Effects of Continuous Positive Airway Pressure on Neurocognitive Function in Obstructive Sleep Apnea Patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES)

Stanford University, Stanford, CA.
Sleep (Impact Factor: 4.59). 12/2012; 35(12):1593-602. DOI: 10.5665/sleep.2226
Source: PubMed


Study Objective: To determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA). Design, Setting, and Participants: The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducted at 5 U.S. university, hospital, or private practices. Of 1,516 participants enrolled, 1,105 were randomized, and 1,098 participants diagnosed with OSA contributed to the analysis of the primary outcome measures. Intervention: Active or sham CPAP Measurements: Three neurocognitive variables, each representing a neurocognitive domain: Pathfinder Number Test-Total Time (attention and psychomotor function [A/P]), Buschke Selective Reminding Test-Sum Recall (learning and memory [L/M]), and Sustained Working Memory Test-Overall Mid-Day Score (executive and frontal-lobe function [E/F]) Results: The primary neurocognitive analyses showed a difference between groups for only the E/F variable at the 2 month CPAP visit, but no difference at the 6 month CPAP visit or for the A/P or L/M variables at either the 2 or 6 month visits. When stratified by measures of OSA severity (AHI or oxygen saturation parameters), the primary E/F variable and one secondary E/F neurocognitive variable revealed transient differences between study arms for those with the most severe OSA. Participants in the active CPAP group had a significantly greater ability to remain awake whether measured subjectively by the Epworth Sleepiness Scale or objectively by the maintenance of wakefulness test. Conclusions: CPAP treatment improved both subjectively and objectively measured sleepiness, especially in individuals with severe OSA (AHI > 30). CPAP use resulted in mild, transient improvement in the most sensitive measures of executive and frontal-lobe function for those with severe disease, which suggests the existence of a complex OSA-neurocognitive relationship.

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    • "Positive airway pressure (PAP) continues to be the most effective treatment for obstructive sleep apnoea (OSA) [1]. A number of studies have shown the benefits of PAP treatment on measures of daytime function for patients treated for OSA [2] [3] [4] [5]. Untreated OSA has been associated with adverse medical conditions including congestive heart failure [6] [7] [8], stroke [9] [10], pulmonary [11] [12] [13] and systemic hypertension [14] [15] [16], cancer [17] and increased mortality [18]. "
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    ABSTRACT: Introduction It has been found that mask style can affect the amount of continuous positive airway pressure (CPAP) required to reduce an apnea/hyponea index (AHI) to <5/hr on a titration study. However, it was not previously known whether switching from one CPAP mask style to another post-titration could affect residual AHI with CPAP. The purpose of this study was to investigate differences in residual AHI with CPAP treatment between oronasal and nasal masks. Methods 21-subjects (age M=62.9, BMI M=29.6 kg/m2) were randomized (14-subjects completed the protocol) to undergo an in-laboratory CPAP titration with either a nasal mask or oronasal mask. Subjects were then assigned this mask for three-weeks of at-home CPAP use with the optimal treatment pressure determined on the laboratory study (CPAP M=8.4 cm of H2O). At the end of this three-week period, data was collected from the CPAP machine, and the subject was given the other mask to use with the same CPAP settings for the next three-weeks at-home (if nasal was given initially, the oronasal was given and vice versa). On completion of the second three-week period, data on residual AHI was again collected and compared to the first three-week period on CPAP. Results A Wilcoxon Signed Rank Test (two-tailed) revealed that residual AHI with CPAP treatment was significantly higher with the oronasal compared to the nasal mask (z=-3.296, p<.001). All 14-subjects had a higher residual AHI with the oronasal vs. nasal mask, and 50% of the subjects had a residual AHI >10/hr in the oronasal mask condition, even though all of these subjects were titrated to an AHI of <5/hr in the laboratory. Conclusion A higher residual AHI was seen in all patients with the use of an oronasal mask compared to a nasal mask. Switching to an oronasal mask post-titration results in an increase in residual AHI with CPAP treatment, and pressure adjustment may be warranted.
    Full-text · Article · Jun 2014 · Sleep Medicine
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    • "Treatment for OSA, such as continuous airway pressure (CPAP), has been shown to decrease sleep disturbance in patients with AD and OSA [14] and, although the cognitive benefits of CPAP are not yet clear, some studies have shown positive improvement in neuropsychological functioning [7, 15]. Overall, there is evidence suggesting that, even in established dementia, there may be merit in addressing this problem and this may be even greater if intervention targeted critical “at risk” periods such as MCI. "
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    ABSTRACT: Purpose. Mild cognitive impairment (MCI) is considered an "at risk" state for dementia and efforts are needed to target modifiable risk factors, of which Obstructive sleep apnoea (OSA) is one. This study aims to evaluate the predictive utility of the multivariate apnoea prediction index (MAPI), a patient self-report survey, to assess OSA in MCI. Methods. Thirty-seven participants with MCI and 37 age-matched controls completed the MAPI and underwent polysomnography (PSG). Correlations were used to compare the MAPI and PSG measures including oxygen desaturation index and apnoea-hypopnoea index (AHI). Receiver-operating characteristics (ROC) curve analyses were performed using various cut-off scores for apnoea severity. Results. In controls, there was a significant moderate correlation between higher MAPI scores and more severe apnoea (AHI: r = 0.47, P = 0.017). However, this relationship was not significant in the MCI sample. ROC curve analysis indicated much lower area under the curve (AUC) in the MCI sample compared to the controls across all AHI severity cut-off scores. Conclusions. In older people, the MAPI moderately correlates with AHI severity but only in those who are cognitively intact. Development of further screening tools is required in order to accurately screen for OSA in MCI.
    Full-text · Article · Jan 2014
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    Full-text · Article · Dec 2012 · Sleep
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