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Executive function in patients with obstructive sleep apnea treated with continuous positive airway pressure

  • ESTHER YUET YING LAU (a1), GAIL A. ESKES (a2) (a3) (a4), DEBRA L. MORRISON (a4) (a5), MALGORZATA RAJDA (a2) (a5) and KATHLEEN F. SPURR (a6)...

Abstract

Obstructive sleep apnea (OSA) is characterized by disrupted breathing and hypoxemia during sleep, daytime sleepiness, and changes in cognition and mood. One important question is regarding the reversibility of cognitive deficits after treatment with continuous positive airway pressure (CPAP). Here, we report the outcomes of CPAP treatment as measured by tests of attention and executive function. Thirty-seven individuals with moderate to severe OSA and compliant on CPAP treatment were studied with working memory tasks, neuropsychological testing, and overnight polysomnographic sleep study and compared to 27 healthy controls. CPAP improved the respiratory disturbance index, minimum and mean oxygen saturation (SpO2), subjective sleep quality, and daytime sleepiness ratings compared to pre-treatment values. In terms of current neurocognitive function, treated individuals with OSA performed at a comparable level to controls on basic working memory storage functions but still showed a significant reduction on tests of working memory requiring the central executive. The OSA group also performed worse on neuropsychological measures of complex attention, executive function, and psychomotor speed. While CPAP is an effective treatment for OSA in terms of ameliorating breathing disruption and oxygen desaturation during sleep, as well as daytime sleepiness, some cognitive deficits may be more resistant to treatment. (JINS, 2010, 16, 1077–1088.)

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Corresponding author

*Correspondence and reprint requests to: Esther Yuet Ying Lau, Add: K641, Knowles Building, Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong. E-mail: eyylau@hku.hk

