The Effects of Successful OSA Treatment on Memory and AD Biomarkers in Older Adults Study (ESSENTIAL)
The Effects of Successful OSA Treatment on Memory and AD Biomarkers in Older Adults (ESSENTIAL) Study
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Katie L Stone, PhD
- Phone Number: 415-476-6128
- Email: katie.stone@ucsf.edu
Study Contact Backup
- Name: Lisa Takemori
- Phone Number: 415-633-6229
- Email: lisa.takemori@ucsf.edu
Study Locations
-
-
Arizona
-
Tucson, Arizona, United States, 85719
- Recruiting
- University of Arizona
-
Principal Investigator:
- Sairam Parsasarathy, MD
-
-
New York
-
New York, New York, United States, 10016
- Recruiting
- New York University
-
Principal Investigator:
- Ricardo Osorio, MD
-
Principal Investigator:
- Acibiades Rodriguez, MD
-
New York, New York, United States, 10023
- Recruiting
- Mount Sinai
-
Principal Investigator:
- Andrew Varga, MD
-
Principal Investigator:
- Jay Guevarra, MD
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15213
- Recruiting
- University of Pittsburgh
-
Principal Investigator:
- Sanjay Patel, MD
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Cognitively normal (TiCS ≥29)
- Age 55-85 years
- Moderate - severe OSA defined as AHI4 ≥20 events/hour or AHI3A>40/hr using a hypopnea criterion of a 4% oxygen desaturation (AHI4) or 3% oxygen desaturation and/or EEG arousal (AHI3A), or equivalent based on in-home testing - Testing must have been completed in past 12 months or confirmed by repeat test
- Not currently on therapy for OSA and has not received treatment for OSA for at least 6months
- Able and willing to be treated for OSA (Treatment group)
- Fluency in English or Spanish
Exclusion Criteria:
- Documented diagnosis of chronic insomnia, or sleep onset insomnia based on Insomnia Severity Index - an answer of severe or very severe in the screening form
- Documented diagnosis of circadian rhythm disorder
- Any current use of supplemental oxygen
- Other sleep-related breathing disorders (central sleep apnea, etc) based on AASM criteria
- Current shift work involving night shift (regular work between 12am and 6am or night shift) within the past 6 mo
- Anticipated scheduled bariatric surgery within the next 3 months
- Chronic regular (> 2 nights per week) of cannabis for sleep
- Chronic regular use (> 2 nights per week) of sedatives/hypnotics for sleep
- Diagnosis of uncontrolled psychiatric disease in the last six months , and/or history of schizophrenia or bipolar disorder. Controlled conditions will include major depressive disorder, panic disorder, generalized anxiety disorder, OCD, substance use disorders, and alcohol abuse/dependence. Personality disorders and neurodevelopmental disorders (e.g. autism, ADHD) are allowed if cognition is within normal limits.
- Taking methylphenidate for ADHD. Unless on stable dose which will be reviewed by the PI to determine.
- Taking GLP-1 agonist semaglutide (Ozempic, Wegovy, Rybelsus), or tirzepatide (Mounjaro, Zepbound), or similar for weightloss, and planning to lose an additional 20lbs or more at the time of enrollment. PI Discretion for determination of why they are taking the drug based on conversation with subject and medical chart, will be documented in form of Note-to-file in the subject's records
- Presence of other comorbid condition that would lead to inability to complete the study protocol (including follow-up for 2 years), or that would affect cognition (e.g. clinically relevant endocrine or hematological conditions).
- Does not have a regular sleeping environment (i.e., sleeps in a different setting > 2 nights per week).
- Currently pregnant or planning to become pregnant.
- Prior diagnosis of a Central nervous system (CNS) disease, such as multiple sclerosis, stroke, Parkinson's disease, Alzheimer's disease, epilepsy, a loss of consciousness > 24 hours, or traumatic brain injury as identified by the Cumulative Illness Rating Scale for Geriatrics (CIRS). Participants who are diagnosed with MCI or Alzheimer's disease based on neuropsychological testing will be excluded. Delirium in the last 12 months.
- Near-miss or prior automobile accident "due to sleepiness" within the past 12 months.
- Employed as a commercial driver during the study (for example, bus drivers, train engineers, airplane pilots).
- Any use of neuroleptics, benzodiazepines, barbiturates, opiates or anti-amyloid therapies.
- Use of other cognitive enhancing drugs will also be excluded if initiated in the last 3 months, or not on stable dose.
- Consumption of >14 alcohol drinks per week, unless alcohol consumption can be reduced if initiated in the last 3 months.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Active Comparator: 3-month OSA treatment
A 3-month OSA treatment by any combination of PAP, OAT, and positional therapy that results in an "effective" AHI3a<15 (rapid multi-modal treatment RMMT).
|
Positive airway pressure (PAP) therapy is a sleep apnea treatment that uses a stream of compressed air to support the airway during sleep.
