Risk of Alzheimer's Disease in Obstructive Sleep Apnea Patients With or Without Treatment: Real‐World Evidence

Objective To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence. Study Design Retrospective cohort study. Methods Patients newly diagnosed with OSA during 1997–2012 were identified using the National...

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Bibliographic Details
Published in:The Laryngoscope 2020-09, Vol.130 (9), p.2292-2298
Main Authors: Tsai, Ming‐Shao, Li, Hsueh‐Yu, Huang, Chung‐Guei, Wang, Robert Y.L., Chuang, Li‐Pang, Chen, Ning‐Hung, Liu, Chi‐Hung, Yang, Yao‐Hsu, Liu, Chia‐Yen, Hsu, Cheng‐Ming, Cheng, Wen‐Nuan, Lee, Li‐Ang
Format: Article
Language:English
Subjects:
Adult
Alzheimer Disease - epidemiology
Alzheimer Disease - etiology
Alzheimer's disease
Continuous positive airway pressure
Continuous Positive Airway Pressure - statistics & numerical data
Databases, Factual
dementia
Female
Humans
Incidence
Male
Middle Aged
obstructive sleep apnea
Otorhinolaryngologic Surgical Procedures - statistics & numerical data
Proportional Hazards Models
Retrospective Studies
Risk Factors
Sleep apnea
Sleep Apnea, Obstructive - psychology
Sleep Apnea, Obstructive - therapy
sleep disturbance
snoring
Taiwan - epidemiology
Treatment Outcome
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Summary:Objective To assess the risk of Alzheimer's disease (AD) in patients with obstructive sleep apnea (OSA) with or without treatment based on real‐world evidence. Study Design Retrospective cohort study. Methods Patients newly diagnosed with OSA during 1997–2012 were identified using the National Health Insurance Research Database of Taiwan. Patients without OSA were randomly selected and matched in a 1:4 ratio by age, sex, urbanization level, and income. All patients were followed up until death or the end of 2013. The primary outcome was AD occurrence. Results This study included 3,978 OSA patients and 15,912 non‐OSA patients. OSA was independently and significantly associated with a higher incidence of AD in an adjusted Cox proportional hazard model (adjusted hazard ratio: 2.12; 95% confidence interval [CI], 1.27–3.56). The average period of AD detection from the time of OSA occurrence was 5.44 years (standard deviation: 2.96). Subgroup analyses revealed that the effect of OSA remained significant in patients aged ≥60 years, male subgroups, patients without CPAP or surgical treatment, and patients without pharmacological therapies. Patients with OSA who received treatment (continuous positive airway pressure or surgery) exhibited a significantly reduced risk of AD compared with those without treatment (incidence rate ratio 0.23, 95% CI, 0.06–0.98). Conclusion OSA is independently associated with an increased risk of AD. Treatment for OSA reduces the AD risk in OSA patients. AD irreversibility renders OSA as a potential modifiable target for slowing or preventing the process of AD development. Level of Evidence IV Laryngoscope, 130:2292–2298, 2020
ISSN:0023-852X
1531-4995
DOI:10.1002/lary.28558