OSA, Sleep Apnea, Obstructive Sleep Apnea, Alzheimer Disease
Conditions
Keywords
sleep, OSA, Sleep Apnea, Obstructive Sleep Apnea, Alzheimer Disease, Sleep Disorder, Alzheimer
Brief summary
Obstructive sleep apnea (OSA) is common in older adults and has recently been implicated in pathogenesis of Alzheimer's disease (AD). Research has shown that sleep disruptions have caused memory impairment. Sleep apnea is a form of sleep disruption. We would like to examine how obstructive sleep apnea may contribute to the progression of Alzheimer's disease.
Detailed description
Aim 1: We will assess the endotypes (mechanisms) underlying OSA in elderly individuals known to be high risk for AD (vs. non-OSA matched controls) using novel recently validated simplified techniques which do not require burdensome complex overnight experiments to assess endotypes (primary outcome loop gain). We will further assess the predicted response to O2 therapy in terms of respiratory outcomes among elderly OSA patients with varying levels of loop gain and pharyngeal collapsibility. Hypothesis 1: A substantial proportion of high AD risk patients with OSA should be O2 responsive as predicted using pathophysiological assessments. Aim 2: We will perform an overnight mechanistic study of oxygen therapy vs. room air in high AD risk patients with OSA (recruited from Aim 1 and others if necessary). Given the frequent intolerance of PAP in elderly patients, we anticipate that oxygen therapy may be a viable therapeutic approach in this fragile population. We will focus on respiratory outcomes (primary outcome: apnea hypopnea index) but also assess sleep dependent memory consolidation on word pairs task given the major impact in the elderly. Hypothesis 2: O2, compared to room air, will improve OSA and neurocognitive outcomes in select elderly OSA patients at risk of AD. Aim 3: Preclinical AD with OSA and non-OSA controls, from Aim 1 will have structural and molecular brain imaging focusing on hippocampal atrophy as a predictor of memory consolidation. We will also assess amyloid and tau in the medial temporal region as function of OSA severity and as a predictor of neurocognitive function. This aim will lay the groundwork for designing a robust clinical trial using neuroimaging outcomes. Hypothesis 3: Impairment in memory consolidation is a function of hippocampal size in OSA patients at risk of AD. Aim 4: We will perform a pilot randomized trial of oxygen vs. PAP therapy in OSA patients with preclinical AD. Hypothesis 4: In preclinical AD with OSA, oxygen will be a viable therapeutic strategy to improve memory.
Interventions
OTHERSupplemental Oxygen
Subjects will be instrumented with a nasal cannula to receive 2L/min supplemental oxygen. The oxygen will be kept at a fixed rate, however, the participant will be titrated to receive a max of 4 liters per min to maintain sats \>90% based on oximetry readings.
Continuous positive airway pressure is a form of positive airway pressure ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person.
OTHERRoom Air
Subjects will be instrumented with a nasal cannula to receive 2L/min pressurized room air. The room air will be kept at a fixed rate, however, the participant will be titrated to receive a max of 4 liters per min to maintain sats \>90% based on oximetry readings.
Sponsors
University of California, San Diego
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Masking description
If subjects have been randomized to receive room air, subjects will have a nasal cannula with pressurized room air to avoid unblinding.
