Effect of CPAP on Cognition, Brain Function, and Structure Among Elderly Patients With OSA: A Randomized Pilot Study

Area of Science:

• Neurology
• Gerontology
• Sleep Medicine

Background:

• Obstructive sleep apnea (OSA) is prevalent in the elderly, yet its cognitive effects and CPAP treatment efficacy remain understudied.
• Aging populations are increasing, highlighting the need to understand OSA's impact on cognitive function in older adults.

Purpose of the Study:

• To investigate cognitive deficits and brain alterations in elderly patients with severe OSA.
• To determine if continuous positive airway pressure (CPAP) treatment can improve these deficits and alterations.

Main Methods:

• A randomized, evaluator-blinded, parallel-group pilot study involving 33 elderly patients (≥ 65 years) with newly-diagnosed severe OSA.
• Patients received either conservative care (CC) or CPAP plus CC for 3 months, with assessments at baseline and 3 months.
• Neuropsychological evaluation and functional/structural MRI of default mode network (DMN) connectivity and cortical thickness were performed.

Main Results:

• No baseline cognitive differences were found between groups.
• CPAP treatment significantly improved episodic memory, short-term memory, and executive functions (processing speed, mental flexibility).
• CPAP increased connectivity in the right middle frontal gyrus and attenuated cortical thinning; no association was found between cognition and DMN connectivity.

Conclusions:

• Elderly patients with severe OSA and cognitive difficulties may benefit from CPAP treatment.
• CPAP therapy positively impacts brain connectivity and reduces cortical thinning in this population.