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Immediate and Long-term Neurocognitive Outcome in Patients with Obstructive Sleep Apnea Syndrome After Continuous Positive Airway Pressure Treatment.

ABSTRACT: Neurocognitive dysfunction is a major clinical consequence in patients with obstructive sleep apnea syndrome (OSAS). The effects of continuous positive airway pressure (CPAP) treatment, as the gold standard of treatment in OSAS, on this major complication are controversial. The duration and compliance of CPAP are thought to be important factors but evidence is lacking. This study is designed to evaluate the effects of immediate (one night), long-term (3 months) influence and the compliances of CPAP treatment on the neurocognitive function in OSAS patients. We enrolled newly diagnosed severe OSAS patients. Neurocognitive function test battery, CANTAB (Cambridge Neuropsychological Test Automated Battery), was performed before, one night and 3 months of CPAP treatment. Patients with CPAP compliance rate ? 70 % and < 50 % were grouped into good and poor adherence subjects, respectively. Fourteen patients were enrolled in final analyses. Six of them were in poor compliant group. Improvements in attention domain were found in all subjects after one-night treatment and maintained till three-month follow-up. Additional improvements in some attention performances and visual memory performances were gained only after three-month treatment. Significant changes of decision-making and response control function were found between good and poor compliance groups after three-month treatment. CPAP can improve some neurocognitive function at the very first day used. Longer treatment of CPAP can additionally improve some other neurocognitive functions. Compliance of CPAP has influence on the recovery of neurocognitive functions in patients with severe OSAS.

SUBMITTER: Lin SW

PROVIDER: S-EPMC4298599 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Immediate and Long-term Neurocognitive Outcome in Patients with Obstructive Sleep Apnea Syndrome After Continuous Positive Airway Pressure Treatment.

Lin Shih-Wei SW Chou Yu-Ting YT Kao Kuo-Chin KC Chuang Li-Pang LP Yang Chien-Ming CM Hu Han-Chung HC Huang Chung-Chi CC Yang Cheng-Ta CT Chen Ning-Hung NH

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 20140919 Suppl 1

Neurocognitive dysfunction is a major clinical consequence in patients with obstructive sleep apnea syndrome (OSAS). The effects of continuous positive airway pressure (CPAP) treatment, as the gold standard of treatment in OSAS, on this major complication are controversial. The duration and compliance of CPAP are thought to be important factors but evidence is lacking. This study is designed to evaluate the effects of immediate (one night), long-term (3 months) influence and the compliances of C ...[more]

PMID: 25621259

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Project description:Study objectiveTo determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA).Design, setting, and participantsThe 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.InterventionActive 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])ResultsThe 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.ConclusionsCPAP 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.Clinical trial informationRegistered at clinicaltrials.gov. Identifier: NCT00051363.CitationKushida CA; Nichols DA; Holmes TH; Quan SF; Walsh JK; Gottlieb DJ; Simon RD; Guilleminault C; White DP; Goodwin JL; Schweitzer PK; Leary EB; Hyde PR; Hirshkowitz M; Green S; McEvoy LK; Chan C; Gevins A; Kay GG; Bloch DA; Crabtree T; Demen WC. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). SLEEP 2012;35(12):1593-1602.

Project description:Background Studies have shown that a significant percentage of patients with obstructive sleep apnea (OSA) do not tolerate continuous positive airway pressure (CPAP) therapy and long-term use may be as low as 30%. Given the lower levels of symptoms and health-related risks, patients with mild sleep apnea may be at even higher risk for non-adherence to long term CPAP. The purpose of our study was to investigate the prevalence and associations of long-term CPAP adherence in first time users with mild sleep apnea diagnosed by home sleep apnea testing (HSAT). Methods We identified all the patients who were diagnosed with mild sleep apnea (5 = < AHI < 15) by home sleep apnea testing from 01/2013 to 06/2019 at a large, combined community and hospital-based sleep practice. Only first time CPAP users were included. Compliance was defined as CPAP usage ≥ 4 h per night on ≥ 70% of nights over 30 consecutive days. We defined long term adherence as compliance on the 12th month following CPAP set up. Patient demographics, comorbidities, and CPAP compliance at 1st, 3rd, 6th, 9th and 12th month after therapy initiation were collected. We compared and identified the factors that had significant difference (P < 0.1) between compliant and non-compliant groups at the 12th month. Results 222 patients were included in the analysis. 57 (25.7%) patients were adherent with long term CPAP treatment. The following factors were associated with a greater likelihood for long-term CPAP adherence: older age, lower body mass index (BMI), presence of a bed partner, non-smoker, presence of Diabetes Mellitus (DM), presence of Heart Failure (CHF), lack of depression, and compliance at 1st, 3rd, 6th and 9th month. Conclusions Long term CPAP compliance in mild sleep apnea patients is low. Long term adherence to CPAP can be predicted based on CPAP adherence during the first three months. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-023-02612-3.

Project description:Background: Obstructive sleep apnea syndrome (OSAS) is an independent risk factor for cardiovascular morbidity and mortality, and it has a detrimental effect on renal function. Obesity is the major risk factor for OSAS, and represents a risk factor for chronic kidney disease. Continuous positive airway pressure (CPAP) is the suggested therapy for moderate-to-severe OSAS. We designed this study to evaluate the effect of CPAP on estimated glomerular filtration rate (e-GFR) in a cohort of obese patients with moderate-to-severe OSAS and normal renal function. Methods: We enrolled 198 obese subjects, divided into two groups (OSAS+ and OSAS-), on the basis of cardiorespiratory monitoring; mild OSAS patients (n = 33) were excluded from the study, thus the analyses were conducted on 165 patients. Comparisons between groups were made by Student t-test or χ2 test as appropriate. Linear regression analyses were used to assess the relationship between baseline e-GFR and different covariates and, in the OSAS+ group, between Δe-GFR and different covariates. A multivariate regression analysis was performed to determinate the independent predictor of the Δe-GFR. Results: OSAS+ subjects showed significantly increased values of systolic blood pressure, HOMA, pulse wave velocity, high-sensitivity C reactive protein and uric acid compared with OSAS- group. OSAS+ group showed significantly lower values of e-GFR and increased values of microalbuminuria. At linear regression analysis e-GFR resulted significantly and inversely related to AHI in the whole study population and in the two groups. After 6 months of CPAP therapy, OSAS+ subjects showed an improvement in respiratory parameters, as well as a significant increase in e-GFR values (104.2 + 19.0 vs. 84.0 + 13.1 ml/min/1.73 m2, P < 0.0001). At multiple regression analysis, Δ apnea/hypopnea index (AHIa) resulted the main independent predictor of Δe-GFR explaining 22% of its variation. Conclusions: Obese OSAS patients show significantly lower values of e-GFR, even if in the normal range, compared with obese non-OSAS subjects. After 6 months of CPAP, e-GFR significantly improved (+20 ml/min/1.73 m2) and ΔAHIa resulted the most important independent predictor of Δe-GFR.

Dataset Information

Immediate and Long-term Neurocognitive Outcome in Patients with Obstructive Sleep Apnea Syndrome After Continuous Positive Airway Pressure Treatment.

Publications

Immediate and Long-term Neurocognitive Outcome in Patients with Obstructive Sleep Apnea Syndrome After Continuous Positive Airway Pressure Treatment.

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