Treatment of Obstructive Sleep Apnea in patients with Alzheimer’s Disease: role of Continuous Positive Airway Pressure therapy

Obstructive Sleep Apnea (OSA) is a frequent comorbidity in patients with Alzheimer’s Disease (AD). This narrative review critically examines current evidence on the relationship between OSA and AD, discussing their shared pathogenic mechanisms. Furthermore, the review focuses on the rationale, effectiveness, and feasibility of Continuous Posi- tive Airway Pressure (CPAP) treatment in patients with comorbid OSA and mild cognitive impairment (MCI) or dementia due to AD. Finally, this review provides clinicians with a practical approach for the proper diagnosis, and management of OSA in patients with AD either in the context of memory clinics and sleep medicine centers. Recent Findings Chronic intermittent hypoxia, glymphatic system failure and sleep disruption are the most important mecha- nisms connecting OSA to AD pathophysiology. Randomized clinical trials and observational studies show that OSA treat- ment with CPAP in patients with AD results in improvement of daytime vigilance, mood and executive functions as well as sleep consolidation. Moreover, it has been shown that CPAP has a mild potential effect on cognitive trajectories over time. Interestingly, adherence rates to CPAP treatment are similar to those reported in the general population. Summary Patients with MCI and AD dementia should be screened for the presence of OSA as part of the routinary clinical evaluation. Given its proven efficacy and feasibility, treatment with CPAP should be offered in patients with comorbid AD and moderate-severe OSA and a proper follow-up should be established to ensure treatment compliance and tolerability.