This study demonstrated that in patients with cognitive impairment, home sleep apnea testing (compared to standard of care using in-laboratory polysomnography) increased the rate of sleep apnea diagnosis and treatment using CPAP, as well as improved patients’ quality of life and comfort when completing sleep testing. This is clinically significant as previous research in the province of Ontario has demonstrated that wait times for sleep study referrals are an average of 4.9 months. Therefore, the present study is a pragmatic demonstration of the clinical utility of home sleep apnea testing in facilitating the diagnosis and management of sleep apnea in a cognitively impaired population.

Obstructive sleep apnea (OSA), which causes abnormal pauses in breathing during sleep, is common in patients with vascular cognitive impairment and Alzheimer’s disease, and exacerbates the cognitive deficits seen in these conditions. Treatment of OSA with continuous positive airway pressure (CPAP) has been shown to slow or stabilize cognitive decline. A major barrier to undergoing testing for OSA is that in-laboratory polysomnography (iPSG), the current standard for diagnosing OSA, is inconvenient for patients with cognitive impairment who may be reliant on others for care or require familiar sleep environments. Home sleep apnea testing (HSAT) is a potentially more convenient and accessible alternative to iPSG. In this single-blind, randomized controlled trial, 122 patients were randomized (1:1) to HSAT or iPSG. We demonstrated that HSAT, compared to iPSG, increased the proportion of patients diagnosed with OSA and treated using CPAP, as well as improved quality of life and comfort with sleep testing. Overall, our findings suggest that ambulatory approaches to diagnose OSA in patients with cognitive impairment may confer significant clinical benefits. Patients in the province of Ontario wait an average of 4.9 months before undergoing iPSG, therefore the present study is a pragmatic demonstration of the clinical utility of home sleep apnea testing in facilitating the diagnosis and management of OSA in a population of patients with cognitive impairment. Next steps for this study include conducting a cost-effectiveness analysis to compare the cost and outcome of the HSAT vs. iPSG arms from the public healthcare payer perspective using the net benefit regression framework over the study period. Moreover, this innovative study has laid the groundwork for future work that can assess the use of HSAT in other patient populations.

Costa YS, Lim ASP, Thorpe KE, Colelli DR, Mitchell S, Masellis M, et al.
Investigating changes in cognition associated with the use of CPAP in cognitive impairment and dementia: A retrospective study. Sleep Med. 2023;101:437-444.
doi: 10.1016/j.sleep.2022.11.037.
PMID: 36516600
https://www.sciencedirect.com/science/article/abs/pii/S138994572201245X