Understanding the relationship between obstructive sleep apnea and comorbid neurocognitive and affective disorders in older adults

Obstructive sleep apnea (OSA) syndrome is characterized by disruptions in oxygen flow resulting in nocturnal choking, loud snoring, and poor sleep. OSA impacts older adults at a disproportionate rate, and it is highly comorbid with neurocognitive and affective disorders. Untreated OSA is a significant risk factor for accelerated cognitive decline and affective disturbances in the aging population. This narrative review was the first to our knowledge to examine the complexity of an interplay between OSA and these comorbidities and provide recommendations for researchers and healthcare practitioners. We highlighted the patterns of under- and misdiagnosis of OSA and neurocognitive disorders in primary care settings due to gaps in construct validity of existing measures, inconsistent terminology and operationalization of neurocognitive and affective disorders, and lack of resources. Pervasive under- or misdiagnosis of OSA and its comorbidities in combination with overwhelmingly poor CPAP treatment compliance negatively impact the geriatric population. Some of the examples provided in this review reflect the Canadian context of the authors practice, although the research gaps and clinical recommendations are applicable more broadly.