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. 2025 Sep 11;17(9):147.
doi: 10.3390/neurolint17090147.

A Pilot Study: The Effect of CPAP Intervention on Sleep Architecture and Cognition in Alzheimer's Disease Patients with Obstructive Sleep Apnea

Carmen L Frias  1 , Marta Almeria  2 , Judith Castejon  2 , Cristina Artero  2 , Giovanni Caruana  2 , Andrea Elias-Mas  2 , Karol Uscamaita  3   4 , Virginia Hawkins  5 , Nicola J Ray  5 , Mariateresa Buongiorno  6   7 , Natalia Cullell  1 , Jerzy Krupinski  2
Affiliations

A Pilot Study: The Effect of CPAP Intervention on Sleep Architecture and Cognition in Alzheimer's Disease Patients with Obstructive Sleep Apnea

Carmen L Frias et al. Neurol Int. .

Abstract

Background: Obstructive sleep apnea (OSA) is highly prevalent in the early stages of Alzheimer's disease (AD), and its hallmark, sleep fragmentation, may accelerate cognitive decline. Continuous positive airway pressure (CPAP) improves OSA-related hypoxia during slow-wave sleep, but its cognitive benefits in AD remain unclear.

Methods: We performed a 12-month sub-analysis of a prospective, longitudinal pilot study that enrolled 21 adults (median age = 77 yr; 71% women) with Mild Cognitive Impairment (MCI) with AD confirmed biomarkers and polysomnography-diagnosed OSA. All participants underwent baseline overnight polysomnography (PSG) and neuropsychological testing (Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)) that were repeated after 12 months. Twelve participants were CPAP-compliant (moderate/severe OSA) and nine were non-users (mild OSA/intolerance). Cognitive change scores (Δ = 12 months -baseline) were compared with Generalized Linear Models (GLM) adjusted for baseline cognition and Apnea-Hypopnea Index (AHI); associations between baseline sleep parameters and cognitive trajectories were examined. And the association of sleep variables with the use of CPAP was also evaluated.

Results: Compared with non-users, CPAP users showed significantly slower global decline (Δ MMSE: p = 0.016) and improvements in overall cognition (Δ RBANS Total: p = 0.028) and RBANS sub-domains (Δ RBANS FC: p = 0.010; Δ RBANS SF: p = 0.045). Longer baseline non-rapid eye movement (NREM) stage 3 and rapid eye movement (REM) sleep, greater total sleep time and sleep efficiency, and right-side sleeping were each linked to better cognitive outcomes, whereas extended NREM stage 2, wakefulness, and supine sleeping were associated with poorer trajectories.

Conclusions: Twelve months of CPAP use was associated with attenuated cognitive decline and domain-specific gains in AD-related MCI with OSA. Sleep architecture and body position during sleep predicted cognitive outcomes, underscoring the therapeutic relevance of optimizing breathing and sleep quality. Larger, longer-term trials are warranted to confirm CPAP's disease-modifying potential and to clarify the mechanistic role of sleep in AD progression.

Keywords: Alzheimer’s disease; CPAP; cognitive decline; mild cognitive impairment; obstructive sleep apnea.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
OSA severity in the full cohort and within the CPAP and non-CPAP groups. Representation of the quantity (n) and percentage (%) of participants with Mild, Moderate, and Severe OSA. OSA, Obstructive Sleep Apnea.
See this image and copyright information in PMC

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