OSA Case Studies

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My long-term goal is to become an independent investigator focused on developing and implementing treatment strategies that may delay the onset of Alzheimer disease (AD) in older adults with obstructive sleep apnea (OSA) comorbid with complex neuropsychiatric conditions. The Mentored Patient-Oriented Career Development Award (K23) integrated training and research that provides me with (1) experiences to identify, diagnose, and treat OSA and residual neuropsychiatric symptoms in older adults at risk for AD, (2) skills in research design, conduct, and outcome analyses, and (3) knowledge of neuroimaging to identify cerebral vascular and AD pathologies.
Significance: The annual conversion rate from MCI to AD is 8–15%,1,2 and total health care spending …show more content…
OSA plays a role in the pathogenesis of depression4,5 and MCI,6,7 and is associated with an early onset of AD,7 suggesting that OSA alone or comorbidities may increase the risk for AD. CPAP shows benefits for depression 8-13 and cognitive deficits,7,14,15 and may delay the onset of AD.7 Thus, identify and treat OSA reduces the rate of conversion to AD in some patients. But untreated residual MCI and depression can result in continuing cognitive decline and increased conversion to AD despite adequate CPAP therapy. The long-term prognosis in these patients remains unclear. There is no data on a continuation treatment of residual cognitive deficits and depression beyond CPAP. Our group and others have shown that the combined treatment of antidepressant and acetylcholinesterase inhibitor (AChEI) in elderly with MCI and depression improve cognition and delays conversion to dementia.16-19 The preliminary data showed that serotoninergic …show more content…
Those meet the criteria for MCI (defined as 1 SD below age and sex adjusted norms on memory) and have a Stop-Bang score of ≥3 will receive out of center OSA diagnostic test for 2 security nights. Total 60 patients with OSA (AHI ≥10) will enroll in this study. All patients will receive CPAP treatment through the study; Brain imaging is offered at baseline and after 16 weeks of CPAP treatment but before add-on medication treatment. At 4 months, those with residual MCI will be treated with donepezil; those have residual depression will be treated with either escitalopram or venlafaxine based on the physicians’ choice. In depressed patients with sleep fragmentation due to urinary incontinence or pain, duloxetine is another option. Patients with both residual depression and cognitive deficits will be treated with antidepressant for 3 months followed by donepezil. Patients will be followed for 12
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