Improved cognitive functions after treatment with an oral appliance in obstructive sleep apnea

Objective The objective of this study was to evaluate the effect of oral appliance (OA) treatment on cognitive functions in patients with obstructive sleep apnea (OSA). Materials and methods In a prospective study, 50 male patients with verified moderate-to-severe OSA received an OA with mandibular advancement. The cognitive functions assessed included working memory, vigilance, executive functioning, and mental pace, measured before as well as after 6 months of treatment. Somnography was used to measure physiological treatment effects. Forty-three patients completed the 6-month follow-up study. Results All domains of cognitive functioning measured improved after 6 months of treatment with an OA (P <; 0.001). The apnea/hypopnea- and oxygen desaturation-indices decreased significantly after treatment (P <; 0.01). An obvious treatment response was reached in 60% of the patients, and 54% of the patients had recovered ie, had normalized breathing during sleep. Conclusion OA with mandibular advancement is a treatment modality for the physiological symptoms of OSA, and may have a positive impact on cognitive functions, after only 6 months of treatment.

[1]  M Palta,et al.  Sleep-disordered breathing and neuropsychological deficits. A population-based study. , 1997, American journal of respiratory and critical care medicine.

[2]  I. Ringqvist,et al.  A Prospective Randomized Study Comparing Two Different Degrees of Mandibular Advancement with a Dental Appliance in Treatment of Severe Obstructive Sleep Apnea , 2003, Sleep and Breathing.

[3]  S. Cappa,et al.  Brain activation changes before and after PAP treatment in obstructive sleep apnea. , 2009, Sleep.

[4]  M. Johns,et al.  Reliability and factor analysis of the Epworth Sleepiness Scale. , 1992, Sleep.

[5]  J. Hedner,et al.  Improvement in Neuropsychological Performance Following Surgical Treatment for Obstructive Sleep Apnea Syndrome , 2002, Acta oto-laryngologica.

[6]  S. Ancoli-Israel,et al.  Relationship between obstructive sleep apnea severity and brain activation during a sustained attention task. , 2009, Sleep.

[7]  R. Cluydts,et al.  Executive control of attention in sleep apnea patients: theoretical concepts and methodological considerations. , 2004, Sleep medicine reviews.

[8]  K. Ferguson,et al.  Oral appliances for snoring and obstructive sleep apnea: a review. , 2006, Sleep.

[9]  D. Gozal,et al.  Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits , 2002, Journal of sleep research.

[10]  T. Saunamäki,et al.  A review of executive functions in obstructive sleep apnea syndrome , 2007, Acta neurologica Scandinavica.

[11]  K. Byth,et al.  Hippocampal area metabolites relate to severity and cognitive function in obstructive sleep apnea. , 2004, Sleep medicine.

[12]  T. Young,et al.  Sleep-disordered breathing and motor vehicle accidents in a population-based sample of employed adults. , 1997, Sleep.

[13]  N. Douglas,et al.  Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. , 2002, American journal of respiratory and critical care medicine.

[14]  I. Deary,et al.  Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. , 1999, American journal of respiratory and critical care medicine.

[15]  M. Schlossberg The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation. , 1986 .

[16]  I. Ringqvist,et al.  A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. , 1999, Acta oto-laryngologica.

[17]  J. Montplaisir,et al.  Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsychological test battery. , 2000, Sleep.

[18]  N J Douglas,et al.  Cognitive function in the sleep apnea/hypopnea syndrome (SAHS). , 2000, Sleep.

[19]  L. Findley,et al.  Vigilance and automobile accidents in patients with sleep apnea or narcolepsy. , 1995, Chest.

[20]  N. Carter,et al.  Excessive daytime sleepiness at work and subjective work performance in the general population and among heavy snorers and patients with obstructive sleep apnea. , 1996, Chest.

[21]  J Zieliński,et al.  Effects of CPAP treatment on psychological status in patients with severe obstructive sleep apnoea , 1996, Journal of sleep research.

[22]  N. Erixon-Lindroth PET studies of the dopamine system in relation to cognitive functions , 2007 .

[23]  Mark C. Jones PRINCIPLES AND PRACTICE OF SLEEP MEDICINE , 1990 .

[24]  Sohee Park,et al.  Schizophrenics show spatial working memory deficits. , 1992, Archives of general psychiatry.

[25]  T. Åkerstedt,et al.  Less effective executive functioning after one night's sleep deprivation , 2005, Journal of sleep research.

[26]  C. Roussos,et al.  Comparison of cognitive performance among different age groups in patients with obstructive sleep apnea , 2008, Sleep and Breathing.

[27]  Å. Tegelberg,et al.  Two different degrees of mandibular advancement with a dental appliance in treatment of patients with mild to moderate obstructive sleep apnea , 2003, Acta odontologica Scandinavica.

[28]  N. Risch,et al.  The continuous performance test, identical pairs version (CPT-IP): I. new findings about sustained attention in normal families , 1988, Psychiatry Research.

[29]  C. Stern,et al.  Functional imaging of working memory in obstructive sleep-disordered breathing. , 2005, Journal of applied physiology.

[30]  S. Redline,et al.  Neuropsychological function in mild sleep-disordered breathing. , 1997, Sleep.

[31]  S. Redline,et al.  Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device. , 1991, Chest.

[32]  I. Hickie,et al.  Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial. , 2005, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[33]  J. Pépin,et al.  Deficits of cognitive executive functions in patients with sleep apnea syndrome. , 1995, Sleep.

[34]  Jennifer D. Davis,et al.  Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: A critical review , 2004, Journal of the International Neuropsychological Society.

[35]  N J Douglas,et al.  Sleep · 4: Sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome , 2004, Thorax.

[36]  T J Lasserson,et al.  Oral appliances for obstructive sleep apnoea. , 2006, The Cochrane database of systematic reviews.

[37]  Sean P. A. Drummond,et al.  Increased brain activation during verbal learning in obstructive sleep apnea , 2006, NeuroImage.

[38]  D. Joffe,et al.  Neuropsychological function in obstructive sleep apnoea. , 1999, Sleep medicine reviews.

[39]  C. Marra,et al.  Does cognitive dysfunction conform to a distinctive pattern in obstructive sleep apnea syndrome? , 2004, Journal of sleep research.

[40]  C. Iber,et al.  Measures of cognitive function in persons with varying degrees of sleep‐disordered breathing: the Sleep Heart Health Study , 2002, Journal of sleep research.

[41]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[42]  D. Hudgel The role of upper airway anatomy and physiology in obstructive sleep apnea. , 1992, Clinics in chest medicine.

[43]  S. F. Cappa,et al.  Cognitive dysfunction in patients with obstructive sleep apnea (OSA): partial reversibility after continuous positive airway pressure (CPAP) , 2003, Brain Research Bulletin.

[44]  J. Fleetham,et al.  Oral appliances for obstructive sleep apnoea. , 2006, The Cochrane database of systematic reviews.

[45]  M. Partinen,et al.  Cognitive function and treatment of obstructive sleep apnea syndrome , 1999, Journal of sleep research.

[46]  J. Fleetham,et al.  The effect of the tongue retaining device on awake genioglossus muscle activity in patients with obstructive sleep apnea. , 1996, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[47]  R. Chervin Epworth sleepiness scale? , 2003, Sleep medicine.

[48]  I. Ringqvist,et al.  Effects and adverse events of a dental appliance for treatment of obstructive sleep apnoea. , 1999, Swedish dental journal.

[49]  Daniel J Buysse,et al.  Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. , 1999, Sleep.