{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:22:19Z","timestamp":1792844539256,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"\n Importance<\/jats:title>\n Obstructive sleep apnea (OSA) is associated with many health conditions, including dementia and early mortality. Prior epidemiological studies linking OSA with Parkinson disease (PD) are conflicting, and no studies have examined the influence of continuous positive airway pressure (CPAP), the criterion standard treatment for OSA, on PD risk.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between OSA with incident Parkinson disease among US veterans and risk modification by CPAP.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This electronic health record (EHR)\u2013based cohort study was conducted among US veterans from January 1, 1999, to December 30, 2022, with mean (SD) follow-up of 4.9 (1.8) years. Veterans with PD at the time of exposure or incomplete records were excluded. Data analysis was completed from September 2024 to September 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n OSA was defined by its appropriate administrative code; CPAP usage was extracted from a semistructured medical interview field in the EHR.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome, cumulative incidence of PD, was calculated adjusting for competing risk of death after balancing for age, race, sex, and smoking status.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 13\u202f737\u202f081 US veterans were screened, and 11\u202f310\u202f411 veterans (1\u202f109\u202f543 female veterans [9.8%]) with mean (SD) age of 60.5 (14.7) years were included in analyses. Of included veterans, 1\u202f552\u202f505 (13.7%) had OSA. Veterans with OSA demonstrated 1.61 additional cases of PD (point estimate; 95% CI, 1.13-2.09) at 6 years from diagnosis per 1000 people compared to those without OSA. Results were confirmed when adjusting for body mass index, vascular comorbidities, psychiatric conditions, and relevant medications and were of greater magnitude in female veterans. Case numbers were significantly reduced when treated with CPAP early in the disease course.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this EHR-based cohort study, OSA appeared to be an independent risk factor for the later development of PD and could be modified by early treatment with CPAP. Effective screening measures and protocols for consistent adherence to CPAP may have large impacts on brain health.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamaneurol.2025.4691","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T16:31:17Z","timestamp":1764001877000},"page":"68","source":"Crossref","is-referenced-by-count":13,"title":["Obstructive Sleep Apnea, Positive Airway Pressure, and Implications of Early Treatment in Parkinson Disease"],"prefix":"10.1001","volume":"83","author":[{"given":"Lee E.","family":"Neilson","sequence":"first","affiliation":[{"name":"Neurology and Research Service, VA Portland Health Care System, Portland, Oregon"},{"name":"VISN 20 Northwest Mental Illness Research, Education and Clinical Center, VA Portland Health Care System, Portland, Oregon"},{"name":"Department of Neurology, Oregon Health & Science University, Portland"},{"name":"Department of Neurology, University of Iowa, Iowa City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Monta\u00f1o","sequence":"additional","affiliation":[{"name":"Neurology and Research Service, VA Portland Health Care System, Portland, Oregon"},{"name":"Department of Neurology, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmine L.","family":"May","sequence":"additional","affiliation":[{"name":"Neurology and Research Service, VA Portland Health Care System, Portland, Oregon"},{"name":"Department of Neurology, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savanah","family":"Sicard","sequence":"additional","affiliation":[{"name":"Neurology and Research Service, VA Portland Health Care System, Portland, Oregon"},{"name":"Department of Neurology, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeilim","family":"Cho","sequence":"additional","affiliation":[{"name":"VISN 20 Northwest Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington"},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle"},{"name":"Department of Neurology, University of Washington School of Medicine, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Iliff","sequence":"additional","affiliation":[{"name":"VISN 20 Northwest Mental Illness Research, Education and Clinical Center, VA Puget Sound Health Care System, Seattle, Washington"},{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle"},{"name":"Department of Neurology, University of Washington School of Medicine, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan E.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Neurology and Research Service, VA Portland Health Care System, Portland, Oregon"},{"name":"VISN 20 Northwest Mental Illness Research, Education and Clinical Center, VA Portland Health Care System, Portland, Oregon"},{"name":"Department of Neurology, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miranda M.","family":"Lim","sequence":"additional","affiliation":[{"name":"Neurology and Research Service, VA Portland Health Care System, Portland, Oregon"},{"name":"VISN 20 Northwest Mental Illness Research, Education and Clinical Center, VA Portland Health Care System, Portland, Oregon"},{"name":"Department of Neurology, Oregon Health & Science University, Portland"},{"name":"Department of Oregon Institute of Occupational Health Sciences, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory D.","family":"Scott","sequence":"additional","affiliation":[{"name":"Pathology and Laboratory Services, VA Portland Health Care System, Portland, Oregon"},{"name":"Department of Pathology, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"noi250080r1","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1038\/s41531-022-00410-y","article-title":"Incidence of Parkinson disease in North America.","volume":"8","author":"Willis","year":"2022","journal-title":"NPJ Parkinsons Dis"},{"issue":"4","key":"noi250080r2","first-page":"1243","article-title":"Screening and targeting risk factors for prodromal synucleinopathy: taking steps toward a prescriptive multi-modal framework.","volume":"14","author":"Neilson","year":"2023","journal-title":"Aging 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