Association Between Obstructive Sleep Apnea and Autonomic Symptoms in Parkinson’s Disease: A Cross-sectional Analysis
Francisco A. Luna-Rangel1, Brenda Gonzalez-Bedolla1, Karen Pozo2, Erick Alejandro Barajas Llamas2, Walter F. Torres-Rodríguez3, Karla Boeta-Lopez4, Elly Robles5, Daniel Rebolledo-Garcia1, Daniel Martinez-Ramirez1
1Tecnológico de Monterrey, 2Neurology department, Tecnológico de Monterrey, 3Geriatrics Department, Universidad de Monterrey, 4Baylor Scott and White, 5Department of Physiology, Anatomy and Genetics, University of Oxford
Objective:
To examine the association between obstructive sleep apnea (OSA) and autonomic burden in patients with Parkinson’s disease (PD)
Background:
Autonomic dysfunction is a common non-motor feature of PD that significantly impacts quality of life. Although OSA is prevalent in PD and has been associated with worse motor and cognitive outcomes, its relationship with autonomic dysfunction particularly across specific autonomic domains remains undescribed.
Design/Methods:
A cross-sectional study was conducted using data from the Parkinson’s Progression Markers Initiative (PPMI; www.ppmi-info.org). Approximately 3,596 patients with complete data were included after excluding those lacking sufficient information on SCOPA-AUT or OSA diagnosis. OSA was defined based on a documented clinical diagnosis. Autonomic dysfunction was assessed using the SCOPA-AUT scale, with domain-specific scores (Gastrointestinal, Urinary, Cardiovascular, Thermoregulatory, Pupillomotor, Sexual, and Total). Multivariable linear regression models were performed, adjusting for age, sex, motor severity (UPDRS-III), and cognition (MoCA). False discovery rate (FDR) correction was applied for multiple comparisons. Additionally, a post hoc analysis was conducted to explore OSA*sex interactions, and non-parametric tests (Mann–Whitney U) were used to confirm distributional differences between groups.
Results:
OSA was significantly associated with higher total SCOPA-AUT scores (β = 1.11; 95% CI: 0.7–1.5; p < 0.001; FDR-corrected p = 0.00024), as well as with specific autonomic domains: Gastrointestinal, Urinary, Pupillomotor, and Sexual. Sex interactions were significant across several domains, indicating a stronger association in males.
Conclusions:
In this cross-sectional analysis, we identified an association between OSA and greater autonomic burden in PD, with heterogeneity across autonomic domains and sex. Longitudinal studies are needed to clarify the directionality of this relationship and to support the development of an emerging line of research in Parkinson’s disease.
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