Sex-Specific Dementia Risk in Older Adults with OSA: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On November 12, 2024, we reported on a study published in the journal SLEEP Advances that assessed sex-specific associations between known or suspected obstructive sleep apnea (OSA) and risk of dementia among older adults.

The study

Researchers tapped data (2010 to 2020) from the longitudinal Health and Retirement Study (HRS) cohort that captures various aspects of health and well-being in a nationally representative sample of Americans aged 50 and older. From an initial sample of 28 058, the team identified adults with known/suspected OSA via self-report or positive results on the validated OSA screening STOP-Bang questionnaire, a tool known to capture undiagnosed cases of OSA. Participants with incident dementia were identified either by self-report, using an HRS-based algorithm based on objective cognitive function assessments. Respondent-level sampling weights were incorporated to ensure results were representative of US community-dwelling adults over age 50 in 2016.

The final sample for analysis comprised 89 155 observations from 18 815 respondents, more than 80% of which were younger than age 70 years. Just more than half (54%) were women and the mean age at first cognitive assessment was 61 years.

The findings

Approximately half the cohort (48%) met study criteria for known/suspected OSA and investigators reported that prevalence was more than twice as high among men (68%) vs women (31%). They identified 2233 incident cases of dementia, comprising 9% of women and 8% of men in the cohort.

Unadjusted sex-stratified analyses showed that known/suspected OSA was associated with higher cumulative incidence of dementia across ages 60–84 years for women and men. By age 80, the cumulative incidence of dementia among study participants with OSA was 4.7% higher for women (95% CI 2.8%-6.7%) and 2.5% higher for men (95% CI 0.5%-4.5%) compared with adults without the condition.

In models adjusted for race and ethnicity and education and cohabitation status, the researchers reported attenuated impact of known/suspected OSA on age-specific dementia. The association, however, did remain statistically significant.

Authors' comment

"Our findings offer new evidence of a sleep-based pathway that underlies sex-specific differences in dementia risk. Further, as OSA is a treatable condition, this study illuminates the impact of a potentially modifiable yet frequently overlooked risk factor for dementia."

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