With PAP therapy, a mask is worn during sleep and a portable machine gently blows pressurized room air from into your upper airway through a tube connected to the mask.
This positive airflow helps keep the airway open, preventing the collapse that occurs during apnea, thus allowing normal breathing.
Other Names:
Oral appliance therapy involves the use of a dental appliance or oral mandibular advancement device that prevents the tongue from blocking the throat and/or advances the lower jaw forward.
These devices help keep the airway open during sleep.
Other Names:
A NightShift Sleep Positioner (Advanced Brain Monitoring) is a neck vibration device, FDA approved to treat positional sleep apnea.
The device detects patient supine position and delivers a small vibratory signal to the back of the neck to prompt position change.
Other Names:
|
|
Other: Waitlist control group
A waitlist control group to receive treatment at the conclusion of the 3-month intervention period.
|
Positive airway pressure (PAP) therapy is a sleep apnea treatment that uses a stream of compressed air to support the airway during sleep.
With PAP therapy, a mask is worn during sleep and a portable machine gently blows pressurized room air from into your upper airway through a tube connected to the mask.
This positive airflow helps keep the airway open, preventing the collapse that occurs during apnea, thus allowing normal breathing.
Other Names:
Oral appliance therapy involves the use of a dental appliance or oral mandibular advancement device that prevents the tongue from blocking the throat and/or advances the lower jaw forward.
These devices help keep the airway open during sleep.
Other Names:
A NightShift Sleep Positioner (Advanced Brain Monitoring) is a neck vibration device, FDA approved to treat positional sleep apnea.
The device detects patient supine position and delivers a small vibratory signal to the back of the neck to prompt position change.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change in overnight memory retention on the A-B verbal paired associates task
Time Frame: 3 months
|
Mean change in percent correct memory
|
3 months
|
|
Change in overnight memory retention on the A-B verbal paired associates task
Time Frame: 12 months
|
Mean change in percent correct memory
|
12 months
|
|
Change in overnight memory retention on the A-B verbal paired associates task
Time Frame: 24 months
|
Mean change in percent correct memory
|
24 months
|
|
Change in Aβ42/ Aβ40 ratio
Time Frame: 3 months
|
Mean change in the Aβ42/ Aβ40 ratio in picograms per millimeter (pg/ml)
|
3 months
|
|
Change in Aβ42/ Aβ40 ratio
Time Frame: 24 months
|
Mean change in the Aβ42/ Aβ40 ratio in picograms per millimeter (pg/ml)
|
24 months
|
|
Change in Plasma P-tau181
Time Frame: 3 months
|
Mean change in p-tau181 levels in the plasma in picograms per millimeter (pg/ml)
|
3 months
|
|
Change in Plasma P-tau181
Time Frame: 24 months
|
Mean change in p-tau181 levels in the plasma in picograms per millimeter (pg/ml)
|
24 months
|
|
Change in P-tau217
Time Frame: 3 months
|
Mean change in p-tau217 levels in the plasma in picograms per millimeter (pg/ml)
|
3 months
|
|
Change in P-tau217
Time Frame: 24 months
|
Mean change in p-tau217 levels in the plasma in picograms per millimeter (pg/ml)
|
24 months
|
|
Change in Neurofibrilary light (NfL)
Time Frame: 3 months
|
Mean change in NfL levels in the plasma in picograms per millimeter (pg/ml)
|
3 months
|
|
Change in Neurofibrilary light (NfL)
Time Frame: 24 months
|
Mean change in NfL levels in the plasma in picograms per millimeter (pg/ml)
|
24 months
|
|
Preclinical Cognitive Composite Score
Time Frame: 3 months
|
Mean change in Preclinical Cognitive Composite Score.
|
3 months
|
|
Preclinical Cognitive Composite Score
Time Frame: 12 months
|
Mean change in Preclinical Cognitive Composite Score.
|
12 months
|
|
Preclinical Cognitive Composite Score
Time Frame: 24 months
|
Mean change in Preclinical Cognitive Composite Score.
|
24 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Change in Task-switching Accuracy
Time Frame: 3 months
|
Change in Task-switching Mean Percent Accuracy
|
3 months
|
|
Change in Task-switching Accuracy
Time Frame: 12 months
|
Change in Task-switching Mean Percent Accuracy
|
12 months
|
|
Change in Task-switching Accuracy
Time Frame: 24 months
|
Change in Task-switching Mean Percent Accuracy
|
24 months
|
|
Change in Task-switching Reaction Time
Time Frame: 3 months
|
Change in Task-switching Mean Reaction Time in milliseconds
|
3 months
|
|
Change in Task-switching Reaction Time
Time Frame: 12 months
|
Change in Task-switching Mean Reaction Time in milliseconds
|
12 months
|
|
Change in Task-switching Reaction Time
Time Frame: 24 months
|
Change in Task-switching Mean Reaction Time in milliseconds
|
24 months
|
|
Change in Psychomotor Vigilance Task (PVT) lapses
Time Frame: 3 months
|
Mean change in number of lapses
|
3 months
|
|
Change in Psychomotor Vigilance Task (PVT) lapses
Time Frame: 12 months
|
Mean change in number of lapses
|
12 months
|
|
Change in Psychomotor Vigilance Task (PVT) lapses
Time Frame: 24 months
|
Mean change in number of lapses
|
24 months
|
|
Change in Psychomotor Vigilance Task (PVT) reaction time
Time Frame: 3 months
|
Mean change in median reaction time in milliseconds.
