Can sleep apnea worsen dementia?

Sleep Apnea Can Worsen Dementia and Should Be Treated with CPAP

Yes, sleep apnea can worsen dementia, and adults with sleep apnea should be treated with continuous positive airway pressure (CPAP), which may improve cognition and decrease the risk of dementia progression. 1

Relationship Between Sleep Apnea and Dementia

Sleep apnea has been identified as both a risk factor for developing dementia and a condition that can accelerate cognitive deterioration in those who already have dementia. The evidence shows:

• Sleep apnea is listed as a medical condition associated with cognitive disorders 1
• Untreated sleep apnea is considered a risk factor that warrants cognitive assessment 1
• There is a strong relationship between severe sleep apnea and severe dementia 2
• Sleep apnea may play a causal role in both Alzheimer's disease and vascular dementia 3

Assessment and Diagnosis

For patients with dementia or at risk for dementia, the following approach is recommended:

1. A careful sleep history should be included in the assessment of any patient at risk for dementia 1

2. Assessment should include:

   • Evaluation of sleep time
   • Symptoms of sleep apnea (snoring, witnessed apneas, excessive daytime sleepiness)
   • Impact on daily functioning

3. Patients with suspected sleep apnea should be referred for polysomnography and/or sleep specialist consultation 1

Treatment Recommendations

The evidence strongly supports treating sleep apnea in patients with dementia:

• Adults with sleep apnea should be treated with CPAP, which may improve cognition and decrease the risk of dementia 1
• CPAP treatment in Alzheimer's disease patients with OSA has shown improvement in cognition, particularly in:
  • Episodic verbal learning and memory
  • Executive functioning
  • Cognitive flexibility
  • Mental processing speed 4

Benefits of Treatment

Treating sleep apnea in dementia patients can provide multiple benefits:

• Improved cognitive functioning 4
• Decreased risk of further cognitive decline 1, 5
• Improved daytime alertness and functionality 3
• Reduced excessive napping and lethargy common in dementia patients 3

Factors Affecting Treatment Success

Several factors may influence the success of CPAP treatment in dementia patients:

• Presence of a caregiver/family member invested in treatment 3
• Setting realistic goals for intervention (e.g., increasing daytime functionality) 3
• Comorbid conditions associated with both sleep apnea and dementia (cardiovascular disease, diabetes) 3

Additional Sleep-Related Recommendations

Beyond treating sleep apnea, other sleep-related recommendations for patients with or at risk for dementia include:

• Avoiding severe (<5 hours) sleep deprivation 1
• Targeting 7-8 hours of sleep per night 1
• Note that while insomnia, long sleep time, daytime napping, sleep fragmentation, and circadian irregularities are associated with dementia, there is insufficient evidence to recommend specific treatments for these conditions to improve cognition 1

Clinical Implications

Sleep apnea appears to be a potentially reversible cause of cognitive decline in dementia patients 4. Clinicians caring for patients with dementia should consider screening for sleep apnea and implementing CPAP treatment when OSA is present, as this may help slow cognitive deterioration and improve quality of life.