0541 Racial/Ethnic Disparities in Links of Obstructive Sleep Apnea Diagnosis and Treatment with Cognitive Impairment in Middle-Aged and Older Adults

Obstructive sleep apnea (OSA) is linked to cognitive impairment, and racial/ethnic disparities exist in both OSA and dementia. We previously identified disparities in OSA diagnosis and treatment among middle-aged and older adults in the Health and Retirement Study (HRS). Here, we tested whether the association between OSA diagnosis/treatment status and incident cognitive impairment differed by race/ethnicity.Data came from the 2016-2020 waves of the HRS, a nationally representative study of middle-aged and older adults in the United States. We included participants who had probable or diagnosed OSA in 2016 determined by a modified STOP-Bang measure or self-reported OSA diagnosis. Self-reported OSA treatments included CPAP, oral appliance, and surgery. We classified participants as: probable-undiagnosed OSA (i.e., no self-reported diagnosis and met criteria for probable OSA on the modified STOP-Bang); diagnosed-untreated OSA; or diagnosed-treated OSA. Our outcome was a diagnosis of either cognitively impaired, no dementia (CIND) or dementia per the Langa-Weir Classification of Cognitive Function in waves 2018 and 2020. We assessed the association of OSA diagnosis/treatment status with incident cognitive impairment using generalized estimating equations. Effect modification by race/ethnicity (Hispanic/Latino, Non-Hispanic Black (NHB), Non-Hispanic White (NHW), Non-Hispanic Other Race) was assessed via an interaction term.We studied 3,881 participants who had probable or diagnosed OSA and were cognitively unimpaired in 2016 (mean 63.0±9.7 years, 52.6% female, 40% minoritized race/ethnicity). Among probable-undiagnosed OSA participants: compared to NHW participants, NHB and Hispanic/Latino participants had 105% (OR=2.05, 95% CI 1.48, 2.84) and 48% (OR=1.48, 95% CI 1.02, 2.11) higher odds of cognitive impairment, respectively. In main effects, diagnosed-treated participants had 22% lower odds of incident cognitive impairment compared to probable-undiagnosed OSA participants (OR=0.78, 95% CI 0.61, 0.99). We found evidence for potential effect modification by race/ethnicity (p for interaction = 0.051). Among NHB participants, diagnosed-treated participants had 54% lower odds of incident cognitive impairment than probable-undiagnosed participants (OR=0.46, 95% CI 0.27, 0.79); these associations were non-significant in NHW and Other racial/ethnic groups.Undiagnosed NHB and Hispanic/Latino individuals with OSA may be at increased risk for cognitive impairment. NHB individuals may have particularly strong cognitive benefits from OSA treatment.National Institute on Aging (R01AG079391).