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https://www.michiganmedicine.org/health-lab/sleep-apnea-contributes-dementia-older-adults-especially-women https://www.michiganmedicine.org/health-lab/sleep-apn

https://www.michiganmedicine.org/health-lab/sleep-apnea-contributes-dementia-older-adults-especially-women https://www.michiganmedicine.org/health-lab/sleep-apnea-cont... While we're speculating as to causes obstructive sleep apnea is associated with dementia, estimates are that 30 million people have it, and we only invented CPAPs in 1980.

jajko 1y ago
Dude, global estimate for OSA is in the range of 1 billion, its a global pandemic
bhouston 1y ago
Are cpaps that widely used to have that significant of an effect? For CPAP to be primarily responsible, we would need a very sizeable portion of the population to be using them, but I think the numbers are less than 3% right? From the article as to the effect size: “For example, in the US, among people aged 81 to 85, 25.1% of those born between 1890–1913 had dementia, compared to 15.5% of those born between 1939–1943,” I'm not saying that CPAPs don't contribute, but they are not likely the main contributors.
- alargemoose 1y ago
  I think you have this backwards. OP is saying sleep apnea is common, but we’ve only had CPAP machines to compensate for it, since the 80s. I don’t see them trying to implicate CPAP as the cause of an increase in dementia.
  - sokoloff 1y ago
    I read that as saying that 3% CPAP usage couldn’t explain a 10% drop in dementia.
  - Someone 1y ago
    I think bhouston is arguing (correctly) you can’t have a 10% of the population drop in dementia prevalence by an intervention that only targets 3% of the population, so even if CPAPs contribute, that does not explain most of the drop. (If everybody who uses CPAPs would get dementia, and they are 100% effective at preventing that, the drop would still be ‘only’ 3% of the population)
aantix 1y ago
I wonder if sleep apnea diagnoses will decrease with the increasing use of GLP-1s? Zepbound is FDA-approved for OSA.
- jaggederest 1y ago
  It 100% will. Interestingly zepbound does more than merely lower weight and thus reduce sleep apnea as a secondary result, it seems to actually help directly from the preliminary studies I've read, much like we're seeing in other domains where GLP-1 drugs actually reduce e.g. fatty liver disease more than the same amount of weight loss alone. I wonder if we'll discover that there's actually an endemic deficiency in endogenous GLP-1 production due to some other cause? The usual suspects of environmental contamination or subclinical infection, perhaps.
mike-the-mikado 1y ago
Isn't sleep apnea associated with obesity, which undoubtedly has been increasing?
- reverendsteveii 1y ago
  yes, but in one case we're talking about OSA causing dementia and in the other we're talking about obesity causing OSA
- m-schuetz 1y ago
  There is also a reverse causality that's often overlooked - People getting obese because they develop sleep apnea. Happened to a relative. Developed allergy-related sleep apnea resulting in significantly reduced sleep quality and quality of life. Was often awake until after midnight due to trouble falling asleep from breathing issues that occured when nose and throat would start to relax. After about two years of this, he let himself go and gain 15kg over the coarse of a single year.
- Der_Einzige 1y ago
  GLP-1 drugs mean that peek obesity is already passed.
pedalpete 1y ago
The prevalence of apnea is likely highly over-estimated. ResMed and Philips, who both make billions off of CPAP, push these high figures. Measures of OSA (Obstructive sleep apnea) are somewhat poor, more focused on the amount of pauses in breathing, rather than oxygen desaturation, which is the secondary measure. Note, you don't breath 100% of the time when you're awake either. I work in sleep and neurotech, and at a large sleep conference last year, a talk was given about better methods to measure apnea. It was clear these measures would have significant challenges in being adopted because it would result in less people being diagnosed as needing CPAP. Lastly, the impact of CPAP in improving cognitive function is inconclusive [1]. Not that it doesn't have an affect. It does in some people, but not in others. [1] https://www.sciencedirect.com/science/article/abs/pii/S1389945724003903 https://www.sciencedirect.com/science/article/abs/pii/S13899...
- aorloff 1y ago
  Did anyone report on reductions in sleep apnea due to GLP-1s ? I would imagine that the introduction of effective weight loss meds en masse might change the trajectory of more than a few sleep apnea sufferers
  - reverendsteveii 1y ago
    I have OSA and I haven't taken GLP-1 agonists but I've taken the road they put a person on. 50 pounds ago I was averaging around 15 apnic/hypopnic events per hour, now it's less than 10. My doctor told me that I may as well keep using my CPAP because it seems to help and it's already paid for but that if these were the results of my initial sleep study he wouldn't have prescribed one to me.
- teamonkey 1y ago
  Slightly off-topic, but as someone in the field, what is your opinion of the apnea-detecting functionality of smart watches?
  - reverendsteveii 1y ago
    I'm in the field, I built the software in your cpap machine and home sleep study that we use to test and treat them. It comes down to microarousals, which is where you wake up just enough to disrupt the sleep cycle without actually becoming consciously aware. A smart watch can detect that, and it can also measure o2 saturation in your blood. To my mind that means that a smart watch can determine whether your sleep is interrupted and by how much, and even gather some evidence that apnea could be among potential causes (there are other ways to have low o2 saturation) but I don't think it can actually diagnose.

