Increased risk of Parkinson disease in female patients with sleep apnea

The sleep concerns of female patients are often diagnosed as depression rather than obstructive sleep apnea.
The sleep concerns of female patients are often diagnosed as depression rather than obstructive sleep apnea.

For many years, obstructive sleep apnea (OSA) was thought to present mostly in men. Women who complained of fatigue and sleepiness were more often diagnosed with depression than sleep apnea. Today, clinicians know that woman can be affected and should be screened appropriately when complaints of daytime sleepiness, fatigue, and unrefreshing sleep are brought to our attention. One recent study shows why this is more important than ever.

OSA is a common sleep disorder. About 25% of men and 10% of women are believed to have the illness. OSA is believed to cause oxidative stress and inflammation in the body. Some believe that these processes may also contribute to the development of Parkinsonian disease.

Parkinson disease (PD) is a neurological malady that causes tremors, bradykinesia, muscle rigidity, and postural instability. It affects about 1-2% of adults over the age of 60.  Idiopathic Parkinson disease is more commonly seen in males.

Until recently, there have been limited studies investigating the association of OSA with the development of PD. For years, we have known that other sleep disorders are seen in patients with PD, including insomnia, restless leg syndrome, hypersomnia, and REM sleep behavior disorder.

In this retrospective longitudinal cohort study of over 9,000 participants, female patients who had OSA were found to have a significant risk of developing Parkinson disease during a 5 year follow-up period.

The reason for the association between PD and OSA is not known, but it is postulated  that there is a relationship between cerebrovascular disease and vascular risk factors seen in these 2 groups. There is thought that the repetitive intermittent hypoxia during apnea may activate an immune response that may affect the dopaminergic system.

The reason why this affects women more than men is unclear, but could be related to the fact that OSA is usually underdiagnosed in women, or is not diagnosed until symptoms have reached a severe stage.

Consider sleep apnea in female patients complaining of daytime sleepiness and fatigue – especially in older females; after menopause, their risk is the same as in men. . Also, monitor patients with OSA for the development of neurological symptoms, as they may be showing signs of Parkinson's disease.

Sharon M. O'Brien, MPAS, PA-C, is a practicing physician assistant and health coach in Asheville, N.C.

Reference

  1. Sheu JJ, Lee HC, Lin HC, Kao LT, Chung SD. A 5-year follow-up study on the relationship between obstructive sleep apnea and Parkinson disease. J Clin Sleep Med 2015;11(12):1403–1408; doi: 10.5664/jcsm.5274.
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