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

IF 4.9 2区医学 Q1 Medicine Sleep Pub Date : 2025-07-11 DOI:10.1093/sleep/zsaf038

Annie C Lajoie, Anne-Louise Lafontaine, R John Kimoff, Andrea Benedetti, Ann R Robinson, Marie Létourneau, Joelle Crane, Amanda Scanga, Francine Noel, Marta Kaminska

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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.

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帕金森病的认知和阻塞性睡眠呼吸暂停：气道正压随机对照试验（COPE-PAP试验）

研究目的：本随机对照试验评估气道正压通气（PAP）治疗阻塞性睡眠呼吸暂停（OSA）对帕金森病（PD）患者认知能力的影响。方法：蒙特利尔认知评估(MoCA) < 27和OSA的PD患者随机接受PAP或鼻扩张片（安慰剂）治疗6个月。主要结局是MoCA从基线到6个月的变化，通过t检验比较各组间治疗意向（ITT）。进行敏感性和每个方案（PP）分析，调整潜在的混杂因素。次要结局包括患者报告和运动结局。探索性结果包括详细的神经认知测试。结果：94名参与者（31%为女性），平均年龄67.3岁（SD 10.5），体重指数28.1 (4.7)kg/m2, MoCA 22.7（3.5）。PAP组（n=48） MoCA变化为0.60,95%CI[-0.08, 1.29]，对照组（n=46） MoCA变化为-0.39,95%CI [-1.21, 0.43]；组间差异1.00,95%CI [-0.06, 2.05] （ITT）。调整后的ITT分析显示，治疗组与对照组相比，MoCA改善了1.44,95%CI[0.09, 2.79]。在PP分析中，PAP组（n=33）与对照组（n=41）的校正组间差异为1.43,95%CI[0.054, 2.81]。非运动症状、抑郁和睡眠质量评分，以及某些执行和精神运动任务的表现，都在PAP治疗后得到改善。PP分析还显示，与对照组相比，PAP患者的运动功能有显著改善。结论：认知能力下降的PD患者应考虑对OSA的评估，因为OSA治疗可能改善认知功能，并可能改善患者报告的和运动预后。

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来源期刊

Sleep Medicine-Neurology (clinical)

CiteScore

8.70

自引率

10.70%

发文量

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