Neuro-cognition in patients of Obstructive Sleep Apnoea Syndrome (original) (raw)
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Applied Neuropsychology: Adult, 2014
By comparing neurocognitive test results from patients with obstructive sleep apnea syndrome (OSAS) and those from patients with simple snoring, we aimed to establish whether OSAS negatively influences cognition. Patients with mild-to-severe OSAS (n ¼ 29) and nonhypoxic simple-snoring patients (n ¼ 30) were admitted to the study. All participants in both groups were evaluated with polysomnography and neurocognitive tests, including the Stroop Test, Rey Auditory Verbal Learning Test, Judgment of Line Orientation, Trail-Making Test, and Symbol Digit Modalities Test (SDMT). Significant differences were identified between the groups for test scores on the Rey 1, SDMT, and Stroop tests. We propose that accurate OSAS diagnosis and treatment might help to prevent cognitive decline.
Does cognitive dysfunction conform to a distinctive pattern in obstructive sleep apnea syndrome?
Journal of Sleep Research, 2004
SUMMAR Y Obstructive sleep apnea (OSA) is a recognized cause of cognitive dysfunction. By using a cross-sectional comparative study, we aimed to verify whether neuropsychological performance of untreated OSA patients conforms to a distinctive pattern. Forty-nine newly diagnosed, untreated OSA patients, 27 with multi-infarctual dementia (MID), 31 with mild to moderate dementia of Alzheimer type (DAT) and 63 with severe chronic obstructive pulmonary disease (COPD), all free from major comorbid dementing conditions were chosen for the study. The groups were matched for age and education. We found a bimodal distribution of cognitive performance in OSA group, which was therefore divided into two clusters having better (OSAb, n ¼ 35) and worse (OSAw, n ¼ 14) performance on a battery of 10 cognitive indexes. Cognitive performances of OSAb, OSAw, MID, DAT and COPD were compared by discriminant analysis. OSAb performed better than OSAw in all but one test. Deductive thinking and verbal attainment were more severely impaired in OSAw than in COPD patients. Constructive ability, deductive thinking and both verbal attainment and immediate memory were comparably impaired in OSAw and DAT. The mean neuropsychological scores of OSAw and MID were comparable, but 71% of OSAw patients had a distinctive cognitive profile, i.e. a group specific pattern of cognitive dysfunction, according to discriminant analysis. One of four newly diagnosed OSA patients had a severe and distinctive neuropsychological dysfunction mainly involving inductive and deductive thinking, and constructive ability. Some analogy with cognitive pattern of MID suggests that a mainly subcortical damage underlies this dysfunction.
Disconnection Between Self-Reported and Objective Cognitive Impairment in Obstructive Sleep Apnea
Journal of Clinical Sleep Medicine, 2019
Study Objectives: Recent studies show that obstructive sleep apnea (OSA) is a possible contributor to abnormal cognitive decline in older adults. These new observations create the need to identify older adults with OSA who are at risk of developing dementia if not treated. This study's goal was to verify whether self-reported cognitive complaints could become a useful tool to screen for objective cognitive deficits in late middle-aged and older adults with OSA. Methods: Fifty-seven participants with OSA with an apnea-hypopnea index (AHI) ≥ 15 events/h (3% or arousal) and aged between 55 and 85 years were compared to 54 participants in a mild/non-OSA group on their ability to evaluate their objective cognitive functioning. They underwent overnight polysomnography followed by a comprehensive neuropsychological assessment. We recruited a similar proportion of participants with mild cognitive impairment (MCI) in both groups (OSA: 36.8%; mild/non-OSA: 35.2%). They filled out questionnaires assessing mood, sleep, and cognition. Group (OSA versus mild/non-OSA) × cognitive status (MCI versus non-MCI) analyses of variance were performed on cognitive complaint questionnaires. Results: We found that among participants without objective cognitive deficits, participants in the OSA group reported more cognitive complaints compared to those in the mild/non-OSA group. Among participants with objective cognitive deficits, those in the OSA group reported less cognitive complaints compared to those in the mild/non-OSA group. Conclusions: Participants with OSA and MCI were less aware of their deficits compared to those in the mild/non-OSA group, possibly reflecting a distinctive OSA-associated cognitive impairment. Our results underscore the importance of referring patients with OSA for a comprehensive neuropsychological assessment when an abnormal cognitive decline is suspected.
Neurocognitive deficits in patients with Obstructive Sleep Apnea Syndrome (OSAS)
In this thorough review of literature, we showed that the majority of OSAS patients suffer from attentional, memory and psychomotor speed decline, while others present impairments in high order cognitive functions such as executive functions and language impairment as well. CPAP treatment is not always helpful in improving cognitive functions, suggesting that OSAS may cause permanent damages in specific brain regions. The effects of sleep fragmentation, hypoxemia, low CBF, inflammation parameters and vascocerebral diseases on cognitive functions are intermingled and synergistic. However, these conclusions need to be treated with caution since most studies are not homogeneous in OSAS severity. Moreover, the diversity in the findings of the research studies presented may be due to differences in methodology and in the types of neuropsychological tests which were used to assess cognitive functions. Furthermore, the treatment duration, low tolerance of treatment, and disease duration ar...
