Obstructive sleep apnea increases risk for dementia in midlife adults, especially women
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Key takeaways:
- Known/suspected obstructive sleep apnea increased dementia risk for midlife men and women, researchers found.
- At every age, obstructive sleep apnea was associated with higher dementia risk for women vs. men.
Adults aged 50 years and older, particularly women, who experienced obstructive sleep apnea appeared to be at higher risk for dementia, according to a new study published in SLEEP Advances.
“Our findings offer new insight into the role of a treatable sleep disorder on long-term cognitive health at the population level for both women and men,” Tiffany J. Braley, MD, MS, the Holtom-Garrett Family Professor of Neurology and section head for multiple sclerosis at Michigan Medicine, said in related university press release.
Approximately 7 million Americans are currently living with dementia, which disproportionately affects women, according to the researchers. Previous studies have explored the relationship between obstructive sleep apnea (OSA) and dementia to identify dementia risk factors before cognitive decline begins. However, the comorbidities and environmental exposures that may create this gender disparity need further investigation, they said.
Further, Braley and colleagues added, population-based data that capture potential undiagnosed OSA cases and include longer follow up and more granular cognitive measures are still needed to understand the relationship between OSA and dementia.
This motivated the researchers to explore gender-specific differences in dementia incidence among midlife and older adults with known or suspected OSA.
Their analysis included 18,815 participants (74% white; 54% women; mean age of women, 61 years; mean age of men, 60 years) aged 50 years and older who were dementia-free at baseline recruited from 2010 to 2020 datasets of the Health and Retirement Study (HRS).
The researchers identified patients with known or suspected OSA via self-reported diagnosis or a positive screen on the STOP-Bang questionnaire, which helps identify OSA using medical history and demographic and sleep data. They found that 48% of participants met criteria for known or suspected OSA, the prevalence of which was more than twice as high in men compared with women (68% vs. 31%).
Also, based on a self-reported diagnosis or an HRS-based objective cognitive functioning algorithm, Braley and colleagues identified a total of 2,233 incident dementia cases (women, 9%; men, 8%).
Next, the researchers analyzed differences in the cumulative incidence of dementia by OSA status using survey-weighted regression models based on pseudo-values to account for covariates such as race/ethnicity, educational attainment and cohabitation status.
In unadjusted sex-stratified analyses, the researchers found that known/suspected OSA was associated with increased cumulative incidence of dementia among women and men aged 60 to 84 years, with higher cumulative incidence among women compared with men at every age.
Braley and colleagues found that, by age 80 years, the cumulative incidence of dementia was 4.7% (CI, 2.8-6.7) greater for women and 2.5% (CI, 0.5-4.5) greater for men with known/suspected OSA compared with women and men without OSA.
The association between known/suspected OSA and age-specific dementia reduced after adjusting for confounding variables but remained significant.
The researchers observed several limitations to this study, including a lack of cognitive data and inability to assess adherence to OSA treatment.
“Sleep apnea increases significantly post-menopause yet remains underdiagnosed,” Galit Levi Dunietz, PhD, MPH, associate professor in the division of sleep medicine at the University of Michigan, said in the release. “We need more epidemiologic studies to better understand how sleep disorders in women impact their cognitive health.”
Reference:
- Sleep apnea contributes to dementia in older adults, especially women. https://www.michiganmedicine.org/health-lab/sleep-apnea-contributes-dementia-older-adults-especially-women. Published Oct. 31, 2024. Accessed Nov. 6, 2024.
Perspective
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Women are twice as likely to develop Alzheimer’s disease as compared to men, a difference that has been attributed to variations in life expectancy. However, this study raises important questions about a treatable condition that may differentially impact brain health in men and women: sleep apnea.
Sleep apnea has been extensively studied in men, but studies have seldom considered sex differences in the impact of sleep apnea on brain health. Our own work has shown that most women with sleep apnea are undiagnosed, and therefore untreated. This suggests a need for additional research on sleep apnea, specifically in women, and the need for clinicians to understand how best to diagnose and treat this common sleep disorder in female patients.
This study is limited by its reliance on patient recall over objective testing and possible gender differences in symptom reporting, though a composite outcome helps address this and supports the main findings.
Regardless, the results suggest that a critical component of brain health is sleep health, and routine screening for common sleep disorders among both men and women could confer long-term health benefits. Providers should consider sleep apnea screening, diagnosis and treatment as an important preventive health practice for everyone, and perhaps especially for women.
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