Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: A critical review

Brown Medical School, Providence, Rhode Island 02906, USA.
Journal of the International Neuropsychological Society (Impact Factor: 3.01). 10/2004; 10(5):772-85. DOI: 10.1017/S1355617704105134
Source: PubMed

ABSTRACT Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a well-recognized clinical sleep disorder that results in chronically fragmented sleep and recurrent hypoxemia. The primary daytime sequelae of the disorder include patient reports of excessive daytime sleepiness, depression, and attention and concentration problems. It has been well established that OSAHS negatively impacts certain aspects of cognitive functioning. The primary goals of this article are to (1) clarify the pattern of cognitive deficits that are specific to OSAHS; (2) identify the specific cognitive domains that improve with treatment; and (3) elucidate the possible mechanisms of cognitive dysfunction in OSAHS. At the conclusion of the paper, we propose a potential neurofunctional theory to account for the etiology of cognitive deficits in OSAHS. Thirty-seven peer-reviewed articles were selected for this review. In general, findings were equivocal for most cognitive domains. Treatment, however, was noted to improve attention/vigilance in most studies and consistently did not improve constructional abilities or psychomotor functioning. The results are discussed in the context of a neurofunctional theory for the effects of OSAHS on the brain.

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    • "In a review by Aloia et al. in 2004, sleep disturbances and hypoxemia were reported to have an effect on mood; however, they suggested that daytime drowsiness instead of hypoxemia occurring at night predicted the severity of depression and anxiety seen in patients with OSAS [19]. In this present study, 10% (13 patients) of the cases had neuropsychiatric diseases and the incidence of neuropsychiatric diseases was higher in patients with daytime drowsiness. "
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    ABSTRACT: Aim. OSAS is a disease characterized by repetitive air flow constraint or cessation due to airway collapse. Diseases that frequently coexist with OSAS and simple snoring were evaluated in this study. Materials and Methods. This study was conducted in the Otorhinolaryngology Department of the Ankara Numune Hospital between April 2008 and April 2010 with 130 patients who presented with the complaints of snoring, witnessed apnea, and daytime drowsiness. Presence of chronic disease was compared to the demographics, BMIs, Epworth Scale scores, polysomnography, and physical examination findings. Results. Comorbid diseases were present in 56 (43.1%) of the patients, and the most presented disease group was cardiovascular system diseases. Age, BMI, daytime drowsiness, and frequency of septum deviation were observed at higher rates in patients with chronic disease. Age, BMI, and frequency of septum deviation were associated with cardiovascular diseases. Endocrine disease was found to increase with decreased oxygen saturation. Neuropsychiatric diseases were associated with daytime drowsiness and age. The mean age was lower in cases with cigarette smoking compared to cases without. Conclusion. Frequency of the comorbidities mostly increased with age as expected. Comorbid diseases were also associated with obesity and daytime drowsiness. Cigarette smoking was associated with early-age disease.
    The Scientific World Journal 04/2013; 2013:709292. DOI:10.1155/2013/709292 · 1.73 Impact Factor
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    • "Inappropriate sleepiness and impaired neurobehavioural function arise from insufficient or poor quality sleep or from sleep disorders such as obstructive sleep apnea (OSA) (Aloia et al., 2004; Engleman and Douglas, 2004). In OSA, these symptoms result from sleep fragmentation and chronic intermittent hypoxia (Beebe and Gozal, 2002) and have a major impact on health, wellbeing and the economy (Sassani et al., 2004; Hillman et al., 2006). "
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    ABSTRACT: OBJECTIVE: To explore the use of detrended fluctuation analysis (DFA) scaling exponent of the awake electroencephalogram (EEG) as a new alternative biomarker of neurobehavioural impairment and sleepiness in obstructive sleep apnea (OSA). METHODS: Eight patients with moderate-severe OSA and nine non-OSA controls underwent a 40-h extended wakefulness challenge with resting awake EEG, neurobehavioural performance (driving simulator and psychomotor vigilance task) and subjective sleepiness recorded every 2-h. The DFA scaling exponent and power spectra of the EEG were calculated at each time point and their correlation with sleepiness and performance were quantified. RESULTS: DFA scaling exponent and power spectra biomarkers significantly correlated with simultaneously tested performance and self-rated sleepiness across the testing period in OSA patients and controls. Baseline (8am) DFA scaling exponent but not power spectra were markers of impaired simulated driving after 24-h extended wakefulness in OSA (r=0.738, p=0.037). OSA patients had a higher scaling exponent and delta power during wakefulness than controls. CONCLUSIONS: The DFA scaling exponent of the awake EEG performed as well as conventional power spectra as a marker of impaired performance and sleepiness resulting from sleep loss. SIGNIFICANCE: DFA may potentially identify patients at risk of neurobehavioural impairment and assess treatment effectiveness.
    Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology 04/2013; 124(8). DOI:10.1016/j.clinph.2013.02.022 · 2.98 Impact Factor
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    • "studies on affective disorders [22] [23] [24] [25] [26]. Aloia et al. reported in a small sample of older patients with OSA more subcortical WMH in the brain MRI of patients with a severe OSA as compared to those with minimal OSA, and a tendency for a positive correlation between these subcortical hyperintensities and depression scores on the Hamilton Depression Scale [27]. The high comorbidity of OSA and depression also suggests that both disorders may share a common neurobiological risk factor. "
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    ABSTRACT: Background and objectiveSeveral studies have investigated the association of obstructive sleep apnea syndrome (OSAS) with depression and anxiety; however, the relationship is still poorly understood. Therefore, we aimed to assess anxious and depressive symptoms in OSA, and evaluate their association with potentially related variables of OSAS.Subjects and methodsThis study included 72 patients newly diagnosed with obstructive sleep apnea and 30 controls. Patients underwent an overnight polysomnography and were assessed using the Epworth sleepiness scale (ESS) for excessive daytime sleepiness (EDS), hospital anxiety and depression scale (HAD) for anxious and depressive symptoms, and Maugeri obstructive sleep apnea syndrome (MOSAS) questionnaire for quality of life (QOL).Results72 OSA patients (60 men and 12 women) whose mean age was 48.8 ± 11.73 yr and mean apnea and hypopnea index (AHI) was 64 ± 21.86, were compared with 30 controls according to their HAD scores. We found that the HAD score for anxiety and depression was higher in OSA patients than in the control group (p = 0.001 and 0.002 respectively). Moreover, the prevalence of symptoms of anxiety in patients with OSA was 33% while that of depression was 51%. Linear regression analysis revealed that daytime sleepiness and reduced QOL were strong predictors of depressive symptoms in OSA patients (P = 0.001 and 0.002 respectively), while reduced QOL was the only predictor of anxious symptoms (p = 0.035). No significant relations were found between severity of psychological symptoms and AHI or nocturnal hypoxemia in OSA patients.Conclusion Anxious and depressive symptoms are highly prevalent in patients with moderate to severe untreated OSAS. The severity of depressive symptoms maybe more related to excessive daytime sleepiness than to nocturnal hypoxemia. The reduced QOL is a strong predictor of psychiatric symptoms in OSAS patients. Therefore, patients with OSAS should be routinely screened for psychiatric symptoms to improve QOL and optimize diagnosis and therapy in these patients.
    07/2012; 61(3):171–177. DOI:10.1016/j.ejcdt.2012.10.032
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