Objective versus Subjective Cognitive Functioning in Patients with Obstructive Sleep Apnea
The Open Sleep Journal
Study objectives: Previous studies have found that patients' neurocognitive functions were affected by OSA symptoms. However, no study has focused on the subjective awareness of cognitive impairments. This study used a subjective rating scale to evaluate OSA patient perceptions of their cognitive impairments, and explore the relationship between subjective and objective cognitive functions. Methods: An independent-group design was used to compare objective and subjective cognitive performance in both the OSA and control groups. An experimental group of 19 male OSA patients and a control group of 19 normal subjects matched in age and education participated in the study. A neurocognitive test battery that measures attention, memory and executive functions, and the SCIRS (Subjective Cognitive Impairment Rating Scale) that measures subjective perception of cognitive impairments were used. Results: On the neurocognitive test measures, OSA patients demonstrated decreased performance on memory and executive function. On the subjective measures, OSA patients reported a mild to moderately negative impact on attention, memory, and emotional control due to OSA. Conclusions: The results show that OSA patients may not be fully aware of their cognitive impairments, especially with regard to their executive functions. The inconsistency suggests that including neurocognitive tests in the evaluation of sleep-related breathing disorders may provide useful information that cannot be obtained through clinical interviews.
Neuropsychological profiles in levels of obstructive sleep apnea?hypopnea syndrome
Sleep and Biological Rhythms, 2007
The aim of this study was to determine the cognitive deficits that accompany different levels of severity of obstructive sleep apnea-hypopnea syndrome (OSAHS). The sample originally consisted of 71 adult male volunteers with at least 11 years of education. Participants were assigned to groups based on their apnea-hypopnea index (AHI). There were 20 participants in the mild-to-moderate OSAHS group (AHI 6-28; mean age 41.8 ± 8.96 years), 16 in the severe OSAHS group (AHI 38-86; mean age 44.5 ± 7.96 years), and 35 in the non-OSAHS group (AHI 0-3; mean age 41.8 ± 8.96 years). Neuropsychological functions were measured using Stroop Test TBAG version, Cancellation Test, Auditory Verbal Learning Test, Serial Digit Learning Test, and Raven Standard Progressive Matrices. Analyses were conducted on z-transformed scores. Multivariate analysis of variance (education as covariate) showed decrease in various functions such as processing speed, disturbance in selective and sustained attention, deficit in visual perception, search and scan, deficit in recognition memory, increase in susceptibility to interference, and decrease in visuospatial reasoning and general ability. Correctness of estimation increased as severity of OSAHS increased. However, principal component analysis showed that OSAHS severity represents impairment in the basic processes of processing speed and vigilance/sustained attention. Untreated OSAHS patients are potential risks to themselves and to others. Controlled studies are necessary for unraveling the functional correlates of OSAHS.
Obstructive sleep apnea–hypopnea and neurocognitive functioning in the Sleep Heart Health Study
Sleep Medicine, 2006
Background and purpose: Obstructive sleep apnea-hypopnea (OSAH) is associated with sleep fragmentation and nocturnal hypoxemia. In clinical samples, patients with OSAH frequently are found to have deficits in neuropsychological function. However, the nature and severity of these abnormalities in non-clinical populations is less well defined. Patients and methods: One hundred and forty-one participants from the Tucson, AZ and New York, NY field centers of the Sleep Heart Health Study completed a battery of neuropsychological tests for 9-40 months (meanZ24 months, SDZ7 months) after an unattended home polysomnogram. Sixty-seven participants had OSAH (AHIO10) and 74 did not have OSAH (control (CTL), apnea-hypopnea index (AHI)!5). In addition to the individual tests, composite variables representing attention, executive function, MotorSpeed and processing speed were constructed from the neuropsychological test battery. Results: There were no significant differences in any individual neuropsychological test or composite variable between the OSAH and CTL groups. However, when time spent with O 2 saturations less than 85% was dichotomized into those participants in the top quartile of the distribution and those in the lower three quartiles, motor speed was significantly impaired in those who were more hypoxemic. In addition, poorer motor speed (model adjusted R 2 Z0.242, P!0.001) and processing speed performance (model adjusted R 2 Z0.122, P!0.001) were associated with more severe oxygen desaturation even after controlling for degree of daytime sleepiness, age, gender and educational level. Conclusions: Mild to moderate OSAH has little impact on the selected measures of attention, executive function, motor speed and processing speed. However, hypoxemia adversely affects both motor and processing speed. These results suggest that in middle-aged to elderly adults the neuropsychological effects of clinically unrecognized mild to moderate OSAH are neither global nor large. q
Sleep Medicine, 2008
Background and purpose: Patients with obstructive sleep apnea syndrome (OSAS) present cognitive deficits similar to those observed with aging. The aim of the study was to assess the effects of age on cognitive functions in OSAS patients. It was hypothesized that older OSAS patients will exhibit significant cognitive dysfunction relative to younger OSAS patients and controls. Patients and methods: Younger and older OSAS patients were compared to younger and older control subjects (age cut-off set at 50 yrs). Participants underwent a polysomnographic (PSG) and neuropsychological evaluation. Variables were analyzed by two-way analyses of variance (ANOVAs) with two factors: Group (control and OSAS) and Age (younger and older). Additionally, we evaluated the contribution of attentional deficits to cognitive dysfunction for each subgroup of patients by using Spearman correlation coefficients. Results: No Group-by-Age interaction was found for any neuropsychological variables (p < 0.05). However, main Group and Age effects were found. Correlations indicated that attentional deficits contributed importantly to a poorer cognitive performance in younger OSAS patients only (p < 0.01). Conclusions: Our results are in agreement with those of the literature for both OSAS-related and aging-related cognitive deficits but did not demonstrate that age interacts with the effects of the OSAS condition to make those cognitive deficits worse.
