Reducing Sleep Apnoea for the Prevention of Dementia

CogSleep OSA Treatment: The intervention is to treat hypoxaemia due to obstructive sleep apnoea (OSA) in older adults for two years using a number of proven modalities including continuous positive airway pressure (CPAP), mandibular advancement splints (MAS), positional therapy and oxygen therapy as determined by the medical officers. In most cases CPAP will be first line therapy. The frequency of the different modalities will be different for each individual as will the number and type of modalities used by each individual. Once provided to participants, all modalities are self-administered and individual will be ask to use the treatment nightly. Description of different modalities available: - CPAP is a machine that delivers air pressure through a face mask which covers participants nose or is placed over their nose and mouth while sleeping. - Mandibular advancement splints (MAS): These devices consist of a customized mouth guard used to treat OSA. MAS function by comfortably positioning the patient’s mandibular forward, clearing the obstructed airway and are only worn while the patient is sleeping. A dentist will need to take dental impressions from the patient to create the custom-made device. - Positional therapy: This device is a compact and is worn across participant’s chest in a soft, adjustable strap. This device delivers gentle vibrations that prompt the participant to shift to his/her side without disturbing his/her sleep. - Oxygen therapy: The oxygen is delivered through plastic tubing known as nasal cannula, typically at a rate of several liters per minute. A decision to step down to other modalities will be based on a treatment plan developed by CogSleep investigators in conjunction with the clinical opinion of the medical officer. Additionally, participants will receive up to 8 behavioural program sessions (30-60 minutes each) over a 6-month period. These sessions will be either face-to-face or telehealth consultations as decided between the trained sleep apnea therapist and the participant. The program will incorporate a collaborative approach using individualised and structured goal-setting in combination with motivational interviewing to further facilitate treatment adherence, engagement and maximal outcomes. The duration of the intervention will be 24 months, with OSA treatment occurring throughout, and the behavioural program for the first 6 months of the study. Treatment adherence using compliance reports from devices will be assessed through the 6 months program and then at 6 and 24 months. Treatment response will be assessed by hypoxic burden (sleep apnea severity) at 6 and 24 months. All participants in both arms will receive 8 psycho education emails for the first 6 months. The psychoeducation material was based on information developed in previous studies from our research lab, and updated to reflect more recent advances in evidence/best practice, as well as to better suit delivery via email. The emails will contain simple and practical tips about sleep hygiene (e.g. the impact of sleep on health, creating a sleep-conducive bedroom, sleep and memory, age-related sleep changes) and healthy brain ageing (e.g. importance of keeping the brain active, diet and exercise, brain health, depression and anxiety).