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: 2.96). 10/2004; 10(5):772-85. DOI: 10.1017/S1355617704105134
Source: PubMed


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 OSA, episodes of (partial) obstruction of the upper airway cause intermittent hypoxemia and arousals during sleep [4], disrupting the sleep architecture and causing an overall poor quality of sleep. OSA results in significant impairments in daytime functioning, including excessive sleepiness, fatigue and mood problems [5]. Moreover, OSA patients often report cognitive complaints [6e8]. "
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    ABSTRACT: Obstructive sleep apnea (OSA) is associated with impairments in cognitive functioning. Although cognitive complaints are related to quality of life, work productivity and health care expenditures, most research and all reviews have focused exclusively on objective cognitive functioning so far. In this systematic review, we assessed the available literature on subjective measures of cognition in adult OSA patients. Concentration complaints were consistently found to be more severe in untreated OSA patients as compared to primary snorers and healthy controls. The same seems to be true for memory and executive function problems, but firm conclusions cannot be made as of yet, due to methodological limitations of the available studies. Cognitive complaints appear to be at least partially related to subjective sleepiness. Importantly, they are not necessarily a sign of objective cognitive impairment. Additional research is needed to explore the relation between cognitive complaints, sleepiness and mood problems using validated and norm-referenced questionnaires for cognitive complaints. In addition, the impact of CPAP treatment on cognitive complaints in OSA warrants further study.
    Sleep Medicine Reviews 12/2014; 19. DOI:10.1016/j.smrv.2014.03.008 · 8.51 Impact Factor
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    • "There is also growing evidence that OSA negatively affects cognitive functioning and mood. Most studies find impairment in the cognitive domains of vigilance, attention, executive functioning, memory and motor coordination [5,6]. The etiology of the cognitive impairment in OSA patients is still unclear, but neuroimaging studies provide evidence that OSA is associated with structural and functional changes in the brain, particularly in the frontal cortex and hippocampus [7,8]. "
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    ABSTRACT: Obstructive sleep apnea is a common sleep disorder in stroke patients. Obstructive sleep apnea is associated with stroke severity and poor functional outcome. Continuous positive airway pressure seems to improve functional recovery in stroke rehabilitation. To date, the effect of continuous positive airway pressure on cognitive functioning in stroke patients is not well established. The current study will investigate the effectiveness of continuous positive airway pressure on both cognitive and functional outcomes in stroke patients with obstructive sleep apnea.Methods/design: A randomized controlled trial will be conducted on the neurorehabilitation unit of Heliomare, a rehabilitation center in the Netherlands. Seventy stroke patients with obstructive sleep apnea will be randomly allocated to an intervention or control group (n = 2x35). The intervention will consist of four weeks of continuous positive airway pressure treatment. Patients allocated to the control group will receive four weeks of treatment as usual. Outcomes will be assessed at baseline, immediately after the intervention and at two-month follow-up.In a supplementary study, these 70 patients with obstructive sleep apnea will be compared to 70 stroke patients without obstructive sleep apnea with respect to cognitive and functional status at rehabilitation admission. Additionally, the societal participation of both groups will be assessed at six months and one year after inclusion. This study will provide novel information on the effects of obstructive sleep apnea and its treatment with continuous positive airway pressure on rehabilitation outcomes after stroke.Trial registration: Trial registration number: Dutch Trial Register NTR3412.
    BMC Neurology 02/2014; 14(1):36. DOI:10.1186/1471-2377-14-36 · 2.04 Impact Factor
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    • "Patients with OSAS have been found with impaired attention abilities [68] and more specifically with a decline in vigilance [74, 75] and in complex attention [76]. Research has shown that severe OSAS patients are characterized by diffused impairments in vigilance [53, 60, 64], in selective and sustained attention as well as alertness [53, 77]. "
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    ABSTRACT: Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) show similar neurocognitive impairments. Effects are more apparent in severe cases, whereas in moderate and mild cases the effects are equivocal. The exact mechanism that causes cognitive dysfunctions in both diseases is still unknown and only suggestions have been made for each disease separately. The primary objective of this review is to present COPD and OSAS impact on cognitive functions. Secondly, it aims to examine the potential mechanisms by which COPD and OSAS can be linked and provide evidence for a common nature that affects cognitive functions in both diseases. Patients with COPD and OSAS compared to normal distribution show significant deficits in the cognitive abilities of attention, psychomotor speed, memory and learning, visuospatial and constructional abilities, executive skills, and language. The severity of these deficits in OSAS seems to correlate with the physiological events such as sleep defragmentation, apnea/hypopnea index, and hypoxemia, whereas cognitive impairments in COPD are associated with hypoventilation, hypoxemia, and hypercapnia. These factors as well as vascocerebral diseases and changes in systemic hemodynamic seem to act in an intermingling and synergistic way on the cause of cognitive dysfunctions in both diseases. However, low blood oxygen pressure seems to be the dominant factor that contributes to the presence of cognitive deficits in both COPD and OSAS.
    02/2014; 2014(9):768210. DOI:10.1155/2014/768210
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