Sleep Apnoea Symptoms And Prevalence In People Attending Memory Services

Research Question We want to improve quality of life and brain health by treating sleep apnoea in people with who present to memory clinics. Here we ask how best to deliver a future interventional trial. Background Convincing biological mechanisms and epidemiological data link sleep with diseases that cause dementia, such as Alzheimer s disease. Improving sleep has potential to modify disease progression, as well as benefit quality of life and general health in people at various stages of dementia. Sleep apnoea is a common cause of sleep disturbance affecting over 50% of adults aged over 65 in research cohorts. Sleep apnoea can be effectively treated with continuous positive airway pressure. Yet, dementia clinicians in the UK estimate only 0-5% of their patients are diagnosed with sleep apnoea. Sleep apnoea may be under recognised and treated in memory clinics. This is because people with memory loss may have variable recall of symptoms, and possibly different symptoms of sleep apnoea. We are missing an opportunity to help many memory clinic patients improve their sleep through treating their sleep apnoea. In future, it is likely that we could improve on current sleep apnoea treatments by tailoring therapy to people with cognitive impairment. Aims and objectives To design interventional trials to test the benefit of treating sleep apnoea in memory clinic patients, we need to know the i) sleep apnoea prevalence and ii) most efficient way to screen for sleep apnoea in our population by determining the symptoms that best predict sleep apnoea and iii) whether or not these symptoms can be detected remotely using a smartphone app, telephone or postal questionnaires in this population. Methods We use an observational cohort design recruiting anyone who attends a memory clinic across 6 sites. Participants will be asked if they would agree to use a wrist-worn respiratory polygraphy device, WatchPat, for one night, and complete 3 questionnaires: i) Epworth Sleepiness Score & ii) STOPBANG are two NICE recommended sleepiness and sleep apnoea screening tools respectively & iii) a study-specific symptom checklist of other potential sleep apnoea symptoms. Participants will have the option of completing and returning the questionnaires via smartphone app, telephone, or postal service. We will record the prevalence of sleep apnoea according to the WatchPat device and develop a statistical model to determine which symptoms best predict sleep apnoea in our population. We will report how many patients choose to complete the questionnaires via app, telephone and mail, and data completeness for these different modes of data collection. Timelines for delivery Two months of protocol optimisation prior to study start-up will lead into study delivery over 17 months. Anticipated impact and dissemination Presentation at national and local scientific and public meetings and peer-reviewed publication will raise awareness of potential sleep apnoea in memory clinics allowing services to benchmark detection rates and change practice if appropriate. Next, we will develop a complex interventional trial with the aim of improving the effectiveness of treatment in memory clinic populations.