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How Diabetes, Dementia and Sleep Apnea are Linked (or Associated)

Here’s a new study out of Japan showing that people with uncontrolled diabetes had about a 35% increased risk of developing dementia. The article talks about how diabetes can cause clogging and blocking of the arteries, leading to lack of oxygen and brain damage. But guess what else causes lack of oxygen? Obstructive sleep apnea. Hypoxia has been shown to cause brain damage in numerous sleep apnea as well as Alzheimer’s research studies. As always, researchers are careful to point out that association never implies causality.

How Being Fat Can Cause Dementia

Being overweight has been associated with a number of medical problems, including diabetes, heart disease, and even cancer. Now a new study shows that being overweight in midlife significantly increases your chances of developing dementia later in life. You can read a summary of the study here.

The researchers are unclear about the reason for this observation, but do suggest the possibility that inflammation from being overweight, or diabetes and cardiovascular complications, can damage brain cells. What they’re majorly missing is the fact that the more overweight you are, the more likely you’ll have obstructive sleep apnea. Obstructive sleep apnea is a major cause of hypoxia and brain injury. I’ve written numerous times in the past that sleep apnea has be shown to directly cause brain tissue injury, especially in areas that control memory, executive function, and even autonomic nervous system center that control breathing and heart rate.

What’s your take on this article?

Deafness and Dementia Linked, Through Sleep Apnea?

There are a number of studies that associate an increased risk of deafness to sleep apnea, and an increased rate of dementia with sleep apnea, so why can’t deafness and dementia be linked, with sleep apnea being the main cause for both conditions? A study that was recently published in Neurology showed that for every 10 dBL hearing loss, after 12 years, the risk of dementia from all causes rose 27%. I’ve written numerous times about how sleep apnea can cause damage to the auditory cortex areas of the brain, as well as to the inner ear. The same process from sleep apnea that causes brain damage can injure areas that control memory, executive function, autonomic function, and hearing.

The next time someone you love can’t seem to hear you, it could be because he or she can’t process your words properly? Do you know someone who’s severely hard of hearing, and has possible dementia?

Alzheimer’s & Down Syndrome: What’s The Connection?

Down syndrome is one of the more common genetic disorders, characterized by mental retardation and underdeveloped facial structures. They also have a very high rate of heart disease, and if they live long enough, many will go on to develop Alzheimer’s disease. It’s been shown that the Alzheimer’s disease process in Down patients is identical to what’s seen in regular Alzheimer’s patients, except that it occurs much earlier (40s and 50s).

We know that Down patients have severely underdeveloped mid and lower jaws. Typically, the tongue will seem too big, and quite often they’ll snore. One study in 1991 showed that 45% of Down patients had obstructive sleep apnea. If you recalculate this number based on more recent scoring criteria, that number will probably be much higher.

It’s likely that the more severe the degree of obstructive sleep apnea, the more narrow the jaws, and the more severe the mental retardation. It’s a given that untreated sleep apnea will cause major brain damage. You could also show that the highly functioning Down patients will have less severe sleep apnea. Of course, you’ll have to do a study to prove this. Intuitively, this makes sense.

What do you think about this connection?

Did My Father Die From Sleep Apnea?

My father died a few months ago from metastatic prostate cancer. Looking back on the series of events that occurred before his death, I’m wondering if it was really from Alzheimer’s Disease aggravated by sleep apnea. Let me explain…

About 4 weeks before his death, my father was a vibrant and young 78. He took classes with undergraduates at Hunter College, performed in a musical theater group, sang in his church choir, played tennis, swam, and and went hiking up a mountain every week. He was originally diagnosed with prostate cancer over 10 years ago, but was in remission until recently, when it finally surfaced in his lower spine. He underwent radiation therapy, which was an ordeal for him, but he managed to fight through it.

One day, we got a call from the hospital ER saying that my father was admitted after begin found unconscious on the sidewalk. A CT of the brain was reported as being normal. Before this, he was completely coherent, and mentally very sharp. After this hospital admission, he kept going in and out, not being able to express himself, and not even remembering who his children were. Over the next 2 weeks, his condition deteriorated even further, and eventually passed away in a wonderful hospice, Calvary Hospital.

During his last few days, he would sometimes talk as if he were a 5 or 6 year old. He even stopped recognizing his family members. During these last two weeks, although not official, he had classic symptoms of Alzheimer’s-like dementia.

I’ve also always suspected that he had an undiagnosed sleep-breathing problem, with very loud breathing and an open mouth during sleep. We know that untreated obstructive sleep apnea can thicken your blood, making it much more viscous, and more likely to stagnate and clot. Sleep apnea patients have increased inflammatory markers such as TNF, IL-2, IL-6, and many others. Cancer is also thought to cause a hypercoagulable state. He also has two other risk factors for sleep apnea: older age and having an Asian facial structure.

Something must have happened that day when my father was walking down the street. He must have clotted or damaged a critical part of his brain that’s responsible for short term memory and face recognition. Whatever happened, it wasn’t large enough to show up on his head CT.

It’s been shown that untreated obstructive sleep apnea can cause brain damage in many different ways. This includes multiple mini-strokes throughout the brain, and lowered gray matter density in parts of the brain that includes memory, executive function, and autonomic nervous system control.

I’m convinced that all modern human’s inability to breathe properly as we get older is a major factor in how quickly we age or develop illnesses. Many of the chronic medical complications or conditions that we die from can be shown to be directly or indirectly related to sleep-breathing problems.

