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

Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA.
Sleep (Impact Factor: 4.59). 03/2011; 34(3):303-314B.
Source: PubMed


To determine associations between obstructive sleep apnea (OSA) and neurocognitive performance in a large cohort of adults.
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.
Sleep and respiratory indices obtained by laboratory polysomnography and several measures of neurocognitive performance.
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.
The impact of OSA on neurocognitive performance is small for many individuals with this condition and is most related to the severity of hypoxemia.

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    • "No study to date has systematically examined the effect of T therapy on sexual function, neurocognitive function and reduced quality of life in men with OSA. This is relevant because obese men with OSA are at increased risk for sexual dysfunction, neurocognitive impairment and reduced quality of life (Young et al., 2002; Budweiser et al., 2009; Quan et al., 2011). The focus of this report was to examine the impact of standard dose T supplementation on sexual function, general and disease-specific quality of life and cognitive function in a randomized placebo controlled study of obese men with OSA. "
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    ABSTRACT: Testosterone (T) deficiency, sexual dysfunction, obesity and obstructive sleep apnea (OSA) are common and often coexist. T prescriptions have increased worldwide during the last decade, including to those with undiagnosed or untreated OSA. The effect of T administration on sexual function, neurocognitive performance and quality of life in these men is poorly defined. The aim of this study was to examine the impact of T administration on sexual function, quality of life and neurocognitive performance in obese men with OSA. We also secondarily examined whether baseline T might modify the effects of T treatment by dichotomizing on baseline T levels pre-specified at 8, 11 and 13 nmol/L. This was a randomized placebo-controlled study in which 67 obese men with OSA (mean age 49 ± 1.3 years) were randomized to receive intramuscular injections of either 1000 mg T undecanoate or placebo at baseline, week 6 and week 12. All participants were concurrently enrolled in a weight loss program. General and sleep-related quality of life, neurocognitive performance and subjective sexual function were assessed before and 6, 12 and 18 weeks after therapy. T compared to placebo increased sexual desire (p = 0.004) in all men, irrespective of baseline T levels. There were no differences in erectile function, frequency of sexual attempts, orgasmic ability, general or sleep-related quality of life or neurocognitive function (all p = NS). In those with baseline T levels below 8 nmol/L, T increased vitality (p = 0.004), and reduced reports of feeling down (p = 0.002) and nervousness (p = 0.03). Our findings show that 18 weeks of T therapy increased sexual desire in obese men with OSA independently of baseline T levels whereas improvements in quality of life were evident only in those with T levels below 8 nmol/L. These small improvements would need to be balanced against potentially more serious adverse effects of T therapy on breathing.
    No preview · Article · Nov 2015 · Andrology
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    • "Neuroimaging studies have showed structural changes in the brains of individuals with OSA [5] [6] [7] [8] [9] [10] [11]. Diffusion-weighted Imaging (DWI) enables valuable information in certain pathologies of the brain. "
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    ABSTRACT: Purpose: We investigated diffusion alterations in specific regions of the brain in morbid obese, obese, and nonobese OSA patients and searched whether there is a correlation between BMI and ADC values. Materials and methods: DWIs of 65 patients with OSA were evaluated. The patients were classified according to BMI as morbid obese (n = 16), obese (n = 27), and nonobese (control, n = 22) groups. ADC measurements were performed from 24 different regions of the brain in each patient. The relationship of BMI with ADC values was searched. Results: The ADC values in hypothalamus, insular cortex, parietal cortex, caudate nucleus, frontal white matter, and posterior limb of internal capsule were all increased in obese patients (n = 43) compared to control group. The ADC values of midbrain, hypothalamus, orbitofrontal cortex, and parietal cortex were significantly increased in morbid obese compared to obese patients. In obese patients, the degree of BMI was positively correlated with ADC values of orbitofrontal cortex, parietal cortex, and hypothalamus. Conclusion: We observed increasing brain vasogenic edema with increasing BMI, suggesting that the main reason of brain diffusion alteration in patients with OSA could be obesity related.
    Full-text · Article · Mar 2014 · The Scientific World Journal
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    • "Clinicians often face difficulty in identifying which patients are at risk of accidents because of the disparity between daytime symptoms and conventional metrics of disease severity [e.g. apnea hypopnea index (AHI)] (Beebe, 2005; Al-Shawwa et al., 2008; Quan et al., 2011). Moreover, the heterogeneity of impairment in the patient population adds to this problem -one patient may be relatively asymptomatic whereas another may be greatly compromised even though both have the same degree of disease measured by sleep study (Beebe, 2005). "
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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.
    Full-text · Article · Apr 2013 · Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology
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