Obstructive Sleep Apnea Outcome Analysis
Overall Goal: This research plan will develop the candidate’s knowledge and skills in the diagnosis and treatment of obstructive sleep apnea, methodology and outcome analyses in longitudinal trials, and neuroimaging to provide expertise in cerebral microvascular contribution to cognitive deterioration and depressive symptoms in elderly patients with OSA.
Significance: Obstructive sleep apnea (OSA) is a major health problem, as more than 22 million adults in the U.S suffer from
OSA but estimates suggest that 85% of individuals with moderate to severe OSA remain undiagnosed.1 Patients with untreated moderate to severe OSA are at a greater risk for depression, mild cognitive impairment (MCI), and dementia compared to those without OSA. In OSA, …show more content…
Also, hypoxia and reoxygenation cause oxidative stress,17,18 that alters blood-brain barrier functions, leading to the formation of C-SVD19-21 and cerebral amyloid angiopathy (CAA).22-25 Hypoperfusion causes an accumulation of toxic Aβ aggregates and a reduction of amyloid clearance.26 The progression of C-SVD has shown to be associated with new onset of depression,27 MCI, and a higher rate of conversion from MCI to dementia28-30 in elderly patients. Therefore, we hypothesize that C-SVD may mediate the associations between OSA and depression and cognitive impairment. The presence of multiple neuropsychiatric manifestations of OSA may represent mixed pathologies and indicate damage to various areas of the brain. In our pilot …show more content…
Patients meet the criteria for MCI (Logical Memory I or II ≤ 11) or a current episode of depression (DSM-V and 12 ≤ HRSD ≤ 30) and have a stop-Bang score of ≥ 3 will receive out of center OSA diagnostic test for 2 consecutive nights. Total 60 patients with OSA (AHI ≥15), including 30 with depression and 30 with MCI, will receive CPAP treatment. Cognitive measures include Verbal Memory (SRT), processing speed (Trial A and Digit Symbol), and executive function (Trial B and Digit Symbol); depression is measured with HRSD and BDI. After 3 months of CPAP treatment, if depressed patients do not respond to CPAP treatment for depression (≤ 50% reduction in HRSD) and patients have a new onset of depression (HRSD≥ 12), they will be treated with serotonergic antidepressants while continuing CPAP treatment. The rationale is that serotonergic antidepressants improve depression and may improve OSA by reducing upper airway collapsibility. MRI (WMHs and WMLs) and DTI (white matter integrity) are used to measure the microvascular burden in all patients at baseline and 6
Significance: Obstructive sleep apnea (OSA) is a major health problem, as more than 22 million adults in the U.S suffer from
OSA but estimates suggest that 85% of individuals with moderate to severe OSA remain undiagnosed.1 Patients with untreated moderate to severe OSA are at a greater risk for depression, mild cognitive impairment (MCI), and dementia compared to those without OSA. In OSA, …show more content…
Also, hypoxia and reoxygenation cause oxidative stress,17,18 that alters blood-brain barrier functions, leading to the formation of C-SVD19-21 and cerebral amyloid angiopathy (CAA).22-25 Hypoperfusion causes an accumulation of toxic Aβ aggregates and a reduction of amyloid clearance.26 The progression of C-SVD has shown to be associated with new onset of depression,27 MCI, and a higher rate of conversion from MCI to dementia28-30 in elderly patients. Therefore, we hypothesize that C-SVD may mediate the associations between OSA and depression and cognitive impairment. The presence of multiple neuropsychiatric manifestations of OSA may represent mixed pathologies and indicate damage to various areas of the brain. In our pilot …show more content…
Patients meet the criteria for MCI (Logical Memory I or II ≤ 11) or a current episode of depression (DSM-V and 12 ≤ HRSD ≤ 30) and have a stop-Bang score of ≥ 3 will receive out of center OSA diagnostic test for 2 consecutive nights. Total 60 patients with OSA (AHI ≥15), including 30 with depression and 30 with MCI, will receive CPAP treatment. Cognitive measures include Verbal Memory (SRT), processing speed (Trial A and Digit Symbol), and executive function (Trial B and Digit Symbol); depression is measured with HRSD and BDI. After 3 months of CPAP treatment, if depressed patients do not respond to CPAP treatment for depression (≤ 50% reduction in HRSD) and patients have a new onset of depression (HRSD≥ 12), they will be treated with serotonergic antidepressants while continuing CPAP treatment. The rationale is that serotonergic antidepressants improve depression and may improve OSA by reducing upper airway collapsibility. MRI (WMHs and WMLs) and DTI (white matter integrity) are used to measure the microvascular burden in all patients at baseline and 6