title: Reduced cognitive function in patients with Parkinson disease and obstructive sleep apnea.
abstract: OBJECTIVE
  To assess the association between obstructive sleep apnea (OSA) and nonmotor symptoms (NMS), including cognitive dysfunction, in patients with Parkinson disease (PD).
  
  
  METHODS
  Patients with idiopathic PD, recruited from a movement disorder clinic, underwent overnight polysomnography. OSA was defined as an apnea-hypopnea index (AHI) ≥15/h. PD severity was assessed using the Hoehn & Yahr (H&Y) scale and the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS). NMS were assessed using the Montreal Cognitive Assessment (MoCA), Epworth Sleepiness Scale (ESS), Fatigue Severity Scale, Apathy Scale, Beck Depression Inventory, Hospital Depression and Anxiety Scale, and PD sleep Scale.
  
  
  RESULTS
  Sixty-seven patients (61.2% male), mean age 64.4 (SD 9.9) years and motor MDS-UPDRS 21.9 (12.6) using levodopa equivalent dose (LED) 752.4 (714.6) mg/d, were studied. OSA occurred in 47 patients (61.6%, mean AHI 27.1/h, SD 20.2/h), and NMS in 57 patients (85%). ESS and MoCA were associated with the AHI (ESS β = 0.0670,p= 0.031; MoCA β = -0.0520,p= 0.043, adjusted for age, sex, body mass index, LED, and H&Y). ESS was associated with respiratory arousals (β = 0.1015,p= 0.011) and intermittent hypoxemia (β = 0.1470,p= 0.006). MoCA was negatively associated with respiratory arousals (β = -0.0596,p= 0.049) but not intermittent hypoxemia.
  
  
  CONCLUSIONS
  OSA is associated with sleepiness and cognitive dysfunction in PD, suggesting that OSA may be a reversible contributor to these NMS. Further studies will be required to evaluate whether OSA treatment can improve excessive sleepiness and cognitive dysfunction in PD.
authors.affiliation: From Clinica Alemana de Santiago (V.P.M.), Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; and Respiratory Division & Sleep Laboratory (P.G., A.R., R.J.K., M.K.), Montreal Neurological Hospital (A.-L.L.), Departments of Medicine and Epidemiology, Biostatistics & Occupational Health (A.B.), and Respiratory Epidemiology and Clinical Research Unit, Research Institute (A.B., M.K.), McGill University Health Centre, Montreal, Canada. vmery@alemana.cl.
authors.forename: Victoria P
authors.initials: VP
authors.lastname: Mery
authors.affiliation: From Clinica Alemana de Santiago (V.P.M.), Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; and Respiratory Division & Sleep Laboratory (P.G., A.R., R.J.K., M.K.), Montreal Neurological Hospital (A.-L.L.), Departments of Medicine and Epidemiology, Biostatistics & Occupational Health (A.B.), and Respiratory Epidemiology and Clinical Research Unit, Research Institute (A.B., M.K.), McGill University Health Centre, Montreal, Canada.
authors.forename: Priti
authors.initials: P
authors.lastname: Gros
authors.affiliation: From Clinica Alemana de Santiago (V.P.M.), Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; and Respiratory Division & Sleep Laboratory (P.G., A.R., R.J.K., M.K.), Montreal Neurological Hospital (A.-L.L.), Departments of Medicine and Epidemiology, Biostatistics & Occupational Health (A.B.), and Respiratory Epidemiology and Clinical Research Unit, Research Institute (A.B., M.K.), McGill University Health Centre, Montreal, Canada.
authors.forename: Anne-Louise
authors.initials: AL
authors.lastname: Lafontaine
authors.affiliation: From Clinica Alemana de Santiago (V.P.M.), Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; and Respiratory Division & Sleep Laboratory (P.G., A.R., R.J.K., M.K.), Montreal Neurological Hospital (A.-L.L.), Departments of Medicine and Epidemiology, Biostatistics & Occupational Health (A.B.), and Respiratory Epidemiology and Clinical Research Unit, Research Institute (A.B., M.K.), McGill University Health Centre, Montreal, Canada.
authors.forename: Ann
authors.initials: A
authors.lastname: Robinson
authors.affiliation: From Clinica Alemana de Santiago (V.P.M.), Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; and Respiratory Division & Sleep Laboratory (P.G., A.R., R.J.K., M.K.), Montreal Neurological Hospital (A.-L.L.), Departments of Medicine and Epidemiology, Biostatistics & Occupational Health (A.B.), and Respiratory Epidemiology and Clinical Research Unit, Research Institute (A.B., M.K.), McGill University Health Centre, Montreal, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Benedetti
authors.affiliation: From Clinica Alemana de Santiago (V.P.M.), Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; and Respiratory Division & Sleep Laboratory (P.G., A.R., R.J.K., M.K.), Montreal Neurological Hospital (A.-L.L.), Departments of Medicine and Epidemiology, Biostatistics & Occupational Health (A.B.), and Respiratory Epidemiology and Clinical Research Unit, Research Institute (A.B., M.K.), McGill University Health Centre, Montreal, Canada.
authors.forename: R John
authors.initials: RJ
authors.lastname: Kimoff
authors.affiliation: From Clinica Alemana de Santiago (V.P.M.), Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile; and Respiratory Division & Sleep Laboratory (P.G., A.R., R.J.K., M.K.), Montreal Neurological Hospital (A.-L.L.), Departments of Medicine and Epidemiology, Biostatistics & Occupational Health (A.B.), and Respiratory Epidemiology and Clinical Research Unit, Research Institute (A.B., M.K.), McGill University Health Centre, Montreal, Canada.
authors.forename: Marta
authors.initials: M
authors.lastname: Kaminska
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000209:etiology*; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000150:complications*; D017286:Polysomnography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications*; D011795:Surveys and Questionnaires