: feasibility concerns and effects on cognition and alertness

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent in Parkinson disease (PD) and is known to contribute to cognitive impairment and daytime sleepiness. We investigated feasibility of continuous positive airway pressure treatment (CPAP) and its effects on subjective daytime sleepiness and cognitive profile in PD plus OSA subjects in a longitudinal three months follow up study.

METHODS: Seventy (age 71.7 ± 7.6, disease duration 9.9 ± 12.3, UPDRS-III 33.7 ± 12.5, MMSE 25.3 ± 3.6; years of education 7.7 ± 3.2) out of 228 consecutive PD patients undergoing in-lab video-polysomnography were found to have obstructive sleep apnea. Thirty-six subjects accepted to titrate therapeutic CPAP. Video-polysomnography, neuropsychological battery evaluating different cognitive domains and subjective scales for daytime sleepiness were scheduled at baseline and after three months. All the patients were given educational informations relative to diagnosis of OSA and benefits of OSA treatment, and an individualized training with CPAP.

RESULTS: Twenty-seven (75%) subjects dropped out of the study due to CPAP intolerance. No demographic or disease-related variables (in particular, severity of OSA), could be found between subjects who completed the study versus those who dropped out. Nine subjects completed the three-month follow up, and there were no significant changes in subjective sleepiness, neuropsychological scores and sleep structure (except for reduction in apnea/hypopnea index and a trend toward increase in stage N3 sleep).

CONCLUSION: Our data show that feasibility of CPAP treatment can be significantly threatened by overall attrition rates. Further studies should consider well-structured adherence promoting interventions. The actual role of OSA as a determinant of the profile of subjective daytime sleepiness and cognition in PD, and the effects of CPAP in PD need to be further studied.

Original languageEnglish
Pages (from-to)114-118
Number of pages5
JournalSleep Medicine
Volume33
DOIs
Publication statusPublished - May 2017

Fingerprint

Sleep Apnea Syndromes
Cognition
Parkinson Disease
Obstructive Sleep Apnea
Continuous Positive Airway Pressure
Therapeutics
Polysomnography
Sleep Stages
Apnea
Sleep
Demography
Education

Keywords

  • Aged
  • Attention
  • Cognition
  • Cognitive Dysfunction
  • Continuous Positive Airway Pressure
  • Feasibility Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Parkinson Disease
  • Patient Compliance
  • Polysomnography
  • Sleep Apnea Syndromes
  • Sleep Apnea, Obstructive
  • Sleep Stages
  • Treatment Outcome
  • Journal Article

Cite this

@article{bdf6938e24d245778ca1b86079507ba1,
title = "Treating sleep apnea in Parkinson's disease with C-PAP: feasibility concerns and effects on cognition and alertness",
abstract = "BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent in Parkinson disease (PD) and is known to contribute to cognitive impairment and daytime sleepiness. We investigated feasibility of continuous positive airway pressure treatment (CPAP) and its effects on subjective daytime sleepiness and cognitive profile in PD plus OSA subjects in a longitudinal three months follow up study.METHODS: Seventy (age 71.7 ± 7.6, disease duration 9.9 ± 12.3, UPDRS-III 33.7 ± 12.5, MMSE 25.3 ± 3.6; years of education 7.7 ± 3.2) out of 228 consecutive PD patients undergoing in-lab video-polysomnography were found to have obstructive sleep apnea. Thirty-six subjects accepted to titrate therapeutic CPAP. Video-polysomnography, neuropsychological battery evaluating different cognitive domains and subjective scales for daytime sleepiness were scheduled at baseline and after three months. All the patients were given educational informations relative to diagnosis of OSA and benefits of OSA treatment, and an individualized training with CPAP.RESULTS: Twenty-seven (75{\%}) subjects dropped out of the study due to CPAP intolerance. No demographic or disease-related variables (in particular, severity of OSA), could be found between subjects who completed the study versus those who dropped out. Nine subjects completed the three-month follow up, and there were no significant changes in subjective sleepiness, neuropsychological scores and sleep structure (except for reduction in apnea/hypopnea index and a trend toward increase in stage N3 sleep).CONCLUSION: Our data show that feasibility of CPAP treatment can be significantly threatened by overall attrition rates. Further studies should consider well-structured adherence promoting interventions. The actual role of OSA as a determinant of the profile of subjective daytime sleepiness and cognition in PD, and the effects of CPAP in PD need to be further studied.",
keywords = "Aged, Attention, Cognition, Cognitive Dysfunction, Continuous Positive Airway Pressure, Feasibility Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neuropsychological Tests, Parkinson Disease, Patient Compliance, Polysomnography, Sleep Apnea Syndromes, Sleep Apnea, Obstructive, Sleep Stages, Treatment Outcome, Journal Article",
author = "Michele Terzaghi and Laura Spelta and Brigida Minafra and Valter Rustioni and Roberta Zangaglia and Claudio Pacchetti and Raffaele Manni",
note = "Copyright {\circledC} 2017 Elsevier B.V. All rights reserved.",
year = "2017",
month = "5",
doi = "10.1016/j.sleep.2017.01.009",
language = "English",
volume = "33",
pages = "114--118",
journal = "Sleep Medicine",
issn = "1389-9457",
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}