Ask Dr. Park: Neurologic Complications of Sleep Apnea

We already know that obstructive sleep apnea can cause stroke, but can it can also cause central sleep apnea, MS, or even Alzheimer’s? How can it lead to various other unexpected conditions such as ADHD, migraines, headaches, dizziness, lightheadedness, various stomach ailments, and even ringing, hearing loss, or vertigo?

Heavy Smoking Found to Increase Dementia Risk—Through Sleep Apnea?

Heavy smokers were found to have more than twice the risk of developing dementia later in life. This study was published recently online in the Archives of Internal Medicine. Besides all the known detrimental effects of smoking in general, nicotine is known to relax the lower esophageal sphincter. This can lead to increased reflex, and what happens when your stomach juices reach your throat? It causes inflammation and swelling, promoting more frequent breathing pauses, especially if you’re on your back and in deep sleep, when your muscles are most relaxed.

Furthermore, the presence of acid in your throat can desensitize chemoreceptors, which can diminish the protective mechanisms that help you to wake up and swallow, so you don’t aspirate your stomach juices into your lungs.

More frequent obstructions as well as prolonged breathing pauses eventually lead to periods of oxygen deprivation to your brain, which leads to inflammation and ultimately brain damage. It’s actually been shown experimentally in mice that chronic hypoxia leads to beta amyloid plaques in the brain. Untreated sleep apnea patients are also found to have multiple areas of brain tissue volume and density in critical areas that control memory, executive function, motor control and involuntary functions.

Notice that heavy alcohol use is also linked with dementia (from muscle relaxation). The combination of alcohol and smoking is a deadly mix. Risks for throat cancer go up exponentially if you add significant alcohol to chronic smoking.

We also know that obesity is linked with an increased risk for cancer. Obesity is definitely linked with obstructive sleep apnea. Obstructive sleep apnea is linked with cardiovascular disease, especially stroke. Anything that increases your risk of obstructive sleep apnea can increase your risk for dementia.

Just thinking outside the box here, but what if your lungs were to be chronically irritated by stomach juices? Could it cause or aggravate asthma, coughing, COPD, or even cancer?

What are your thoughts on my hypothesis? I’d like to hear your opinion.

Traumatic Brain Injury & Sleep Apnea

Here’s a tragic story of Owen Thomas, a talented University of Pennsylvania football lineman that recently committed suicide. An autopsy revealed early stages of chronic traumatic encephalopathy (CTE), a brain disorder that’s typically seen in football players who suffer repeated head trauma. Typically, findings are similar to what’s seen in Alzheimer’s disease, with neurofibrilary tangels and amyloid plaques. The surprising thing about Thomas’ condition was his age—he was only 21.

Former Tampa Bay Bucaneer Tom McHale died at age 45 of CTE last year. McHale was the 6th former NFL player to be discovered post-mortem to have CTE since 2002. If you add to these findings that football player in general (especially linemen) have a much higher incidence of obstructive sleep apnea, this could explain the high incidence of degenerative brain disease in football players.

It’s a given that you’ll hit your head repeatedly while playing football. Having played football and and rugby in school, I’ve taken a number of hits to the head myself.

The human brain has an amazing ability to heal and regenerate, but when place in adverse conditions, scarring and inflammation occurs. It’s been proven that chronic intermittent hypoxia (from obstructive sleep apnea) causes major brain damage in critical areas of the brain, including parts that are responsible for memory, executive function, motor skills, and autonomic function. Hypoxia can also induce amyloid plaques to build up in brain tissues. Damage to the brain, in the presence of hypoxia, can only lead to bad things.

I realize all this is pure speculation, but is there justification for routine screening for obstructive sleep apnea in all football players? I’d like to hear your opinion about this.

Brain Injury And Obstructive Sleep Apnea

 

I recently came across a study what showed that people who suffer from strokes have much more difficulty recovering brain function if they have obstructive sleep apnea. This makes total sense. Once you have brain damage of any type, having chronic hypoxia and blood stagnation can definitely prevent proper healing. This study assumed that only some people who have strokes have obstructive sleep apnea, but numerous studies show that the vast majority of stoke patients have undiagnosed obstructive sleep apnea. We also know that having obstructive sleep apnea significantly increases your chances of having a stroke by up to 300%. 

With recent increased awareness of traumatic brain injury in football players as well as in returning war veterans, it's important to at least screen for undiagnosed obstructive sleep apnea with both of these groups for people, early, rather than after the damage is done. Knowing that about 1/4 of all men will have at least mild sleep apnea, looking for and treating an underling sleep apnea condition can improve recovery after any form of brain injury, not to mention prevention of further brain injury and impairment. 

What years of do think about my theory? Is it plausible, or am I just over-hyping sleep apnea?

More Links Between Sleep Apnea & Alzheimer’s Disease

A patient happened to comment that her husband has Alzheimer's disease, and also has severe sleep apnea. She notices that for years, he stops breathing repeatedly at night, with multiple gasps for air and frequent awakenings. Unfortunately, he's not able to tolerate his CPAP machine. She's convinced that her husband's worsening brain function is aggravated, if not caused by his untreated sleep apnea. 

She's brought up this issue with numerous prominent Alzheimer's doctors and is usually told that there's no connection, and her idea is blown off. 

Knowing what we already know about sleep apnea and brain damage, I totally agree with her. Numerous studies have shown significant brain damage in multiple parts of the brain from untreated sleep apnea, including tissue volume loss, tissue density loss, lacunar infarcts, and decreased metabolism in critical areas of the brain. One recent study showed that CPAP therapy significantly increases brain gray matter volume after 3 months of usage. Executive functioning and short term memory were also significantly improved.

Should there be more research into the association between sleep apnea and Alzheimer's? What do you think?

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