Eligibility
Sex/Gender
ALL
Age
65 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
1. Age 65-85 years 2. Gender: Men or Women 3. MOCA \> 26 4. Independently living and able to drive 5. OSA (AHI ≥ 15/h) or no OSA 6. Subjects must consent to waiving their right to obtain their PHS score (since the score is not yet actionable and could lead to social stress and ethical dilemmas)
Exclusion criteria
1. Currently smoking 2. History of COPD or asthma 3. Heart Failure Class III or IV, unstable cardiovascular disease, or uncontrolled hypertension 4. Neuromuscular Disease 5. Drowsy Driving (ESS \> 18/24) 6. Inability to complete study procedures, such as questionnaire that are only available/validated in English 7. Lack of decisional capacity to provide informed consent 8. Participants in whom magnetic resonance imaging Magnetic Resonance Imaging \[MRI\] is contraindicated including, but not limited to, those with a pacemaker, presence of metallic fragments near the eyes or spinal cord, or cochlear implant 9. Presence of a brain tumor or lobar stroke 10. Current drug or alcohol abuse/dependence 11. Prisoners
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Loop Gain (LG) - Crossover | Over 8 hours on each of the two crossover treatment nights | A method used to measure respiratory stability of the negative feedback chemoreflex control system using a specialized Positive Airway Pressure machine called a pCrit. The overall loop gain of the ventilatory system reflects the ratio of the ventilatory response to the disturbance that elicited the response (LG = ventilatory response/ventilatory disturbance). The higher the loop gain, the potentially more unstable the respiratory control system becomes. Result specified as change from room air condition to oxygen condition during the crossover trial |
| Apnea Hypopnea Index - Crossover | Over 8 hours on each of the two crossover treatment nights | The number of times a person stops breathing and periods of shallow breathing with a marked decrease in blood oxygen concentration every hour on average. A score lower than five indicates normal sleep (no sleep apnea), 5-15 indicates mild sleep apnea, 15-30 indicates moderate sleep apnea, and a score greater than 30 indicates severe sleep apnea. Result specified as change from room air condition to oxygen condition during the crossover trial |
| Neuroimaging - BRAAK12 tauPET | Two 1-hour long scans | MRI and PET Scans. This study will examine pre-clinical Alzheimer's disease with OSA patients using brain imaging (structural MRI and amyloid/tau PET). MRI will be conducted to provide a structural image suitable for coregistering the PET image and observing white matter integrity. The scan should take 35 minutes. These will be MPRAGE images collected using the standard ADNI protocol at the in-house 3T MRI scanner at the University of California San Diego Altman Clinical and Translational Research Institute (ACTRI). The PET scan should take 70-90 minutes and uses the 18F-MK6240 tracer. Result given is the Standardized Uptake Value Ratio (SUVR) of tau protein in the BRAAK1-2 regions, the earliest regions to develop tau pathology in Alzheimer's disease |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Epworth Sleepiness Scale (ESS) - Parallel | 12 weeks | A self-administered questionnaire with 8 questions. Respondents are asked to rate, on a 4-point scale (0-3), their usual chances of dozing off or falling asleep while engaged in eight different activities. The ESS score (the sum of 8 item scores, 0-3) can range from 0 to 24. The higher the ESS score, the higher that person's average sleep propensity in daily life. Result specified as change from week 1 to week 12 during the parallel treatment trial |
| Pittsburgh Sleep Quality Index (PSQI) - Parallel | 12 weeks | A 19-item, self-rated questionnaire designed to measure sleep quality and disturbance over the past month. The sleep component scores are summed to yield a total score ranging from 0 to 21 with the higher total score (referred to as global score) indicating worse sleep quality. Result specified as change from week 1 to week 12 during the parallel treatment trial |
| Insomnia Severity Index (ISI) - Parallel | 12 weeks | A 7-item self-report form to assess insomnia severity. Total score categories: 0-7 = No clinically significant insomnia, 8-14 = Subthreshold insomnia, 15-21 = Clinical insomnia (moderate severity), 22-28 = Clinical insomnia (severe). Result specified as change from week 1 to week 12 during the parallel treatment trial |
Countries
United States
Participant flow
Recruitment details
Participants were recruited from the University of California San Diego sleep clinic and via online advertisement across the San Diego area. Recruitment and enrollment occurred between October 8, 2021 and April 1, 2025.
Pre-assignment details
182 participants were consented to take part in the study. 40 did not meet neurocogntive criteria. 40 did not have sleep apnea during their baseline sleep study, however, 10 of these participants were assigned to a control group for neuroanatomical scans. Of the remaining 112, 24 declined to take part in the randmoized trial following their baseline sleep study.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 68.0 years STANDARD_DEVIATION 1.7 |
| Baseline apnea-hypopnea index | 6.9 units on a scale STANDARD_DEVIATION 4.3 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 76 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants |
| Race (NIH/OMB) More than one race | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants |
| Race (NIH/OMB) White | 13 Participants |
| Region of Enrollment United States | 74 participants |
| Sex: Female, Male Female | 38 Participants |
| Sex: Female, Male Male | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk | EG004 affected / at risk | EG005 affected / at risk | EG006 affected / at risk | EG007 affected / at risk | EG008 affected / at risk |
|---|---|---|---|---|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 10 | 0 / 18 | 0 / 20 | 0 / 7 | 0 / 7 | 0 / 9 | 0 / 7 | 0 / 5 | 0 / 5 |
| other Total, other adverse events | 0 / 10 | 1 / 18 | 0 / 20 | 0 / 7 | 0 / 7 | 0 / 9 | 0 / 7 | 0 / 5 | 0 / 5 |
| serious Total, serious adverse events | 0 / 10 | 0 / 18 | 0 / 20 | 0 / 7 | 0 / 7 | 0 / 9 | 0 / 7 | 0 / 5 | 0 / 5 |
Outcome results
None listed