Biomarkers in Obstructive Sleep Apnoea: Predicting Neurodegenerative Risk and Treatment-Responsive Vulnerability

Background: Obstructive sleep apnoea (OSA) is increasingly associated with earlier onset and accelerated trajectories of neurodegenerative change. Mechanistically, this relationship is thought to reflect convergent pathways spanning intermittent hypoxia. Biomarker profiling offers a pragmatic route to interrogate these processes in vivo, providing quantitative indices for risk stratification and for monitoring the biological response to OSA therapy in the context of cognitive decline prevention. Objectives: The present study undertakes a scoping review on the mechanistic links between OSA and neurodegeneration, as well as the utility of biomarkers for risk stratification and monitoring efficacy of treatment to mitigate cognitive decline. Methods: A literature search was conducted using PubMed, Scopus, Embase and Cochrane from January 2000 to February 2026. Search terms included “Obstructive sleep apnoea”, “Continuous Positive Airway Pressure”, “Uvulopalatopharyngoplasty”, “Biomarkers”, “Genomics”, “Alzheimer Disease” and “Parkinson Disease”. We included all studies that analysed biomarker changes in OSA patients and/or the effect of CPAP on biomarkers. Studies with only cognitively impaired cohorts, editorials, opinion pieces, conference abstracts, non-human studies, and non-English studies were excluded. Results: A total of 59 unique studies were included. Forty of them analysed biomarkers involved in the pathophysiology behind neurodegeneration in OSA patients, while 26 described the changes in biomarkers post therapy. Notably, 15 studies were included in both aspects. Lastly, eight studies explored novel applications of multiomics technologies.