Editing Sleep apnea (section)

== Complications ==
OSA is a serious medical condition with systemic effects; patients with untreated OSA have a greater mortality risk from [[cardiovascular disease]] than those undergoing appropriate treatment.<ref name="Das-2022">{{Cite journal |last1=Das |first1=Aneesa M. |last2=Chang |first2=Judy L. |last3=Berneking |first3=Michael |last4=Hartenbaum |first4=Natalie P. |last5=Rosekind |first5=Mark |last6=Ramar |first6=Kannan |last7=Malhotra |first7=Raman K. |last8=Carden |first8=Kelly A. |last9=Martin |first9=Jennifer L. |last10=Abbasi-Feinberg |first10=Fariha |last11=Nisha Aurora |first11=R. |last12=Kapur |first12=Vishesh K. |last13=Olson |first13=Eric J. |last14=Rosen |first14=Carol L. |last15=Rowley |first15=James A. |date=2022-10-01 |title=Enhancing public health and safety by diagnosing and treating obstructive sleep apnea in the transportation industry: an American Academy of Sleep Medicine position statement |journal=Journal of Clinical Sleep Medicine |language=en |volume=18 |issue=10 |pages=2467–2470 |doi=10.5664/jcsm.9670 |issn=1550-9389 |pmc=9516580 |pmid=34534065}}</ref> Other complications include [[hypertension]], congestive [[heart failure]], [[atrial fibrillation]], [[coronary artery disease]], [[stroke]], and [[type 2 diabetes]].<ref name="Das-2022" /> Daytime fatigue and sleepiness, a common symptom of sleep apnea, is also an important public health concern regarding transportation crashes caused by drowsiness.<ref name="Das-2022" /> OSA may also be a risk factor of [[COVID-19]]. People with OSA have a higher risk of developing severe complications of [[COVID-19]].<ref>{{cite web |title=Obstructive sleep apnea – Symptoms and causes |url=https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 |url-status=live |archive-url=https://web.archive.org/web/20190811195722/https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/syc-20352090 |archive-date=11 August 2019 |access-date=30 March 2022 |website=Mayo Clinic |language=en}}</ref> 

[[Alzheimer's disease]] and severe obstructive sleep apnea are connected<ref name="ReferenceB">{{cite journal |last1=Andrade |first1=A. |last2=Bubu |first2=O. M. |last3=Varga |first3=A. W. |last4=Osorio |first4=R. S. |year=2018 |title=The relationship between Obstructive Sleep Apnea and Alzheimer's Disease |journal=Journal of Alzheimer's Disease |volume=64 |issue=Suppl 1 |pages=S255–S270 |doi=10.3233/JAD-179936 |pmc=6542637 |pmid=29782319}}</ref> because there is an increase in the protein [[beta-amyloid]] as well as [[White matter|white-matter]] damage. These are the main indicators of Alzheimer's, which in this case comes from the lack of proper rest or poorer sleep efficiency resulting in [[neurodegeneration]].<ref name="Jackson et al 2020">{{cite journal |last1=Jackson |first1=Melinda L. |last2=Cavuoto |first2=Marina |last3=Schembri |first3=Rachel |last4=Doré |first4=Vincent |last5=Villemagne |first5=Victor L. |last6=Barnes |first6=Maree |last7=O'Donoghue |first7=Fergal J. |last8=Rowe |first8=Christopher C. |last9=Robinson |first9=Stephen R. |title=Severe Obstructive Sleep Apnea Is Associated with Higher Brain Amyloid Burden: A Preliminary PET Imaging Study |journal=Journal of Alzheimer's Disease |date=10 November 2020 |volume=78 |issue=2 |pages=611–617 |doi=10.3233/JAD-200571 |pmid=33016907 |s2cid=222145149 |url=https://www.sciencedaily.com/releases/2020/11/201111104918.htm |url-access=subscription |access-date=26 February 2021 |archive-date=28 January 2021 |archive-url=https://web.archive.org/web/20210128005317/https://www.sciencedaily.com/releases/2020/11/201111104918.htm |url-status=live }}</ref><ref name="Weihs Frenzel Grabe 2021 pp. 