Sleep apnea disguised as dementia

American Academy of Dental Sleep Medicine
Thursday, October 6, 2011

In a New York Times blog post the dangers of obstructive sleep apnea masquerading as dementia was discussed. Last year, Alzheimer’s specialist Dr. Ronald Petersen met a new patient at the Mayo Clinic. She was only in her 60s but had trouble concentrating. “She couldn’t follow a television program or stay focused during a conversation,” said Dr. Petersen. What first seemed like early symptoms of dementia, soon indicated a sleep disorder. Although she was unaware of having any sleep problems, her son reported that “she was snoring like a freight train.”

The patient was sent for an overnight sleep study. The results indicated that she had obstructive sleep apnea (OSA). This condition causes pauses in breath during sleep. These pauses prevent oxygen flow and REM sleep. Risk for OSA increases with age and weight gain. Symptoms can exacerbate or mimic dementia symptoms.
There are several successful treatment options including continuous positive airway pressure (CPAP) and oral appliance therapy. Treating sleep apnea often reduces the feeling of excessive daytime sleepiness.

Within a year of starting CPAP treatment, the patient’s scores on neuropsychological tests were normal range.

Dr. Sonia Ancoli-Israel has studied OSA for 30 years. She noted that almost half of older adults experience apnea to some degree, with even higher rates among those with dementia. Seniors who live alone may not know they snore. They may also think it’s normal to feel sleepy during the day.

It’s important to know the signs of OSA. Unfortunately, 80 to 90 percent of people with sleep apnea are unaware of their condition. Untreated OSA is frequently linked to cognitive decline. It also raises the risk for heart disease, stroke, diabetes and driving accidents. “If you’re waking up hundreds of times a night and you’re not getting enough oxygen to the brain, of course you’ll see the effect,” said Dr. Ancoli-Israel.

She and her team, in a study published in 2008 in The Journal of the American Geriatrics Society, found that treating sleep apnea with CPAP improved attention, judgment and decision-making.

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