A recent study published in SLEEP Advances highlights the varying risk of dementia in men and women with obstructive sleep apnea (OSA), revealing that women may face a higher threat. The research underscores the need for targeted interventions to address modifiable risk factors for dementia, especially in older adults.
Dementia in the U.S.: A Growing Concern
Dementia, a progressive condition marked by cognitive decline and behavioral changes due to neurodegenerative diseases, affects an estimated seven million Americans. Identifying risk factors that can be modified is essential for effective prevention and intervention, particularly as the aging population continues to grow.
While women are more likely to develop dementia than men, factors that contribute to this difference remain unclear. Research into how environmental factors and health conditions disproportionately affect women is ongoing, as these may play a role in dementia risk.
Obstructive Sleep Apnea: A Hidden Risk Factor
OSA, characterized by repeated episodes of blocked breathing during sleep, is linked to disrupted rest and oxygen deprivation. The condition is more common as people age and has been identified as a risk factor for dementia. However, studies that separate data by sex and track participants over extended periods have been limited.
About the Study
This study used data from 18,815 adults aged 50 and older, who were part of the Health and Retirement Study (HRS). The participants, with an average age of 60 for men and 61 for women, were dementia-free at the start of the study. Researchers used a combination of cognitive tests and a screening tool, the STOP-Bang questionnaire, to identify cases of OSA, as many individuals with OSA are undiagnosed.
The study tracked participants over ten years to determine the incidence of dementia, comparing men and women with and without OSA.
Findings: OSA and Dementia Risk
The results showed that 9% of women and 8% of men developed dementia during the study. About 48% of participants had known or suspected OSA, with a higher prevalence among men (68%) compared to women (31%). Additionally, people with OSA were more likely to have lower educational attainment.
The study found that the presence of OSA increased the risk of developing dementia, particularly between the ages of 60 and 84. By age 80, women with OSA had a 4-7% higher chance of developing dementia compared to those without OSA, while men had a 2.5% higher risk. This difference in risk between men and women widened with age.
The study also calculated the population-attributable risk (PAR%) for dementia due to OSA. The PAR% was 10.3% for women and 13.2% for men, indicating that OSA plays a more significant role in the dementia risk for men.
OSA’s Impact on Women
The study further explored the mechanisms by which OSA increases dementia risk, particularly in women. Sleep disturbances caused by OSA may lead to the accumulation of harmful proteins in the brain, such as tau and amyloid β42, both linked to Alzheimer’s disease. OSA can also cause chronic inflammation, impairing brain function and increasing the risk of other health issues like cardiovascular disease.
Women with OSA are more likely to experience lower quality of life, poor sleep, fatigue, depression, and cognitive decline compared to men with the condition. The risk of OSA in women increases after menopause, with later menopause onset appearing to reduce dementia risk.
Conclusions and Next Steps
This population-based study emphasizes that OSA is a significant risk factor for dementia, especially in older adults. The research highlights the importance of identifying and treating undiagnosed OSA, which affects an estimated 80% of patients with the condition.
Previous studies have suggested that treatments like positive airway pressure (PAP) may help protect individuals with OSA from cognitive decline, including Alzheimer’s disease. However, more research is needed to better understand how OSA affects men and women differently and to identify potential interventions.
Future studies with larger and more diverse groups, as well as improved methodologies, could provide crucial insights into the long-term relationship between OSA and dementia, potentially leading to new strategies to reduce dementia risk in older adults.
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