87–96">{{cite journal |last1=Weihs |first1=Antoine |last2=Frenzel |first2=Stefan |last3=Grabe |first3=Hans J. |date=13 July 2021 |title=The Link Between Obstructive Sleep Apnoea and Neurodegeneration and Cognition |url=https://pub.dzne.de/record/155442/files/19530.pdf |url-status=live |journal=Current Sleep Medicine Reports |publisher=Springer Science and Business Media LLC |volume=7 |issue=3 |pages=87–96 |doi=10.1007/s40675-021-00210-5 |issn=2198-6401 |s2cid=235801219 |archive-url=https://web.archive.org/web/20240206225000/https://pub.dzne.de/record/155442/files/19530.pdf |archive-date=6 February 2024 |access-date=6 February 2024 |doi-access=free}}</ref><ref>{{cite journal |last1=Lee |first1=Min-Hee |last2=Lee |first2=Seung Ku |last3=Kim |first3=Soriul |last4=Kim |first4=Regina E. Y. |last5=Nam |first5=Hye Ryeong |last6=Siddiquee |first6=Ali T. |last7=Thomas |first7=Robert J. |last8=Hwang |first8=Inha |last9=Yoon |first9=Jee-Eun |last10=Yun |first10=Chang-Ho |last11=Shin |first11=Chol |date=20 July 2022 |title=Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood |journal=[[JAMA Network Open]] |volume=5 |issue=7 |pages=e2222999 |doi=10.1001/jamanetworkopen.2022.22999 |pmc=9301517 |pmid=35857321 }}</ref> Having sleep apnea in mid-life brings a higher likelihood of developing Alzheimer's in older age, and if one has Alzheimer's then one is also more likely to have sleep apnea.<ref name="Owen et al 2020">{{cite journal |last1=Owen |first1=Jessica E |last2=Benediktsdottir |first2=Bryndis |last3=Cook |first3=Elizabeth |last4=Olafsson |first4=Isleifur |last5=Gislason |first5=Thorarinn |last6=Robinson |first6=Stephen R |title=Alzheimer's disease neuropathology in the hippocampus and brainstem of people with obstructive sleep apnea |journal=Sleep |date=21 September 2020 |volume=44 |issue=3 |pages=zsaa195 |doi=10.1093/sleep/zsaa195 |pmid=32954401 |url=https://www.sciencedaily.com/releases/2020/09/200928103416.htm |doi-access=free |access-date=1 March 2021 |archive-date=20 November 2020 |archive-url=https://web.archive.org/web/20201120140234/https://www.sciencedaily.com/releases/2020/09/200928103416.htm |url-status=live }}</ref> This is demonstrated by cases of sleep apnea even being misdiagnosed as [[dementia]].<ref>{{cite news |first=Paul |last=Span |date=6 October 2010 |title=When Sleep Apnea Masquerades as Dementia |url=https://newoldage.blogs.nytimes.com/2010/10/06/when-sleep-apnea-masquerades-as-dementia/ |work=New York Times |url-status=live |archive-url=https://web.archive.org/web/20210309174427/https://newoldage.blogs.nytimes.com/2010/10/06/when-sleep-apnea-masquerades-as-dementia/ |archive-date=9 March 2021 |access-date=1 March 2021}}</ref> With the use of treatment through CPAP, there is a reversible risk factor in terms of the amyloid proteins. This usually restores brain structure and cognitive impairment.<ref>{{cite journal |last1=Liguori |first1=Claudio |last2=Chiaravalloti |first2=Agostino |last3=Izzi |first3=Francesca |last4=Nuccetelli |first4=Marzia |last5=Bernardini |first5=Sergio |last6=Schillaci |first6=Orazio |last7=Mercuri |first7=Nicola Biagio |last8=Placidi |first8=Fabio |date=1 December 2017 |title=Sleep apnoeas may represent a reversible risk factor for amyloid-β pathology |journal=Brain |volume=140 |issue=12 |pages=e75 |doi=10.1093/brain/awx281 |pmid=29077794 |doi-access=free}}</ref><ref>{{cite journal |last1=Castronovo |first1=Vincenza |last2=Scifo |first2=Paola |last3=Castellano |first3=Antonella |last4=Aloia |first4=Mark S. |last5=Iadanza |first5=Antonella |last6=Marelli |first6=Sara |last7=Cappa |first7=Stefano F. |last8=Strambi |first8=Luigi Ferini |last9=Falini |first9=Andrea |date=1 September 2014 |title=White Matter Integrity in Obstructive Sleep Apnea before and after Treatment |url=https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/ |url-status=live |journal=Sleep |volume=37 |issue=9 |pages=1465–1475 |doi=10.5665/sleep.3994 |pmc=4153061 |pmid=25142557 |archive-url=https://web.archive.org/web/20210304122831/https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/ |archive-date=4 March 2021 |access-date=1 March 2021}}</ref><ref name="Cooke Ayalon Palmer Loredo 2009 pp. 305–309">{{cite journal |last1=Cooke |first1=Jana R. |last2=Ayalon |first2=Liat |last3=Palmer |first3=Barton W. |last4=Loredo |first4=Jose S. |last5=Corey-Bloom |first5=Jody |last6=Natarajan |first6=Loki |last7=Liu |first7=Lianqi |last8=Ancoli-Israel |first8=Sonia |date=15 August 2009 |title=Sustained Use of CPAP Slows Deterioration of Cognition, Sleep, and Mood in Patients with Alzheimer's Disease and Obstructive Sleep Apnea: A Preliminary Study |journal=Journal of Clinical Sleep Medicine |publisher=American Academy of Sleep Medicine (AASM) |volume=05 |issue=4 |pages=305–309 |doi=10.5664/jcsm.27538 |issn=1550-9389 |s2cid=24123888 |doi-access=free}}</ref> Evidence continues to be found supporting there is an association between [[Body mass index|BMI]] and Alzheimer's.<ref>{{Cite journal |last1=Lee |first1=Eun Hye |last2=Yoo |first2=Heejin |last3=Kim |first3=Young Ju |last4=Cheon |first4=Bo Kyoung |last5=Ryu |first5=Seungho |last6=Chang |first6=Yoosoo |last7=Yun |first7=Jihwan |last8=Jang |first8=Hyemin |last9=Kim |first9=Jun Pyo |last10=Kim |first10=Hee Jin |last11=Koh |first11=Seong-Beom |last12=Jeong |first12=Jee Hyang |last13=Na |first13=Duk L. |last14=Seo |first14=Sang Won |last15=Kang |first15=Sung Hoon |date=2024-08-29 |title=Different associations between body mass index and Alzheimer's markers depending on metabolic health |journal=Alzheimer's Research & Therapy |volume=16 |issue=1 |pages=194 |doi=10.1186/s13195-024-01563-z |doi-access=free |issn=1758-9193 |pmc=11363444 |pmid=39210402}}</ref> There is also evidence of increased risk of developing Alzheimer's for those with a higher BMI in women ages 70 and above.<ref>{{Cite journal |last1=Gustafson |first1=Deborah |last2=Rothenberg |first2=Elisabet |last3=Blennow |first3=Kaj |last4=Steen |first4=Bertil |last5=Skoog |first5=Ingmar |date=2003-07-14 |title=An 18-Year Follow-up of Overweight and Risk of Alzheimer Disease |url=http://archinte.jamanetwork.com/article.aspx?doi=10.1001/archinte.163.13.1524 |journal=Archives of Internal Medicine |language=en |volume=163 |issue=13 |pages=1524–1528 |doi=10.1001/archinte.163.13.1524 |pmid=12860573 |issn=0003-9926|url-access=subscription }}</ref> While [[continuous positive airway pressure]] (CPAP) wasn't found to significantly improve cognitive performance, it was found to benefit other symptoms like depression, anxiety, etc.<ref>{{Cite journal |last1=Oliver |first1=Cerys |last2=Li |first2=Haoxuan |last3=Biswas |first3=Bijetri |last4=Woodstoke |first4=David |last5=Blackman |first5=Jonathan |last6=Butters |first6=Anneka |last7=Drew |first7=Cheney |last8=Gabb |first8=Victoria |last9=Harding |first9=Sam |last10=Hoyos |first10=Camilla M. |last11=Kendrick |first11=Adrian |last12=Rudd |first12=Sarah |last13=Turner |first13=Nicholas |last14=Coulthard |first14=Elizabeth |date=2024-02-01 |title=A systematic review on adherence to continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA) in individuals with mild cognitive impairment and Alzheimer's disease dementia |url=https://linkinghub.elsevier.com/retrieve/pii/S1087079223001259 |journal=Sleep Medicine Reviews |volume=73 |pages=101869 |doi=10.1016/j.smrv.2023.101869 |pmid=37924680 |issn=1087-0792}}</ref>