Positive airway pressure adherence among patients with obstructive sleep apnea and cognitive impairment: A narrative review

Adults with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) have increased rates of Obstructive Sleep Apnea (OSA). Positive Airway Pressure (PAP) is the first-line treatment for OSA and may have potential benefits for slowing cognitive decline in these individuals. However, adherence is low in PAP users overall and those with cognitive impairment may have unique challenges. Furthermore, there has been little systematic study of the use of PAP or strategies to enhance PAP adherence among those with AD or MCI. The aim of this review is to examine existing observational, quasi-experimental and experimental studies of the effects of PAP on cognitive function. In addition, our goal was to gather evidence about the adherence rates, and support for PAP among adults with MCI and mild to moderate AD. Through searches of electronic databases (University of Utah Library, SAGE Publishing, PubMed, Wiley, EBSCO, Science Direct, ProQuest, and NCBI), we identified 11 articles that fit our study inclusion criteria. Synthesis of data was performed with a focus on cognitive outcomes of PAP interventions and adherence. Findings from the studies showed that multiple indices of memory improved with PAP use. Adherence in MCI and AD populations was largely comparable to adherence reported in general adult populations, but more research is needed to optimize systems for providing support for PAP users and caregivers. Results support PAP as a promising intervention in this population but more research is needed to make definitive conclusions about the relationship between PAP use and improved cognitive function. Furthermore, research is needed to determine if additional interventions are needed to support patients and caregivers.