A Breath of Fresh Air: Innovative Solutions for Addressing Sleep Apnea and Cognitive Decline in Older Adults

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Neal K. Shah, CEO of CareYaya Health Technologies, discussed how sleep apnea and cognitive decline may be interrelated and disproportionately affecting minoritized populations.

Neal K. Shah  (Credit: CareYaya Health Technologies)

Neal K. Shah

Credit: CareYaya Health Technologies

Sleep apnea, a potentially serious sleep disorder characterized by repeated breathing interruptions during sleep, affects millions of Americans. While often overlooked, untreated obstructive sleep apnea (OSA) can have far-reaching consequences, particularly on cognitive function. Recent research has highlighted the bidirectional relationship between sleep apnea and cognitive decline, with those suffering from sleep apnea being at higher risk for developing Alzheimer's disease and related dementias (ADRD).1 Those with ADRD are 5 times more likely to have OSA than non-cognitively impaired individuals.2 OSA's negative impacts on sleep quality and other factors may further exacerbate cognitive decline. Treating OSA can therefore slow the cognitive decline of ADRD, improving quality of life for patients and relieving burden on family caregivers.3

Possible mechanisms in the relation between OSA and cognitive deterioration

The impact of sleep apnea on cognitive health is especially concerning for minority populations, who bear a disproportionate burden of both sleep apnea and ADRD. Studies have shown that sleep apnea is 2.1 times more prevalent in Black populations compared with White, while ADRD is twice as common.4 Despite this increased risk, up to 95% of affected Black individuals may be undiagnosed, leaving them vulnerable to the detrimental effects of untreated sleep apnea on their cognitive function.

Early detection and treatment of sleep apnea are crucial for slowing cognitive decline and improving quality of life for patients and their caregivers. Treating sleep apnea can help mitigate the negative impacts on sleep quality and other factors that may exacerbate cognitive decline. However, significant barriers to diagnosis and treatment exist, particularly for underserved communities, highlighting the urgent need for innovative solutions to address these unmet needs.

In this article, we will explore the complex relationship between sleep apnea and cognitive decline, with a focus on the disparities faced by minority populations. We will also discuss the current challenges in sleep apnea diagnosis and treatment access, and introduce CareYaya's groundbreaking initiative, SleepEasyLab, which aims to bridge these gaps and promote sleep health equity through a community-based approach.

Barriers to Sleep Apnea Diagnosis in Underserved Communities

Despite the significant impact of sleep apnea on cognitive health, many individuals, particularly those from underserved communities, face numerous barriers to receiving a timely diagnosis. One major obstacle is the lack of routine screening by primary care providers (PCPs).5 Sleep apnea often goes unrecognized, as PCPs may not consistently ask about sleep disturbances or screen for sleep disorders during regular check-ups. This oversight is particularly pronounced in Black populations, who are less likely to report sleep complaints, further contributing to the underdiagnosis of sleep apnea in this group.6

Barriers Encountered to OSA Diagnosis

Even when sleep apnea is suspected, accessing diagnostic testing can be a significant challenge. The gold standard for diagnosis is an in-lab polysomnography (PSG) study, which involves an overnight stay in a sleep laboratory. However, these studies can be prohibitively expensive, with costs ranging from $1,000 to $7,000.7 Moreover, long wait times, often extending from weeks to over a year, can delay diagnosis and treatment, especially in underserved areas with limited sleep laboratory facilities.

Transportation challenges and caregiver limitations pose additional barriers for older adults and those with cognitive impairments. Many individuals may struggle to arrange transportation to and from the sleep laboratory, particularly if they do not have a caregiver available to accompany them. The time and financial constraints of caregiving can also make it difficult for families to prioritize sleep apnea testing, particularly when faced with competing demands of managing ADRD.

Home sleep apnea tests (HSATs) have emerged as a more accessible and affordable alternative to in-lab PSG studies.8 However, unassisted HSATs have limitations, particularly for older adults and those with cognitive impairments. The devices can be complicated to set up and use, leading to high variability and failure rates in these populations. Inadequate support and monitoring during the testing process can result in incomplete or inaccurate data, further compromising the diagnostic accuracy of unassisted HSATs.

CareYaya's Innovative Solution: SleepEasyLab

CareYaya, a health technology startup dedicated to improving care access and affordability, has developed SleepEasyLab, a groundbreaking service model that aims to address the unmet needs in sleep apnea diagnosis for underserved populations. At the heart of SleepEasyLab is CareYaya's nationwide network of over 15,000 pre-health college student caregivers. These compassionate and motivated students are uniquely positioned to bridge the gaps in care by providing in-home assistance with sleep apnea testing.

Through SleepEasyLab, CareYaya trains students to facilitate Type-2 home sleep apnea tests (HSATs) for older adults and those with cognitive impairments. By offering hands-on support and guidance, these student caregivers help offset the social determinants of health barriers that often limit access to sleep apnea screening. This fully-assisted, home-based approach not only improves the accessibility and affordability of testing but also ensures that the HSAT process is comfortable, safe, and effective for the target population.

Type-2 Home Sleep Apnea Test from WatchPATTM ONE

To ensure the highest quality of care, CareYaya has partnered with sleep medicine experts, including Dr. Zheng (Jane) Fan, Professor of Neurology and Medical Director of the UNC-Chapel Hill Sleep Laboratory. Affordable at-home screening enables the identification of high-risk individuals and facilitates timely referrals for further evaluation and treatment.

