ABSTRACT

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive deficits. We investigated the cognitive and socio-cognitive profiles of patients with severe OSA, controlling for potentially relevant mediating variables (i.e. age, body-mass index, cognitive reserve and depression). Moreover, we studied the neuropsychological profile of a high-risk OSA phenotype characterized by severe OSA and severe nocturnal hypoxemia.

Method: We assessed 29 previously untreated severe OSA patients with a mean age of 55.6 (± 9.9 years) and a mean apnea-hypopnea index (AHI) of 53.1 (± 17.4). A control group of 34 healthy participants was also enrolled. Participants completed an extensive neuropsychological battery that included social cognition, a relatively new investigation area among OSA patients.

Data analysis: Data were analyzed with a Bayesian approach. Specifically, Bayesian ANCOVA was used to investigate whether the grouping variable could predict test performance. Age, body-mass index, cognitive reserve and state of depression were added as covariates to the null model to weight the effects of these potential confounding factors. Three groups were analyzed: healthy controls (H), OSA with severe apnea and severe nocturnal oxygen desaturation (D⁺), and OSA with severe apnea non-desaturators (D⁻). Performances on the various neuropsychological tests were treated as the dependent variables.

Results: The results indicate that non-verbal reasoning, the theory of mind skills, and mental shifting ability were impaired in OSA patients. Patients with severe nocturnal hypoxemia underperformed compared to patients with the same severity of apnea but non-desaturators. Additionally, we observed a trend toward a worse performance among OSA desaturator patients in the following abilities: constructional ability, short term verbal memory, phonological fluency, and the ability to inhibit automatic and dominant responses.

Conclusion: The data suggest a key role of hypoxemia in affecting cognitive functioning in OSA patients. Executive functions and the concomitant involvement of social cognition are particularly affected.

摘要

简介：阻塞性睡眠呼吸暂停 (OSA) 患者患有多种神经认知缺陷。我们调查了重度 OSA 患者的认知和社会认知特征，控制了可能相关的中介变量（即年龄、体重指数、认知储备和抑郁）。此外，我们研究了以严重 OSA 和严重夜间低氧血症为特征的高风险 OSA 表型的神经心理学特征。

方法：我们评估了 29 名以前未经治疗的重度 OSA 患者，平均年龄为 55.6 (± 9.9 岁)，平均呼吸暂停低通气指数 (AHI) 为 53.1 (± 17.4)。还招募了一个由 34 名健康参与者组成的对照组。参与者完成了广泛的神经心理学电池，其中包括社会认知，这是 OSA 患者中一个相对较新的研究领域。

数据分析：使用贝叶斯方法分析数据。具体而言，贝叶斯 ANCOVA 用于研究分组变量是否可以预测测试性能。年龄、体重指数、认知储备和抑郁状态作为协变量添加到空模型中，以加权这些潜在混杂因素的影响。分析了三组：健康对照 (H)、具有严重呼吸暂停和严重夜间氧饱和度降低 (D ⁺ ) 的 OSA 和具有严重呼吸暂停非去饱和度 (D ^- ) 的OSA 。在各种神经心理学测试中的表现被视为因变量。

结果：结果表明，OSA 患者的非语言推理、思维技能理论和心理转移能力受损。与具有相同严重程度的呼吸暂停但未使用去饱和剂的患者相比，患有严重夜间低氧血症的患者表现不佳。此外，我们观察到 OSA 去饱和剂患者在以下能力方面表现更差的趋势：构建能力、短期语言记忆、语音流畅性以及抑制自动和显性反应的能力。

结论：数据表明低氧血症在影响 OSA 患者认知功能中的关键作用。执行功能和社会认知的伴随参与尤其受到影响。