Cognition and obstructive sleep apnea in Parkinson's disease: randomized controlled trial of positive airway pressure

Abstract

Study objectives: This randomized controlled trial assessed the effects of positive airway pressure (PAP) treatment of obstructive sleep apnea (OSA) on cognition in patients with Parkinson's disease (PD).

Methods: Individuals with PD with Montreal Cognitive Assessment (MoCA) ≤ 27 and OSA were randomized to PAP or nasal dilator strips (placebo) for 6 months. The primary outcome was the change in MoCA from baseline to 6 months compared by t-test between groups by intention to treat (ITT). Sensitivity and per protocol (PP) analyses were performed, adjusting for potential confounders. Secondary outcomes included patient-reported and motor outcomes. Exploratory outcomes comprised detailed neurocognitive tests.

Findings: We randomized 94 participants (31% female) with a mean age of 67.3 (standard deviation 10.5) years, body mass index of 28.1 (4.7) kg/m2, and MoCA of 22.7 (3.5). The change in MoCA in the PAP group (n = 48) was 0.60, 95% CI [-0.08, 1.29] and in the control group (n = 46) -0.39, 95% CI [-1.21, 0.43]; between-group difference 1.00, 95% CI [-0.06, 2.05] (ITT). Adjusted ITT analyses showed improved MoCA by 1.44, 95% CI [0.09, 2.79], in treated versus control groups. In PP analyses, the adjusted between-group difference was 1.43, 95% CI [0.054, 2.81] between PAP (n = 33) versus control (n = 41) groups. Nonmotor symptoms, depression and sleep quality scores, and performance on certain executive and psychomotor tasks improved with PAP. PP analyses also showed significant improvement in motor function in PAP compared to control groups.

Conclusions: Evaluation for OSA in PD patients with reduced cognition should be considered as OSA treatment may improve cognitive function, and possibly patient-reported and motor outcomes.

Clinical trial information: Registered as "Cognition and Obstructive Sleep Apnea in Parkinson's Disease, Effect of Positive Airway Pressure Therapy (COPE-PAP)" at ClinicalTrials.gov. ID: NCT02209363. https://clinicaltrials.gov/study/NCT02209363?term=kaminska&rank=4.

Keywords: CPAP; MDS-UPDRS; MoCA; Parkinson’s disease; cognitive function; neurocognitive assessment; obstructive sleep apnea; randomized controlled trial; sleep disorders.