A systematic review on adherence to continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) in individuals with mild cognitive impairment and Alzheimer's disease dementia

Cerys Oliver; Haoxuan Li; Bijetri Biswas; David Woodstoke; Jonathan Blackman; Anneka Butters; Cheney Drew; Victoria Gabb; Sam Harding; Camilla M Hoyos; Adrian Kendrick; Sarah Rudd; Nicholas Turner; Elizabeth Coulthard

doi:10.1016/j.smrv.2023.101869

A systematic review on adherence to continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) in individuals with mild cognitive impairment and Alzheimer's disease dementia

Sleep Med Rev. 2024 Feb:73:101869. doi: 10.1016/j.smrv.2023.101869. Epub 2023 Oct 24.

Authors

Affiliations

¹ Cardiff University, Cardiff, UK; University of Bristol, Bristol, UK.
² University of Bristol, Bristol, UK; University Hospitals Bristol and Weston NHS Trust, Bristol, UK.
³ University of Bristol, Bristol, UK.
⁴ University of Bristol, Bristol, UK; North Bristol NHS Trust, Bristol, UK.
⁵ Cardiff University, Cardiff, UK.
⁶ North Bristol NHS Trust, Bristol, UK.
⁷ Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia.
⁸ University of Bristol, Bristol, UK; University Hospitals Bristol and Weston NHS Trust, Bristol, UK; University of the West of England, Bristol, UK.
⁹ University of Bristol, Bristol, UK; North Bristol NHS Trust, Bristol, UK. Electronic address: elizabeth.coulthard@bristol.ac.uk.

PMID: 37924680
DOI: 10.1016/j.smrv.2023.101869

Abstract

Obstructive sleep apnoea (OSA) is highly prevalent in mild cognitive impairment (MCI) and Alzheimer's disease (AD). The gold standard treatment for OSA is continuous positive airway pressure (CPAP). Long-term, well-powered efficacy trials are required to understand whether CPAP could slow cognitive decline in individuals with MCI/AD, but its tolerability in this group remains uncertain. The present review investigates CPAP adherence among individuals with OSA and MCI/AD. Electronic searches were performed on 8 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Six independent studies and four secondary analyses included 278 unique participants (mean age = 72.1 years). In five of the retained studies, around half of participants (45% N = 85 MCI, 56% N = 22 AD) were adherent to CPAP, where ≥4 h use per night was considered adherent. Three of the retained studies also reported average CPAP use to range between 3.2 and 6.3 h/night. CPAP adherence in individuals with MCI and AD is low, albeit similar to the general elderly population. Reporting adherence in future studies as both average duration as well as using a binary cut-off would improve our understanding of the optimum CPAP use in dementia clinical trials and care.

Keywords: Alzheimer’s; Cognitive impairment; Continuous positive airway pressure; Dementia; Sleep apnoea.

Publication types

Systematic Review
Review

MeSH terms

Aged
Alzheimer Disease*
Cognitive Dysfunction*
Continuous Positive Airway Pressure*
Humans
Patient Compliance*
Sleep Apnea, Obstructive* / psychology
Sleep Apnea, Obstructive* / therapy