The association between obstructive sleep apnea and neurocognitive performance--the Apnea Positive Pressure Long-term Efficacy Study (APPLES).

STUDY OBJECTIVES To determine associations between obstructive sleep apnea (OSA) and neurocognitive performance in a large cohort of adults. STUDY DESIGN Cross-sectional analyses of polysomnographic and neurocognitive data from 1204 adult participants with a clinical diagnosis of obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES), assessed at baseline before randomization to either continuous positive airway pressure (CPAP) or sham CPAP. MEASUREMENTS Sleep and respiratory indices obtained by laboratory polysomnography and several measures of neurocognitive performance. RESULTS Weak correlations were found for both the apnea hypopnea index (AHI) and several indices of oxygen desaturation and neurocognitive performance in unadjusted analyses. After adjustment for level of education, ethnicity, and gender, there was no association between the AHI and neurocognitive performance. However, severity of oxygen desaturation was weakly associated with worse neurocognitive performance on some measures of intelligence, attention, and processing speed. CONCLUSIONS The impact of OSA on neurocognitive performance is small for many individuals with this condition and is most related to the severity of hypoxemia.

[1]  T. Young,et al.  Burden of sleep apnea: rationale, design, and major findings of the Wisconsin Sleep Cohort study. , 2009, WMJ : official publication of the State Medical Society of Wisconsin.

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

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

[4]  D. Deptula,et al.  Neuropsychological dysfunction in sleep apnea. , 1987, Sleep.

[5]  M. Crossley,et al.  Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. , 1999, Chest.

[6]  Deborah A. Nichols,et al.  The Apnea Positive Pressure Long-term Efficacy Study (APPLES): rationale, design, methods, and procedures. , 2006, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[7]  D. Dinges,et al.  Neurocognitive consequences of sleep deprivation. , 2005, Seminars in neurology.

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

[9]  J. Samkoff,et al.  A review of studies concerning effects of sleep deprivation and fatigue on residents' performance , 1991, Academic medicine : journal of the Association of American Medical Colleges.

[10]  R. Bootzin,et al.  Obstructive sleep apnea-hypopnea and neurocognitive functioning in the Sleep Heart Health Study. , 2006, Sleep medicine.

[11]  Herman Buschke,et al.  Selective reminding for analysis of memory and learning , 1973 .

[12]  J. Concato,et al.  Obstructive sleep apnea as a risk factor for stroke and death. , 2005, The New England journal of medicine.

[13]  A. Amfilochiou,et al.  Sleep apnea‐related cognitive deficits and intelligence: an implication of cognitive reserve theory , 2005, Journal of sleep research.

[14]  A. Rechtschaffen.  A manual of standardized terminology, techniques and scoring system for sleep of human subjects , 1968 .

[15]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[16]  Marie Diener-West,et al.  Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. , 2010, American journal of respiratory and critical care medicine.

[17]  K M Hla,et al.  Population-based study of sleep-disordered breathing as a risk factor for hypertension. , 1997, Archives of internal medicine.

[18]  E. Verstraeten.  Neurocognitive effects of obstructive sleep apnea syndrome , 2007, Current neurology and neuroscience reports.

[19]  L. McEvoy,et al.  The impact of moderate sleep loss on neurophysiologic signals during working-memory task performance. , 2002, Sleep.

[20]  D. Gozal,et al.  Behavioral and Anatomical Correlates of Chronic Episodic Hypoxia during Sleep in the Rat , 2001, The Journal of Neuroscience.

[21]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

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

[23]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .

[24]  R. Bootzin,et al.  Sleep and reported daytime sleepiness in normal subjects: the Sleep Heart Health Study. , 2004, Sleep.

[25]  R. Millman,et al.  Treatment effects on brain activity during a working memory task in obstructive sleep apnea , 2009, Journal of sleep research.

[26]  B. Caffo,et al.  Sleep-Disordered Breathing and Mortality: A Prospective Cohort Study , 2009, PLoS medicine.

[27]  J. Kaprio,et al.  Cognitive function in middle-aged snorers and controls: role of excessive daytime somnolence and sleep-related hypoxic events. , 1988, Sleep.

[28]  H. Levin,et al.  Selective reminding test: an examination of the equivalence of four forms. , 1985, Journal of clinical and experimental neuropsychology.

[29]  E. Hoddes,et al.  The history and use of the Stanford sleepiness scale , 1971 .

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

[31]  D. Gronwall.  Paced Auditory Serial-Addition Task: A Measure of Recovery from Concussion , 1977, Perceptual and motor skills.

[32]  A. Alpérovitch,et al.  Breathing Disorders During Sleep and Cognitive Performance in an Older Community Sample: The EVA Study , 1996, Journal of the American Geriatrics Society.

[33]  David F. Dinges,et al.  Microcomputer analyses of performance on a portable, simple visual RT task during sustained operations , 1985 .

[34]  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.

[35]  Jan Hedner,et al.  Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. , 2002, American journal of respiratory and critical care medicine.

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

[37]  T. Weaver.  Outcome measurement in sleep medicine practice and research. Part 2: assessment of neurobehavioral performance and mood. , 2001, Sleep medicine reviews.

[38]  Daniel J Buysse,et al.  Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research , 2000 .

[39]  F. Richer,et al.  Neurobehavioral manifestations in obstructive sleep apnea syndrome before and after treatment with continuous positive airway pressure. , 1992, Sleep.

[40]  Jose M Marin,et al.  Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study , 2005, The Lancet.

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

[42]  H. Völzke,et al.  Smoking status, obesity and hypertension in a general population sample: a cross-sectional study. , 2006, QJM : monthly journal of the Association of Physicians.

[43]  D. Beebe,et al.  The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data. , 2003, Sleep.

[44]  A. Pack,et al.  Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. , 1993, The American review of respiratory disease.

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

[46]  C. Feuerstein,et al.  Cognitive executive dysfunction in patients with obstructive sleep apnea syndrome (OSAS) after CPAP treatment. , 1998, Sleep.

[47]  J. Malin,et al.  Neuropsychological investigations and event-related potentials in obstructive sleep apnea syndrome before and during CPAP-therapy , 1998, Journal of the Neurological Sciences.