Dementia

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The Daily Mail reported last week on a new Harvard University study linking sleeping pills to dementia, but this and other similar studies fail to take into account the well established link between sleep apnoea and dementia.

This links is well documented, and a study published in the Journal of the American Medical Association last year found that, “women who have breathing problems during sleep were up to 50 per cent more likely to develop cognitive impairment or dementia than women who sleep normally.”

The important factor missing here is that sleeping pills suppress the respiratory centres, causing the onset of apnoeas, which in turn leads to the increased risk of dementia. The sleeping pills are therefore indirectly responsible for the increased incidence of dementia, so cutting out the pills will only be effective if the patient is not already suffering from sleep apnoea.

Dementia is one of the biggest burdens facing the NHS. Some experts believe the cost of caring for patients will rise to £35billion annually within the next two decades. There are currently 800,000 Britons with dementia, including Alzheimer’s disease. We therefore need more research into the link between sleep apnoea and dementia, and to start testing all elderly people for sleep apnoea as a preventative measure.

 

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In the Daily Mail yesterday Jenny Hope reports on a new study published in the Journal of the American Medical Association that indicates a link between sleep apnoea and dementia. The study that found women who have breathing problems during sleep were up to 50 per cent more likely to develop cognitive impairment or dementia than women who sleep normally. The research involved only older women, but the mechanism is likely to be important in triggering similar problems in men.

Dr Kristine Yaffe and a team from the University of California, San Francisco, carried out a study involving almost 300 women with an average age of 82 years who did not have dementia. The women were given medical tests for breathing disorders during sleep, which measured the number of times their breathing was interrupted or briefly ceased while they were asleep, and levels of oxygen deprivation, or hypoxia, in the brain. One-third met the criteria for sleep-disordered breathing. After more than four years of follow-up, 36 per cent of the women developed mild cognitive impairment or dementia. Forty-seven women (45 per cent) with prevalent sleep-disordered breathing developed mild cognitive impairment or dementia compared with 31 per cent of those without sleep-disordered breathing – an increase of 50 per cent in the numbers affected.

Dr Yaffe said, “Given the high prevalence and significant morbidity associated with both sleep-disordered breathing and cognitive impairment in older populations, establishing whether a prospective association exists between sleep-disordered breathing and cognition is important. This is especially important because effective treatments for sleep-disordered breathing exist.

“Furthermore, the finding that hypoxia and not sleep fragmentation or duration seems to be associated with risk of mild cognitive impairment or dementia provides clues to the mechanisms through which sleep-disordered breathing might promote cognitive impairment. The increased risk for cognitive impairment associated with sleep-disordered breathing opens a new avenue for additional research on the risk for development of mild cognitive impairment or dementia and exploration of preventive strategies that target sleep quality including sleep-disordered breathing.”

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