The association between sleep apnea and neurodegenerative disorders: A systematic review and meta‐analysis with an emphasis on precision‐medicine
Bibliographic record
Abstract
Abstract Background Previous meta‐analyses that assessed the possible link between sleep apnea (SA) and dementia included cohorts with patients having self‐reported diagnoses of SA as exposures and nonspecific cognitive diagnoses as outcomes, undermining clinical implications. We aimed to assess the association between SA and specific neurodegenerative causes of dementia and to review the use of precision‐medicine tools supporting clinical diagnoses in studies. Method We performed a systematic review and meta‐analysis in conformity with the PRISMA guidelines. Two investigators searched the Web of Science Core Collection databases from inception to March 1st, 2021. Cohort studies were included if they: 1) used either polysomnography (PSG) or International Classification of Diseases (ICD) codes for SA diagnosis, and 2) measured the risk of all‐cause dementia, mild cognitive impairment, Alzheimer’s disease (AD), vascular dementia (VaD), Parkinson’s disease (PD), Lewy body dementia (LBD), frontotemporal dementia (FTD), and/or mixed dementia. The use of biomarkers to support clinical diagnoses in eligible studies was collected. Studies of cross‐sectional design, that used self‐administered questionnaires for the diagnosis of SA, or that measured solely cognitive scores as outcomes were excluded. Pooled analyses of hazard ratios (HR) were obtained for every type of dementia using a random effects model. Result Among the 1,191 records identified, 8 studies were included, representing a total of 1,249,975 patients. Patients with SA had a 43% increased risk of developing any of the aforementioned types of dementia (HR: 1.43 [1.26‐1.62], 95% CI). They were 34% more likely to develop all‐cause dementia (HR: 1.34 [1.15‐1.57], 95% CI), 28% more likely to develop AD (HR: 1.28 [1.16‐1.41], 95% CI) and 54% more likely to develop PD (HR: 1.54 [1.30‐1.84], 95% CI). No statistically significant association was found with VaD. One study reported a two‐fold increased risk of LBD with SA. No study used biomarkers such as regional cortical atrophy on brain imaging or genetic testing. Results remained consistent after sensitivity analyses. Conclusion While SA appears to be associated with an increased risk of all‐cause dementia, notably for AD, PD and LBD, future studies will have to be conducted using more rigorous precision‐medicine tools in order to better characterize the specific associations between these conditions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.070 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.018 | 0.034 |
| Bibliometrics | 0.008 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".