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Dr. Sandeep Suri, Senior Diabetologist, Advance Diabetes & Critical Care, Holy Help Hospital, Hisar, India; and Dr Sanjay Kalra, 06 March 2025
Individuals with obstructive sleep apnea face a higher risk of developing Parkinsons disease, but early initiation of continuous positive airway pressure (CPAP) therapy may help lower that risk, according to a preliminary EHR-based cohort study in military veterans. The study is scheduled for presentation at the 77th Annual Meeting of the American Academy of Neurology (AAN) to be held in San Diego from April 5–9, 2025.1,2
This study examined OSA as a potential risk factor for Parkinson’s disease using data from the VA Corporate Data Warehouse (CDW), covering more than 20 years of medical records and more than 20 million veterans. The ICD-10 code G47.33 (OSA+) was used to define OSA. The primary study outcomes were PD diagnosis and all-cause mortality. PD diagnoses were validated using two case definitions with positive predictive values (PPV) of 76% and 90% (PMID 37309872). Continuous Positive Airway Pressure (CPAP) use was determined from the HealthFactor field, a semi-structured dataset derived from medical interviews. Participants without HealthFactor data were excluded from the secondary CPAP analysis. Ten percent of the participants with sleep apnea had documented use of a CPAP machine. Based on the timing of the initiation of CPAP, subjects were categorized into CPAP+ Early (those who received CPAP treatment within 2 years of OSA diagnosis) and CPAP+ Late (those who received CPAP two years after OSA diagnosis).
A total of 1,552,505 veterans with OSA (OSA+) and 9,759,246 without OSA (OSA-) were identified. Of those with sleep apnea, 3.4% developed Parkinsons disease within five years compared to 3.8% of those who did not have sleep apnea. After balancing for birth year/age, sex, smoking status, race, ethnicity, and pseudo-randomization by covariates—along with adjustment for the competing risk of death, OSA+ was associated with a significantly increased incidence of PD. Five years after a sleep apnea diagnosis, there were 1.8 additional cases of PD per 1,000 individuals compared to those without sleep apnea..
Among CPAP users, those in the CPAP+ Late group had a similar PD incidence to CPAP non-users with 9.5 and 9.0 cases of Parkinsons disease per 1,000 people. In contrast, the CPAP+ Early group exhibited a significantly lower rate of Parkinson’s disease, with 2.3 fewer cases per 1,000 people (p < 0.001) when compared to people who did not use CPAP.
These findings suggest that OSA may significantly increase the risk of Parkinsons disease. It may be a modifiable risk factor as CPAP treatment reduces the risk, as is evident from this study. Future studies are needed to follow people more closely after receiving a sleep apnea diagnosis and over longer periods of time, state the authors.
References
1. American Academy of Neurology News Release. Available at: https://www.aan.com/PressRoom/Home/PressRelease/5239. Dated March 2, 2025. Accessed on March 5, 2025.
2. Isabella Montano, et al. Obstructive sleep apnea is a risk factor for Parkinson’s disease and CPAP mitigates risk of PD: An EHR-based cohort study in military veterans. AAN 77th Annual Meeting Abstract.
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