References

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Alchanatis, M., Zias, N., Deligiorgis, N., Amfilochiou, A., Dionellis, G., & Orphanidou, D. (2005). Sleep apnea-related cognitive deficits and intelligence: An implication of cognitive reserve theory. Journal of Sleep Research, 14, 6975.
Aloia, M.S., Arnedt, J.T., Davis, J.D., Riggs, R.L., & Byrd, D. (2004). Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: A critical review. Journal of the International Neuropsychological Society, 10, 772785.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: American Psychiatric Association.
Baddeley, A.D. (1996a). Exploring the central executive. The Quarterly Journal of Experimental Psychology, 49A, 528. doi: 10.1080/713755608
Baddeley, A.D. (1996b). The fractionation of working memory. Proceedings of the National Academy of Sciences of the United States of America, 93, 1346813472. doi: 10.1073/pnas.93.24.13468
Baddeley, A.D. (2003). Working memory: Looking back and looking forward. Nature Reviews Neuroscience, 4, 829839.
Baddeley, A.D., & Della Sala, S. (1996). Working memory and executive control. Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 351, 13971404.
Barnes, M., Houston, D., Worsnop, C.J., Neill, A.M., Mykytyn, I.J., Kay, A., et al. . (2002). A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. American Journal of Respiratory Critical Care Medicine, 165, 773780.
Bédard, M.A., Montplaisir, J., Malo, J., Richer, F., & Rouleau, I. (1993). Persistent neuropsychological deficits and vigilance impairments in sleep apnea syndrome after treatment with continuous positive airway pressure (CPAP). Journal of Clinical and Experimental Neuropsychology, 15, 330341. doi: 10.1080/01688639308402567
Beebe, D.W., & Gozal, D. (2002). Obstructive sleep apnea and the prefrontal cortex: Towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. Journal of Sleep Research, 11, 116. doi: 10.1046/j.1365-2869.2002.00289.x
Bonnet, M.H. (1993). Vigilance/sleepiness sequelae of sleep disordered breathing and sleep apnea: Cognitive effects of sleep and sleep fragmentation. Sleep, 16, S65S67.
Buysse, D.J., Reynolds, C.F. III, Monk, T.H., Berman, S.R., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193213. doi: 10.1016/0165-1781(89)90047-4
Coltheart, M. (1981a). MRC psycholinguistic database user manual: Version 1, from http://www.psych.rl.ac.uk/User_Manual_v1_0.html
Coltheart, M. (1981b). The MRC psycholinguistic database. Quarterly Journal of Experimental Psychology, 33(A), 497505.
Daneman, M., & Carpenter, P.A. (1980). Individual differences in working memory and reading. Journal of Verbal Learning and Verbal Behavior, 19, 450466.
Décary, A., Rouleau, I., & Montplaisir, J. (2000). Cognitive deficits associated with sleep apnea syndrome: A proposed neuropsychological test battery. Sleep, 23, 369381.
Della Sala, S., Baddeley, A., Papagno, C., & Spinnler, H. (1995). Dual-task paradigm: A means to examine the central executive. In Grafman, J., Holyoak, K.J. & Boller, F. (Eds.), Structure and functions of the human frontal cortex (pp. 161171). New York: Annals of the New York Academy of Sciences.
Douglas, N.J. (1998). Systematic review of the efficacy of CPAP. Thorax, 53, 414415.
Duff, S.C., & Logie, R.H. (2001). Processing and storage in working memory span. The Quarterly Journal of Experimental Psychology, 54A, 3148.
Engleman, H.M., Kingshott, R.N., Martin, S.E., & Douglas, N.J. (2000). Cognitive function in the sleep apnea/hypopnea syndrome (SAHS). Sleep, 23, S102S108.
Engleman, H.M., Martin, S.E., Deary, I.J., & Douglas, N.J. (1994). Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/Hypopnea syndrome. Lancet, 343, 572575. doi: 10.1016/S0140-6736(94)91522-9
Engleman, H.M., Martin, S.E., Deary, I.J., & Douglas, N.J. (1997). Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax, 52, 114119.
Felver-Grant, J.C., Bruce, A.S., Zimmerman, M., Sweet, L.H., Millman, R.P., & Aloia, M.S. (2007). Working memory in obstructive sleep apnea: Construct validity and treatment effects. Journal of Clinical Sleep Medicine, 3, 589594.
Ferini-Strambi, L., Baietto, C., Di Giolia, M.R., Castaldi, P., Castronovo, C., Zucconi, M., et al. . (2003). Cognitive dysfunction in patients with obstructive sleep apnea (OSA): Partial reversibility after continuous positive airway pressure (CPAP). Brain Research Bulletin, 61, 8792. doi: 10.1016/S0361-9230(03)00068-6
Feuerstein, C., Naëgelé, B., Pepin, J.-L., & Levy, P. (1997). Frontal lobe-related cognitive functions in patients with sleep apnea syndrome before and after treatment. Acta Neurologica Beligica, 97, 96107.
Gevins, A.S., & Cutillo, B.A. (1993). Spatiotemporal dynamics of component processes in human working memory. Electroencephalography and Clinical Neurophysiology, 87, 128143.
Gevins, A., Smith, M.E., Le, J., Leong, H., Bennett, J., Martin, N., et al. . (1996). High resolution evoked potential imaging of the cortical dynamics of human working memory. Electroencephalography and Clinical Neurophysiology, 98, 327348.
Grunstein, R. (2005). Continuous positive airway pressure treatment for obstructive sleep apnea-hypopnea syndrome. In Kryger, M.H., Roth, T. & Dement, W.C. (Eds.), Principles and practice of sleep medicine (4th ed., pp. 10661080). Philadelphia: Elsevier Saunders.
Hartenbaum, N., Collop, N., Rosen, I.M., Phillips, B., George, C.F., Rowley, J.A., et al. . (2006). Sleep apnea and commercial motor vehicle operators: Statement from the joint task force of the American College of Chest Physicians, the American College of Occupational and Environmental Medicine, and the National Sleep Foundation. Chest, 130, 902905. doi: 10.1378/chest.130.3.902
