4th International Conference on Vascular Dementia
Suny Upstate Medical University, USA
Title: Sleep apnea is a risk factor for cognitive decline of vascular origin
Biography: Antonio Culebras
Clinical evidence suggests that moderate to severe obstructive sleep apnea (OSA) is a risk factor for development of vascular cognitive impairment as a result of cerebral subcortical small vessel disease expressed as leukoaraiosis and silent infarctions. A recent studyrnshowed that old women with OSA AHI>15 were more likely to develop cognitive impairment (AOR, 1.85; [95% (CI), 1.11-3.08].rnOther authors have shown that. OSA AHI>15 is a risk factor for cerebral white matter changes in middle-aged and older patientsrn(OR:2.08 [95% (CI):1.05-4.13]) and for silent cerebral infarction in > 65 y/o patients (OR:2.44 [95% (CI):1.03-5.80]). Intermittentrnnocturnal hypoxia in patients with moderate to severe OSA contributes to ischemic damage in the cerebral periventricular territoryrnof long penetrating terminal arteries. Blood flow may be already precarious as a result of diabetic vascular autonomic dysregulationrnand poorly controlled hypertension. Ischemic damage to the cerebral periventricular white matter disturbs the connections of therncortex with the thalamus leading to subcortical dementia characterized by apathy, decreased executive functions, poor memory andrnin later difficulty walking and urinary incontinence. Treatment of OSA with CPAP may lower cerebrovascular risk by decreasing 24-hrnurinary catecholamine excretion, improving arterial stiffness, improving baroreflex sensitivity and reducing mean 24-h ambulatory blood pressure. CPAP applications may delay onset of dementia. However, CPAP applications will not modify structural lesions ofrnthe brain and therefore early diagnosis and treatment of sleep apnea before structural brain damage ensues is strongly recommended,particularly in patients with several risk factors for stroke.
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