jajko 1y ago

Dude, global estimate for OSA is in the range of 1 billion, its a global pandemic

bhouston 1y ago

Are cpaps that widely used to have that significant of an effect? For CPAP to be primarily responsible, we would need a very sizeable portion of the population to be using them, but I think the numbers are less than 3% right? From the article as to the effect size: “For example, in the US, among people aged 81 to 85, 25.1% of those born between 1890–1913 had dementia, compared to 15.5% of those born between 1939–1943,” I'm not saying that CPAPs don't contribute, but they are not likely the main contributors.

alargemoose 1y ago
I think you have this backwards. OP is saying sleep apnea is common, but we’ve only had CPAP machines to compensate for it, since the 80s. I don’t see them trying to implicate CPAP as the cause of an increase in dementia.
- sokoloff 1y ago
  I read that as saying that 3% CPAP usage couldn’t explain a 10% drop in dementia.
- Someone 1y ago
  I think bhouston is arguing (correctly) you can’t have a 10% of the population drop in dementia prevalence by an intervention that only targets 3% of the population, so even if CPAPs contribute, that does not explain most of the drop. (If everybody who uses CPAPs would get dementia, and they are 100% effective at preventing that, the drop would still be ‘only’ 3% of the population)

aantix 1y ago

I wonder if sleep apnea diagnoses will decrease with the increasing use of GLP-1s? Zepbound is FDA-approved for OSA.

jaggederest 1y ago
It 100% will. Interestingly zepbound does more than merely lower weight and thus reduce sleep apnea as a secondary result, it seems to actually help directly from the preliminary studies I've read, much like we're seeing in other domains where GLP-1 drugs actually reduce e.g. fatty liver disease more than the same amount of weight loss alone. I wonder if we'll discover that there's actually an endemic deficiency in endogenous GLP-1 production due to some other cause? The usual suspects of environmental contamination or subclinical infection, perhaps.

mike-the-mikado 1y ago

Isn't sleep apnea associated with obesity, which undoubtedly has been increasing?

reverendsteveii 1y ago
yes, but in one case we're talking about OSA causing dementia and in the other we're talking about obesity causing OSA
m-schuetz 1y ago
There is also a reverse causality that's often overlooked - People getting obese because they develop sleep apnea. Happened to a relative. Developed allergy-related sleep apnea resulting in significantly reduced sleep quality and quality of life. Was often awake until after midnight due to trouble falling asleep from breathing issues that occured when nose and throat would start to relax. After about two years of this, he let himself go and gain 15kg over the coarse of a single year.
Der_Einzige 1y ago
GLP-1 drugs mean that peek obesity is already passed.

pedalpete 1y ago

The prevalence of apnea is likely highly over-estimated. ResMed and Philips, who both make billions off of CPAP, push these high figures. Measures of OSA (Obstructive sleep apnea) are somewhat poor, more focused on the amount of pauses in breathing, rather than oxygen desaturation, which is the secondary measure. Note, you don't breath 100% of the time when you're awake either. I work in sleep and neurotech, and at a large sleep conference last year, a talk was given about better methods to measure apnea. It was clear these measures would have significant challenges in being adopted because it would result in less people being diagnosed as needing CPAP. Lastly, the impact of CPAP in improving cognitive function is inconclusive [1]. Not that it doesn't have an affect. It does in some people, but not in others. [1] https://www.sciencedirect.com/science/article/abs/pii/S1389945724003903 https://www.sciencedirect.com/science/article/abs/pii/S13899...

aorloff 1y ago
Did anyone report on reductions in sleep apnea due to GLP-1s ? I would imagine that the introduction of effective weight loss meds en masse might change the trajectory of more than a few sleep apnea sufferers
- reverendsteveii 1y ago
  I have OSA and I haven't taken GLP-1 agonists but I've taken the road they put a person on. 50 pounds ago I was averaging around 15 apnic/hypopnic events per hour, now it's less than 10. My doctor told me that I may as well keep using my CPAP because it seems to help and it's already paid for but that if these were the results of my initial sleep study he wouldn't have prescribed one to me.
teamonkey 1y ago
Slightly off-topic, but as someone in the field, what is your opinion of the apnea-detecting functionality of smart watches?
- reverendsteveii 1y ago
  I'm in the field, I built the software in your cpap machine and home sleep study that we use to test and treat them. It comes down to microarousals, which is where you wake up just enough to disrupt the sleep cycle without actually becoming consciously aware. A smart watch can detect that, and it can also measure o2 saturation in your blood. To my mind that means that a smart watch can determine whether your sleep is interrupted and by how much, and even gather some evidence that apnea could be among potential causes (there are other ways to have low o2 saturation) but I don't think it can actually diagnose.