TY - JOUR

T1 - Treating sleep apnea in Parkinson's disease with C-PAP

T2 - feasibility concerns and effects on cognition and alertness

AU - Terzaghi, Michele

AU - Spelta, Laura

AU - Minafra, Brigida

AU - Rustioni, Valter

AU - Zangaglia, Roberta

AU - Pacchetti, Claudio

AU - Manni, Raffaele

N1 - Copyright © 2017 Elsevier B.V. All rights reserved.

PY - 2017/5

Y1 - 2017/5

N2 - BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent in Parkinson disease (PD) and is known to contribute to cognitive impairment and daytime sleepiness. We investigated feasibility of continuous positive airway pressure treatment (CPAP) and its effects on subjective daytime sleepiness and cognitive profile in PD plus OSA subjects in a longitudinal three months follow up study.METHODS: Seventy (age 71.7 ± 7.6, disease duration 9.9 ± 12.3, UPDRS-III 33.7 ± 12.5, MMSE 25.3 ± 3.6; years of education 7.7 ± 3.2) out of 228 consecutive PD patients undergoing in-lab video-polysomnography were found to have obstructive sleep apnea. Thirty-six subjects accepted to titrate therapeutic CPAP. Video-polysomnography, neuropsychological battery evaluating different cognitive domains and subjective scales for daytime sleepiness were scheduled at baseline and after three months. All the patients were given educational informations relative to diagnosis of OSA and benefits of OSA treatment, and an individualized training with CPAP.RESULTS: Twenty-seven (75%) subjects dropped out of the study due to CPAP intolerance. No demographic or disease-related variables (in particular, severity of OSA), could be found between subjects who completed the study versus those who dropped out. Nine subjects completed the three-month follow up, and there were no significant changes in subjective sleepiness, neuropsychological scores and sleep structure (except for reduction in apnea/hypopnea index and a trend toward increase in stage N3 sleep).CONCLUSION: Our data show that feasibility of CPAP treatment can be significantly threatened by overall attrition rates. Further studies should consider well-structured adherence promoting interventions. The actual role of OSA as a determinant of the profile of subjective daytime sleepiness and cognition in PD, and the effects of CPAP in PD need to be further studied.

AB - BACKGROUND: Obstructive sleep apnea (OSA) is highly prevalent in Parkinson disease (PD) and is known to contribute to cognitive impairment and daytime sleepiness. We investigated feasibility of continuous positive airway pressure treatment (CPAP) and its effects on subjective daytime sleepiness and cognitive profile in PD plus OSA subjects in a longitudinal three months follow up study.METHODS: Seventy (age 71.7 ± 7.6, disease duration 9.9 ± 12.3, UPDRS-III 33.7 ± 12.5, MMSE 25.3 ± 3.6; years of education 7.7 ± 3.2) out of 228 consecutive PD patients undergoing in-lab video-polysomnography were found to have obstructive sleep apnea. Thirty-six subjects accepted to titrate therapeutic CPAP. Video-polysomnography, neuropsychological battery evaluating different cognitive domains and subjective scales for daytime sleepiness were scheduled at baseline and after three months. All the patients were given educational informations relative to diagnosis of OSA and benefits of OSA treatment, and an individualized training with CPAP.RESULTS: Twenty-seven (75%) subjects dropped out of the study due to CPAP intolerance. No demographic or disease-related variables (in particular, severity of OSA), could be found between subjects who completed the study versus those who dropped out. Nine subjects completed the three-month follow up, and there were no significant changes in subjective sleepiness, neuropsychological scores and sleep structure (except for reduction in apnea/hypopnea index and a trend toward increase in stage N3 sleep).CONCLUSION: Our data show that feasibility of CPAP treatment can be significantly threatened by overall attrition rates. Further studies should consider well-structured adherence promoting interventions. The actual role of OSA as a determinant of the profile of subjective daytime sleepiness and cognition in PD, and the effects of CPAP in PD need to be further studied.

KW - Aged

KW - Attention

KW - Cognition

KW - Cognitive Dysfunction

KW - Continuous Positive Airway Pressure

KW - Feasibility Studies

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Neuropsychological Tests

KW - Parkinson Disease

KW - Patient Compliance

KW - Polysomnography

KW - Sleep Apnea Syndromes

KW - Sleep Apnea, Obstructive

KW - Sleep Stages

KW - Treatment Outcome

KW - Journal Article

U2 - 10.1016/j.sleep.2017.01.009

DO - 10.1016/j.sleep.2017.01.009

M3 - Article

C2 - 28449889

VL - 33

SP - 114

EP - 118

JO - Sleep Medicine

JF - Sleep Medicine

SN - 1389-9457

ER -