CPAP Could Lower Risk of Parkinson’s for Sleep Apnea Patients

For many people with sleep apnea, sleeping in a continuous positive airway pressure (CPAP) machine is less than ideal. However, the device could protect neurological health, a new study suggests.

According to preliminary data released on March 2, starting CPAP treatment within two years of an obstructive sleep apnea (OSA) diagnosis could reduce the risk of Parkinson’s disease.

The research will be presented at the American Academy of Neurology’s annual meeting in San Diego from April 5-9, but it has not yet been published in a peer-reviewed journal.

A growing body of evidence suggests that sleep apnea and Parkinson’s disease are connected—about four in 10 people with Parkinson’s have also been diagnosed with this sleep disorder.

“While our study found an increased risk of Parkinson’s disease, the good news is people can do something about it, by using CPAP as soon as they are diagnosed with the sleep disorder,” study author Gregory Scott, MD, PhD, staff physician at the Veterans Affairs Portland Health Care System, said in a press release.

About 30 million Americans are estimated to have OSA, but only 6 million have been diagnosed. Of those who have been diagnosed, most don’t stick with CPAP use long-term.

Here’s what experts had to say about the new research, how sleep apnea, CPAP use, and Parkinson’s might be linked, and tips for lowering your risk of health issues related to this sleep disorder.

If you have OSA, it means you have a blocked airway during sleep, which makes it hard for your body to get enough oxygen. It can also lead to symptoms such as snoring or gasping for breath. The CPAP machine can counteract these issues—the device includes a mask that goes over the nose and mouth, pushing air into the airways to keep them open.

To further investigate how this sleep apnea treatment might have an effect on a person’s neurological health long-term, researchers examined 20 years of medical records from over 1.5 million U.S. veterans with OSA. They compared those records to data from 9.7 million veterans who didn’t have the condition.

However, after adjusting for factors such as age, sex, and smoking, the team found that there were 1.8 more cases of Parkinson’s disease per 1,000 people in the OSA group as compared to the non-OSA group.

From there, the study authors zeroed in on the 10% of OSA patients who used a CPAP machine. Though they didn’t have information about how frequently people used the devices, they split people with sleep apnea into two groups: CPAP users who started treatment within two years of their diagnosis and CPAP users who received the machine after two years.

People who started using their CPAP late saw a relatively similar rate of Parkinson’s disease as those who didn’t use a CPAP at all. However, starting CPAP treatment within two years of diagnosis was linked to a lower Parkinson’s rate—there were 2.3 fewer cases per 1,000 people in comparison to those who didn’t use a CPAP.

These results suggest that “OSA may be an important, modifiable risk factor for the development of [Parkinson’s disease],” the study authors concluded.

Despite evidence of a link between the two, experts aren’t totally sure if sleep apnea raises your Parkinson’s disease risk—or if it’s the other way around.

“Whether sleep apnea can increase the risk of Parkinson’s is not clear,” Marta Kaminska, MD, a Parkinson’s researcher and associate professor of medicine at McGill University, told Health.

However, she said, “some studies have found that people diagnosed with sleep apnea have a higher chance of being diagnosed with Parkinson’s in the years following the sleep apnea diagnosis.”

Sleep apnea makes breathing harder during sleep, reduces blood oxygen levels, and causes fragmented sleep. That can, in turn, drive oxidative stress and inflammation, changes in blood vessel function, impaired waste clearance from the brain, injury to neurons, and altered brain function, Kaminska explained.

Other research has found that this lack of blood in oxygen may indirectly lead to changes in brain proteins associated with Parkinson’s disease.

On the other hand, it’s well known that Parkinson’s can cause sleep disturbances, which can start before the Parkinson’s is diagnosed. Some people may be diagnosed with sleep apnea but find their sleep changes were due to Parkinson’s all along, Kaminska noted.

However, it’s difficult for researchers to parse out what’s actually behind this link, she said.

“Sleep apnea is common in Parkinson’s disease, but then, it is common in older adults anyway. So [we] don’t know if it is the Parkinson’s disease or age [that could cause sleep apnea],” Sonia Ancoli-Israel, PhD, sleep apnea researcher and professor emeritus of psychiatry at the University of California, San Diego School of Medicine, told Health.

For people who do have both conditions, evidence shows that sleep apnea can speed up Parkinson’s patients’ decline in motor function and cognitive function, worsen excessive daytime sleepiness, and increase their risk of cardiovascular and cerebrovascular diseases.

Because sleep apnea is linked to a slew of health issues—including a higher risk of type 2 diabetes, stroke, heart attack, dementia, and more—treating it is critical.

There are other strategies beyond CPAP, including surgery, positional therapy, and nerve stimulation. However, CPAP is usually the most recommended.

“CPAP therapy can correct sleep apnea completely,” said Kaminska.

Unfortunately, many people struggle to tolerate the CPAP machine, complaining of uncomfortable masks, skin inflammation, air leaks, claustrophobia, nasal congestion, and difficulty exhaling.

One report estimates that just 34% of people with OSA used their CPAP machines for seven hours a night; overall, adherence can range from 30% and 60%.

“[CPAP] needs to be used every night,” said Ancoli-Israel. “That comfort depends totally on getting the right mask.”

Most doctors do recommend that people with CPAP machines use them all night for the best health outcomes. But even some use is beneficial.

Importantly, Ancoli-Israel said, treating sleep apnea promptly may not be the key contributor to reducing Parkinson’s risk—exercising, eating well, quitting smoking, and limiting alcohol intake might also play a role.

But if you suspect you might have sleep apnea, talk to a healthcare provider to get diagnosed and treated as quickly as you can.

“Sleep apnea should always be treated as soon as possible,” said Ancoli-Israel. “We do know that people with sleep apnea are at increased risk for Alzheimer’s, so it could be true for Parkinson’s as well.”