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Research Links Untreated Sleep Problems to Mental Declines

As if there weren’t enough clear and compelling reasons to address the critical health issue of obstructive sleep apnea and heavy snoring, researchers at New York University’s Center for Cognitive Neurology have just exposed another one — it turns out that people who have been diagnosed with apnea or who snore heavily but who aren’t treated for the problem are much more likely to develop degenerative brain issues at an earlier age than those who seek and continue treatment.

Obstructive sleep apnea is a sleep disorder in which the tissues and muscles of the airway collapse upon themselves when the person diagnosed with the condition falls asleep. The blockage of the airway occurs multiple times throughout the night, and in the most severe cases it happens hundreds of times. Each time it occurs the body goes without air for a period of time until the brain suddenly panics and awakens it. Those who observe people with sleep apnea describe periods without breathing interrupted by a split-second awakening and explosive gasping for air, with the patient completely unaware that it is happening. The condition has been linked to cardiovascular problems, increased risk of stroke, high blood pressure, obesity, diabetes and depression.

This most recent study is not indicating that memory problems are caused by apnea or the breathing problems represented by heavy snoring, but that it hastens the appearance of the symptoms (or that treatment delays the onset of symptoms). According to lead researcher Dr. Ricardo Osorio, a research assistant professor of psychiatry, “There is a question whether sleep disruption is an early symptom or a risk factor.”

“Treatment may not cure the disease, but may delay the onset of memory problems,” says Osorio. The optimal treatment is use of a continuous positive airway pressure machine (CPAP), which is considered the gold standard for the treatment of apnea, and the difference in time is significant, with those who use the CPAP device delaying the onset of mild mental decline by as much as ten years. “That’s a big gap,” he says. “Our assumption is that a [sleep breathing problem] works both ways – it is an early symptom and can be a risk factor.”

With awareness of obstructive sleep apnea and its dangers on the rise, more and more people are seeking diagnosis, and that is a good thing. It is estimated that it impacts as many as 53 percent of senior men and 26 percent of senior women. “Sleep apnea is underdiagnosed in the elderly and unrecognized as a potential risk factor for Alzheimer’s disease.”

To determine the value of treatment, Osori and his team analyzed data that ha been collected from nearly 2,500 patients between the ages of 55 and 90. They were categorized based on a number of factors, including whether and to what degree they were experiencing memory problems or Alzheimer’s disease, whether they had been diagnosed with breathing problems and if they had, whether they were being treated for the condition. What they found in comparing the information in the medical records was that people who had been diagnosed with either heavy snoring or obstructive sleep apnea were more likely to be diagnosed with mild mental decline approximately ten years earlier than their peers who were not experiencing the sleep or breathing issues. The difference was striking, with those who were identified with the breathing issues beginning to see cognitive decline at the age of 77, while those who did not snore or have sleep apnea not having memory problems until they were closer to the age of 90, some 13 years later.

Taking the study even farther, the group looked at those who had been diagnosed with Alzheimer’s disease and determined that among those who had been diagnosed with heavy snoring or apnea, the age of onset was approximately 83 while those who did not have sleep apnea or snoring issues were not diagnosed until the age of 88.

Most tellingly of all, those who had been diagnosed with sleep apnea and who had been compliant with treatment, using the CPAP device regularly, were found to have delays in the development of cognitive impairment that were roughly equivalent to those who had no breathing problems at all, with the difference being the onset of symptoms at the age of 82 versus at the age of 72 for those who did not seek or receive treatment.

Continuous positive airway pressure, or CPAP, has been found to be remarkably effective in the treatment of obstructive sleep apnea, but it can be cumbersome and uncomfortable to use. As a result, many patients who have been diagnosed with the condition either refuse to utilize the device entirely or end up noncompliant. The device consists of a motor that generates the flow of oxygen, and which is connected to a tube and a mask that covers both the nose and the mouth. A gentle flow of air is sent through the airway as the patient sleeps, keeping the airway open and preventing the lack of oxygen that is characteristic of the disease. Patients have objected to a number of aspects of the CPAP machine, including the fact that they do not like the way that it looks in their bedroom, the fact that the equipment is noisy, and the discomfort of having to wear the mask over the face every night while sleeping. But for those who overcome these objections, the difference in health has proven to be remarkable, and this latest study is just another reason why patients should be urged to overcome the discomfort and make adjustments.

According to Dr. Sam Gandy, director of the Center for Cognitive Health at Mount Sinai Hospital in New York City, the information yielded in this study is “extremely important because this is an intervention – CPAP – that can be readily prescribed and may delay onset of mental decline.”

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