|
3 months
|
|
Change in Psychomotor Vigilance Task (PVT) reaction time
Time Frame: 12 months
|
Mean change in median reaction time in milliseconds.
|
12 months
|
|
Change in Psychomotor Vigilance Task (PVT) reaction time
Time Frame: 24 months
|
Mean change in median reaction time in milliseconds.
|
24 months
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Cognitive Impairment Severity
Time Frame: Baseline
|
Severity of cognitive impairment based on normed cutoffs with the National Alzheimer's Coordinating Centers Uniform Data Set-3 (UDS-3) assessment.
|
Baseline
|
|
Cognitive Impairment Severity
Time Frame: 24 months
|
Severity of cognitive impairment based on normed cutoffs with the National Alzheimer's Coordinating Centers Uniform Data Set-3 (UDS-3) assessment.
|
24 months
|
|
Clinical Dementia Rating (CDR) Scale (0-3)
Time Frame: Baseline
|
Clinical Dementia Rating on a scale of 0-3 based on clinical assessment, 0 being no impairment, and 3 being severe impairment.
|
Baseline
|
|
Sleepiness Score
Time Frame: Baseline
|
Epworth Sleepiness Scale (ESS) Questionnaire Score.
Higher scores mean more severe sleepiness.
|
Baseline
|
|
Sleepiness Score
Time Frame: 3 months
|
Epworth Sleepiness Scale (ESS) Questionnaire Score.
Higher scores mean more severe sleepiness.
|
3 months
|
|
Sleepiness Score
Time Frame: 24 months
|
Epworth Sleepiness Scale (ESS) Questionnaire Score.
Higher scores mean more severe sleepiness.
|
24 months
|
|
Insomnia Severity
Time Frame: Baseline
|
Insomnia Severity Index (ISI) Questionnaire Score.
Higher scores mean more severe insomnia symptoms.
|
Baseline
|
|
Insomnia Severity
Time Frame: 3 months
|
Insomnia Severity Index (ISI) Questionnaire Score.
Higher scores mean more severe insomnia symptoms.
|
3 months
|
|
Insomnia Severity
Time Frame: 24 months
|
Insomnia Severity Index (ISI) Questionnaire Score.
Higher scores mean more severe insomnia symptoms.
|
24 months
|
|
Psychiatric Symptom Questionnaires: Geriatric Depression Scale (GDS)
Time Frame: Baseline
|
Scores of 0-4 are considered normal, depending on age, education, and complaints; 5-8 indicate mild depression; 9-11 indicate moderate depression; and 12-15 indicate severe depression.
|
Baseline
|
|
Psychiatric Symptom Questionnaires: Hamilton Anxiety Rating Scale (HAM-A)
Time Frame: Baseline
|
Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0-56, where <17 indicates mild severity, 18-24 mild to moderate severity and 25-30 moderate to severe.
|
Baseline
|
|
Psychiatric Symptom Questionnaires: Clinician-Administered PTSD Scale (CAPS)
Time Frame: Baseline
|
CAPS-5 symptom cluster severity scores are calculated by summing the individual item severity scores for symptoms corresponding to a given DSM-5 cluster: Criterion B (items 1-5); Criterion C (items 6-7); Criterion D (items 8-14); and, Criterion E (items 15-20).
Severity scores range from 0-4, with 0 being absent to 4 being extreme/incapacitating.
|
Baseline
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Katie L Stone, PhD, California Pacific Medical Center Research Institute
- Principal Investigator: Ricardo Osorio, MD, New York University
- Principal Investigator: Andrew Varga, MD, Icahn School Of Medicine At Mount Sinai
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Brain Diseases
- Central Nervous System Diseases
- Nervous System Diseases
- Mental Disorders
- Respiratory Tract Diseases
- Neurocognitive Disorders
- Respiration Disorders
- Cognition Disorders
- Dementia
- Tauopathies
- Neurodegenerative Diseases
- Sleep Wake Disorders
- Apnea
- Sleep Disorders, Intrinsic
- Dyssomnias
- Sleep Apnea Syndromes
- Cognitive Dysfunction
- Alzheimer Disease
- Sleep Apnea, Obstructive
Other Study ID Numbers
Other Study ID Numbers
- AG080609
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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