Annals of the American Thoracic Society
There is emerging evidence that obstructive sleep apnea (OSA) is a risk factor for preclinical Alzheimer's disease (AD). An American Thoracic Society workshop was convened that included clinicians, basic scientists, and epidemiologists with expertise in OSA, cognition, and dementia, with the overall objectives of summarizing the state of knowledge in the field, identifying important research gaps, and identifying potential directions for future research. Although currently available cognitive screening tests may allow for identification of cognitive impairment in patients with OSA, they should be interpreted with caution. Neuroimaging in OSA can provide surrogate measures of disease chronicity, but it has methodological limitations. Most data on the impact of OSA treatment on cognition are for continuous positive airway pressure (CPAP), with limited data for other treatments. The cognitive domains improving with CPAP show considerable heterogeneity across studies. OSA can negatively influence risk, manifestations, and possibly progression of AD and other forms of dementia. Sleepdependent memory tasks need greater incorporation into OSA testing, with better delineation of sleep fragmentation versus intermittent hypoxia effects. Plasma biomarkers may prove to be sensitive, feasible, and scalable biomarkers for use in clinical trials. There is strong biological plausibility, but insufficient data, to prove bidirectional causality of the associations between OSA and aging pathology. Engaging, recruiting, and retaining diverse populations in health care and research may help to decrease racial and ethnic disparities in OSA and AD. Key recommendations from the workshop include research aimed at underlying mechanisms; longer-term longitudinal studies with objective assessment of OSA, sensitive cognitive markers, and sleep-dependent cognitive tasks; and pragmatic study designs for interventional studies that control for other factors that may impact cognitive outcomes and use novel biomarkers.
Cognition and daytime functioning in sleep-related breathing disorders
Progress in Brain Research, 2011
Sleep-related breathing disorders encompass a range of disorders in which abnormal ventilation occurs during sleep as a result of partial or complete obstruction of the upper airway, altered respiratory drive, abnormal chest wall movement, or respiratory muscle function. The most common of these is obstructive sleep apnea (OSA), occurring in both adults and children, and causing significant cognitive and daytime dysfunction and reduced quality of life. OSA patients experience repetitive brief cessation of breathing throughout the night, which causes intermittent hypoxemia (reductions in hemoglobin oxygen levels) and fragmented sleep patterns. These nocturnal events result in excessive daytime sleepiness, and changes in mood and cognition.Chronic excessive sleepiness during the day is a common symptom of sleep-related breathing disorders, which is assessed in sleep clinics both subjectively (questionnaire) and objectively (sleep latency tests). Mood changes are often reported by patients, including irritability, fatigue, depression, and anxiety. A wide range of cognitive deficits have been identified in untreated OSA patients, from attentional and vigilance, to memory and executive functions, and more complex tasks such as simulated driving. These changes are reflected in patient reports of difficulty in concentrating, increased forgetfulness, an inability to make decisions, and falling asleep at the wheel of a motor vehicle. These cognitive changes can also have significant downstream effects on daily functioning. Moderate to severe cases of the disorder are at a higher risk of having a motor vehicle accident, and may also have difficulties at work or school.A number of comorbidities may also influence the cognitive changes in OSA patients, including hypertension, diabetes, and stroke. These diseases can cause changes to neural vasculature and result in neural damage, leading to cognitive impairments. Examination of OSA patients using neuroimaging techniques such as structural magnetic resonance imaging and proton magnetic resonance spectroscopy has observed significant changes to brain structure and metabolism. The downstream effects of neural, cognitive, and daytime functional impairments can be significant if left untreated. A better understanding of the cognitive effects of these disorders, and development of more effective assessment tools for diagnosis, will aid early intervention and improve quality of life of the patient.