By leveraging its extensive caregiver network and collaborating with sleep medicine professionals, SleepEasyLab has the potential to make a significant impact on patient outcomes, healthcare costs, and health equity. Early detection and treatment of sleep apnea can slow cognitive decline, improve quality of life, and reduce the burden on caregivers. Moreover, by identifying and addressing sleep apnea in underserved populations, SleepEasyLab can help prevent the cascading effects of untreated sleep disorders, such as increased healthcare utilization and costs associated with comorbidities like cardiovascular disease and diabetes.

This innovative approach not only fills a critical gap in sleep apnea care but also exemplifies the power of community-driven solutions in advancing health equity. By empowering pre-health students to serve as agents of change, SleepEasyLab fosters intergenerational connections, builds trust within communities, and inspires the next generation of healthcare leaders to prioritize equitable access to care. The potential for SleepEasyLab to transform sleep health equity on a national level is truly exciting.

A pilot study will measure the effectiveness of SleepEasyLab through key metrics such as the identification of high-risk individuals and follow-up diagnosis rates. By tracking the diagnostic yield and apnea-hypopnea index (AHI) of referred participants, CareYaya will build a compelling case for the clinical utility and cost-saving potential of its approach, laying the groundwork for future partnerships with sleep labs and insurance providers.

With its unique blend of technology, community engagement, and workforce development, SleepEasyLab has the potential to revolutionize sleep apnea care delivery and advance health equity on an unprecedented scale.

The Future of Sleep Health Equity

This project represents a significant step towards addressing the unmet needs in sleep apnea diagnosis for underserved populations. By demonstrating the effectiveness of a student-facilitated HSAT model, CareYaya aims to establish a new standard of care that prioritizes accessibility, affordability, and patient-centered support.

The success of the project has far-reaching implications for the future of sleep health equity. By improving access to sleep apnea diagnosis in underserved groups, particularly Black older adults with Alzheimer's disease and related dementias (ADRD), we can lay the foundation for earlier intervention and better health outcomes. Treating sleep apnea can slow cognitive decline, enhance quality of life, and reduce the burden on caregivers and healthcare systems. By empowering pre-health students to serve as advocates and change agents, SleepEasyLab is cultivating a new generation of healthcare leaders who prioritize equitable access to care.

As we look to the future, it is clear that initiatives like SleepEasyLab are not only desirable but necessary. The COVID-19 pandemic has exposed and exacerbated the deep-rooted health disparities that persist in our society, underscoring the urgent need for innovative, community-driven solutions. This model offers a compelling example of how we can harness technology, human capital, and collaborative partnerships to bridge gaps in care and improve health outcomes for all.

We call upon healthcare stakeholders – from clinicians and researchers to policymakers and payers – to prioritize sleep health equity and support initiatives like SleepEasyLab. By working together to expand access to sleep apnea diagnosis and treatment, we can make significant strides in reducing health disparities, improving quality of life, and building a more just and equitable healthcare system for all. The future of sleep health is in our hands, and with collective action, we can make it a reality.

REFERENCES
1. Mansukhani, Meghna P., Naima Covassin, and Virend K. Somers. 2019. “Neurological Sleep Disorders and Blood Pressure: Current Evidence.” Hypertension 74 (4): 726–32.
2. Emamian, Farnoosh, Habibolah Khazaie, Masoud Tahmasian, Guy D. Leschziner, Mary J. Morrell, Ging-Yuek R. Hsiung, Ivana Rosenzweig, and Amir A. Sepehry. 2016. “The Association Between Obstructive Sleep Apnea and Alzheimer’s Disease: A Meta-Analysis Perspective.” Frontiers in Aging Neuroscience 8 (April): 78.
3. Richards, Kathy C., Nalaka Gooneratne, Barry Dicicco, Alexandra Hanlon, Stephen Moelter, Fannie Onen, Yanyan Wang, et al. 2019. “CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea.” Journal of the American Geriatrics Society 67 (3): 558–64.
4. Dudley, Katherine A., and Sanjay R. Patel. 2016. “Disparities and Genetic Risk Factors in Obstructive Sleep Apnea.” Sleep Medicine 18 (February): 96–102.
5. Miller, Jennifer N., and Ann M. Berger. 2016. “Screening and Assessment for Obstructive Sleep Apnea in Primary Care.” Sleep Medicine Reviews 29 (October): 41–51.
6. Williams, Natasha J., João V. Nunes, Ferdinand Zizi, Kola Okuyemi, Collins O. Airhihenbuwa, Gbenga Ogedegbe, and Girardin Jean-Louis. 2015. “Factors Associated with Referrals for Obstructive Sleep Apnea Evaluation among Community Physicians.” Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine 11 (1): 23–26.
7. Henry, Olivia, Alexandra Brito, Marguerite Cooper Lloyd, Robert Miller, Eleanor Weaver, and Raghu Upender. 2022. “A Model for Sleep Apnea Management in Underserved Patient Populations.” Journal of Primary Care & Community Health 13: 21501319211068969.
8. Davis, Lauren Evoy, Chester Wu, and Susan Stiles. 2023. “What to Know about at-Home Sleep Apnea Tests.” NCOA Adviser. October 24, 2023. https://www.ncoa.org/adviser/sleep/home-sleep-apnea-tests/.

Neal K. Shah is the CEO of CareYaya Health Technologies, one of the fastest-growing health tech startups in America. He runs a social enterprise and applied research lab utilizing AI and neurotech to advance health equity, with a focus on neurological care for elders with dementia. Shah has advanced AI projects to improve neurological care with support from the National Institutes of Health, Johns Hopkins AITC and Harvard Innovation Labs. Neal is a “Top Healthcare Voice” on LinkedIn with a 35k+ following.

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