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May 23, 2023
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CPAP improves cognition in patients with Parkinson’s disease, obstructive sleep apnea

Fact checked byKristen Dowd
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Key takeaways:

  • Patients with Parkinson’s disease, obstructive sleep apnea and decreased cognition treated with CPAP had improved cognitive function.
  • Better cognition may be achieved with obstructive sleep apnea treatment.

WASHINGTON — Among patients with Parkinson’s disease, obstructive sleep apnea and decreased cognition, CPAP therapy improved cognitive function, according to an abstract presented at the American Thoracic Society International Conference.

Marta Kaminska

“Our results show that most patients can use CPAP to some extent and that cognitive benefits can be derived even from use for under 4 hours per night,” Marta Kaminska, MD, MSc, FRCP(C), principal investigator and associate professor in the department of medicine at McGill University, and Annie C. Lajoie, MD, associate professor at Institut Universitaire de Pneumologie et de Cardiologie de Québec, told Healio in a statement.

Infographic showing changes in Montreal Cognitive Assessment scores in per-protocol analysis at 6 months.
Data were derived from Lajoie AC, et al. Cognition and obstructive sleep apnea in Parkinson's disease, effect of positive airway pressure therapy (COPE-PAP Trial). Presented at: American Thoracic Society International Conference; May 19-24, 2023; Washington, D.C.
Annie C. Lajoie

In a randomized placebo-controlled trial, Kaminska, Lajoie and colleagues analyzed 94 patients (mean age, 67.3 years; 31% women) with Parkinson’s disease, obstructive sleep apnea (OSA) and a score of less than 27 on the Montreal Cognitive Assessment (MoCA) to find out how CPAP changes their cognition after 6 months.

Researchers randomly assigned patients to receive CPAP or placebo in the form of nasal dilator strips and conducted two analyses to assess cognitive outcomes. The intention-to-treat analysis featured all patients using their last recorded cognitive assessment, whereas the per-protocol analysis featured those who had an assessment at 6 months and continuous users of CPAP for 6 months.

The per-protocol population consisted of 33 patients using CPAP at 6 months and 41 control patients. For patients using CPAP within this analysis, 3 hours and 14 minutes per night was the overall mean usage time at 6 months. Further, CPAP was used 66% of nights, and when used, the mean duration at 6 months was 4 hours and 13 minutes, according to the abstract.

Within the intention-to-treat population, 48 patients received CPAP and 46 patients received placebo. Compared with those receiving placebo, those receiving CPAP showed a “trend to improvement” rather than decline on the MoCA over 6 months (–0.39; 95% CI, –1.21 to 0.43 vs. 0.6; 95% CI, –0.08 to 1.29), according to the abstract.

Similarly, researchers observed positive changes to MoCA scores in patients using CPAP in the per-protocol analysis vs. patients using placebo (0.91; 95% CI, 0.01-1.81 vs. –0.44; 95% CI, –1.36 to 0.49; between-group difference, P = .04) at 6 months.

“We were happy to see a statistically significant improvement in global cognitive function in our per-protocol analyses, and a trend in intention-to-treat analyses,” Kaminska and Lajoie told Healio. “This suggests CPAP treatment of OSA has a role in Parkinson’s disease patients with reduced cognition in, not only stabilizing, but even potentially improving cognition. Unfortunately, CPAP therapy remains a challenge in all Parkinson’s patients with cognitive decline. However, patients with Parkinson’s should not be denied sleep testing and a trial of treatment for any identified obstructive sleep apnea.

“It remains unknown if correction of sleep apnea can result in a change in the trajectory of Parkinson’s progression and more work is warranted in this regard,” Kaminska and Lajoie added.

For more information:

Marta Kaminska MD, MSc, FRCP(C), can be reached at marta.kaminska@mcgill.ca.

Annie C. Lajoie, MD, can be reached at annie.lajoie@criucpq.ulaval.ca.