Sleep apnoea may pose increased Parkinson’s disease risk

People with obstructive sleep apnoea (OSA) seem predisposed to later development of Parkinson’s disease (PD), but this risk can be mitigated by early treatment with continuous positive airway pressure (CPAP), as reported in a study.

In a large cohort of US veterans, OSA was associated with a nearly twofold higher risk of PD (hazard ratio [HR], 1.92, 95 percent confidence interval [CI], 1.55–2.38; p<0.001). The number of additional cases of PD due to OSA ranged from 0.51 (95 percent CI, 0.26–0.76) per 1,000 people at the 2-year follow-up to 1.61 (95 percent CI, 1.13–2.09) per 1,000 people at the 6-year follow-up. [JAMA Neurol 2025;doi:10.1001/jamaneurol.2025.4691]

When OSA was categorized according to severity, the risk of PD was present for both mild (HR, 3.17, 95 percent CI, 2.45–4.11) and severe (HR, 3.42, 95 percent CI, 2.87–4.09) forms of OSA. The cumulative incidence of PD relative to veterans without OSA started to increase at year 5 for those with mild OSA and was already higher at year 1 for those with severe OSA.

More importantly, CPAP use within 2 years of OSA diagnosis reduced the risk of incident PD by 31 percent (HR, 0.69, 95 percent CI, 0.56–0.85). For every 1,000 people OSA followed for 5 years, CPAP treatment prevented about 2.28 cases of PD.

The analyses included 11,310,411 veterans (mean age 60.5 years, 90.1 percent male, 81 percent White), of which 1,552,505 (13.7 percent) had OSA. The mean follow-up duration was 4.9 years.

“These data establish additional clinical rationale for early screening and intervention of sleep-disordered breathing as a key strategy in supporting brain health,” according to the authors.

The upper airway obstruction in OSA is enough to cause significant intermittent arterial hypoxemia and hypercapnia, which can trigger a cascade of haemodynamic, metabolic, and inflammatory events, they explained. Chronic intermittent hypoxia in the brain results in mitochondrial dysfunction, which has been implicated in PD pathogenesis. [J Clin Med 2020;9:297; Am J Physiol Cell Physiol 2010;298:C1594-C1602; Lancet 2024;403:293-304]

“If you stop breathing and oxygen is not at a normal level, your neurons are probably not functioning at a normal level either,” said lead author Dr Lee Neilson from Oregon Health & Science University, Portland, Oregon, US.

“Add that up night after night, year after year, and it may explain why fixing the problem by using CPAP may build in some resilience against neurodegenerative conditions, including Parkinson’s,” Neilson added.

Neilson and colleagues acknowledged several limitations to the study, including the inability to assess CPAP adherence beyond the use of administrative codes or to understand the physical, cognitive, or other social factors influencing the decision to wear or tolerate CPAP.

“Therefore, the possibility remains that the individuals who are offered and adhere to CPAP are already the most likely to benefit, and it is unknown whether this benefit would extend to any potential user if CPAP adherence were enforced more broadly,” they said.