Disability
The Association Between Obstructive Sleep Apnea and Dementia in Adults with Down Syndrome Alianna Higgins* Alianna Higgins Eric Salina
Background
People with Down syndrome are predisposed to Alzheimer dementia due to the triplication of the 21st chromosome and are also at increased risk for obstructive sleep apnea (OSA) due to airway morphology. OSA is a known risk factor for Alzheimer dementia in the general population; yet, how OSA impacts Alzheimer dementia in Down syndrome has not been examined. We aimed to document the prevalence of OSA in adults with Down syndrome in the United States and examine the association between OSA and dementia in this population.
Methods
We used Medicaid claims data from 2011-2019 that included a sample of 118,539 adults with Down syndrome. We identified OSA and Alzheimer dementia by ICD-9 and ICD-10 codes. We used Cox proportional hazards models to assess the relationship between OSA and time to dementia.
Findings
20.1% of our cohort had OSA, with 13.4% of those with OSA also having Alzheimer dementia. Of those with at least one OSA claim, 55% were male and 40% were aged 18-25 in their first year in our cohort. Of those with no OSA claims, 50% were male, and 34% were aged 18-25 in their first year of our cohort. Race, ethnicity, eligibility type, and dual enrollment were similar comparing those with and without OSA claims. In our unadjusted model, those with OSA were not at more risk of dementia compared to those without OSA (HR 1.01, 95% CI 0.97-1.05), among those aged 35 and older. After adjusting for age and dual enrollment, those with OSA had 1.16 times the hazard of developing dementia compared to those without OSA (95% CI 1.11-1.21), among participants aged 35 and older.
Conclusion
OSA and Alzheimer dementia are burdensome conditions for people with Down syndrome and our results highlight that OSA could impact Alzheimer dementia development. Further, the link between OSA and Alzheimer dementia has implications for healthcare practice and policy for people with Down syndrome.