Johns, M.W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep Research, 14, 540545.
Johns, M.W. (1992). Reliability and Factor Analysis of the Epworth Sleepiness Scale. Sleep Research, 15, 376381.
Jones, K., & Harrison, Y. (2001). Frontal lobe function, sleep loss and fragmented sleep. Sleep Medicine Reviews, 5, 463475.
Kim, H.C., Young, T., Matthews, C.G., Weber, S.M., Woodard, A.R., & Palta, M. (1997). Sleep-disordered breathing and neuropsychological deficits. American Journal of Respiratory Critical Care Medicine, 156, 18131819.
Kingshott, R.N., Vennelle, M., Hoy, C.J., Engleman, H.M., Deary, I.J., & Douglas, N.J. (2000). Predictors of improvements in daytime function outcomes with CPAP therapy. American Journal of Respiratory Care Medicine, 161, 866871.
Kushida, C.A., Littner, M., Morgenthaler, T., Alessi, C., Bailey, D., Coleman, J.J., et al. . (2005). Practice parameters for the indications for polysomnography and related procedures: An update for 2005. Sleep, 28, 299521.
Levine, B., Robertson, I.H., Clare, L., Carter, G., Hong, J., Wilson, B.A., et al. . (2000). Rehabilitation of executive functioning: An experimental-clinical validation of goal management training. Journal of the International Neuropsychological Society, 6, 299312.
Lis, S., Krieger, S., Hennig, D., Christian, R., Kirsch, P., Seeger, W., et al. . (2008). Executive function and cognitive subprocesses in patients with obstructive sleep apnoea. Journal of Sleep Research, 17, 271. doi: 10.1111/j.1365-2869.2008.00660.x
Montplaisir, J., Bédard, M.A., Richer, F., & Rouleau, I. (1992). Neurobehavioral manifestations in obstructive sleep apnea syndrome before and after treatment with continuous positive airway pressure. Sleep, 15(Suppl.), S17S19.
Naëgelé, B., Launois, S.H., Mazza, S., Feuerstein, C., Pépin, J.-L., & Lévy, P. (2006). Which memory processes are affected in patients with obstructive sleep apnea? An evaluation of 3 types of memory. Sleep, 29, 533544.
Naëgelé, B., Pepin, J.L., Levy, P., Bonnet, C., Pellat, J., & Feuerstein, C. (1998). Cognitive executive dysfunction in patients with obstructive sleep apnea syndrome (OSAS) after CPAP treatment. Sleep, 21, 392397.
Naëgelé, B., Thouvard, V., Pepin, J.L., Levy, P., Bonnet, C., Perret, J.E., et al. . (1995). Deficits of cognitive executive functions in patients with sleep apnea syndrome. Sleep, 18, 4352.
Patel, S.R., White, D.P., Malhotra, A., Stanchina, M.L., & Ayas, N.T. (2003). Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea. Archives of Internal Medicine, 163, 565571. doi: 10.1001/archinte.163.5.565
Rechtschaffen, A., & Kales, A. (1968). A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Los Angeles: UCLA Brain Information Service/Brain Research Institute.
Salthouse, T.A. (1996). The processing-speed theory of adult age differences in cognition. Psychological Review 103, 403428. doi: 10.1037/0033-295X.103.3.403
Sánchez, A.I., Buela-Casal, G., Bermúdez, M.P., & Casas-Maldonado, F. (2001). The effects of continuous positive air pressure treatment on anxiety and depression levels in apnea patients. Psychiatry and Clinical Neuroscience, 55, 641646.
Sanner, B.M., Klewer, J., Trumm, A., Randerath, W., Kreuzer, I., & Zidek, W. (2000). Long-term treatment with continuous positive airway pressure improves quality of life in obstructive sleep apnoea syndrome. European Respiratory Journal, 16, 118122.
Sateia, M.J. (2003). Neuropsychological impairment and quality of life in obstructive sleep apnea. Clinical Chest Medicine, 24, 249259. doi: 10.1016/S0272-5231(03)00014-5
Saunamäki, T., & Jehkonen, M. (2007). A review of executive functions in obstructive sleep apnea syndrome. Acta Neurologica Scandinavica, 115, 111. doi: 10.1111/j.1600-0404.2006.00744.x
Smith, E.E., Jonides, J., & Koeppe, R.A. (1996). Dissociating verbal and spatial working memory using PET. Cerebral Cortex, 6, 1120. doi: 10.1093/cercor/6.1.11
Smith, E.E., Jonides, J., Koeppe, R.A., Awh, E., Schumacher, E.H., & Minoshima, S. (1995). Spatial versus object working memory: PET investigations. Journal of Cognitive Neuroscience, 7, 337356.
Sternberg, S. (1966). High-speed scanning in human memory. Science, 153, 652654. doi: 10.1126/science.153.3736.652
Sternberg, S. (1969). Memory-scanning: Mental processes revealed by reaction-time experiments. American Scientist, 57, 421457.
Sturm, W., Willmes, K., Orgass, B., & Hartje, W. (1997). Do specific attention deficits need specific training? Neuropsychological Rehabilitation, 7, 81103.
Thomas, R.J., Rosen, B.R., Stern, C.E., Weiss, W., & Kwong, K.K. (2005). Functional imaging of working memory in obstructive sleep-disordered breathing. Journal of Applied Physiology, 98, 22262234. doi: 10.1152/japplphysiol.01225.2004
Verstraeten, E., Cluydts, R., Pevernagie, D., & Hoffmann, G. (2004). Executive function in sleep apnea: Controlling for attentional capacity in assessing executive attention. Sleep, 27, 685693.
Weaver, T.E. (2001). Outcome measurement in sleep medicine practice and research. Part 2: Assessment of neurobehavioral performance and mood. Sleep Medicine Reviews, 5, 223236. doi: 10.1053/smrv.2001.0153
Wechsler, D. (1987). Wechsler memory scale-revised manual. New York: The Psychological Corporation.
Wilson, M.D. (1988). The MRC psycholinguistic database: Machine readable dictionary, Version 2. Behavioural Research Methods, Instruments and Computers, 20, 611.

Keywords

Executive function in patients with obstructive sleep apnea treated with continuous positive airway pressure

  • ESTHER YUET YING LAU (a1), GAIL A. ESKES (a2) (a3) (a4), DEBRA L. MORRISON (a4) (a5), MALGORZATA RAJDA (a2) (a5) and KATHLEEN F. SPURR (a6)...

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