Abstract
Purpose
Obstructive sleep apnea syndrome is a clinical sleep disorder defined by total or partial airflow restraint during sleep that results in fragmented sleep and hypoxemia, impacting negatively with cognitive functioning. This review was conducted on studies investigating structural brain alteration and cognitive impairment in obstructive sleep apnea syndrome.
Method
We searched on PubMed databases and screening references of included studies and review articles for additional citations. From initial 190 publications, only 17 met search criteria and described the cognitive impairment in obstructive sleep apnea syndrome.
Results
Findings showed that patients with this syndrome had worse performance than healthy controls in attention, memory, and executive functions, showing specific neuroanathomical features. Cognitive impairment is also related to the severity of pathology. Treatment could improve certain cognitive aspects.
Conclusions
Cognitive deficits seem to be mainly attributable to decreased daytime vigilance and nocturnal hypoxemia.
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References
Shpirer I, Elizur A, Shorer R, Peretz RB, Rabey JM, Khaigrekht M (2011) Hypoxemia correlates with attentional dysfunction in patients with obstructive sleep apnea. Sleep Breath 16(3):821–827
Franklin KA, Lindberg E (2015) Obstructive sleep apnea is a common disorder in the population—a review on the epidemiology of sleep apnea. J Thorac Dis 7(8):1311–1322
Bédard MA, Montplaisir J, Richer F, Rouleau I, Malo J (1991) Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychol 13(6):950–964
Gharibeh T, Mehra R (2010) Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options. Nat Sci Sleep 2:233
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale Murray. k 14(6):540–545
Zimmermann P, Denzel K, Ruehle KH (1993) Quantitative Untersuchungen zur Erfassung der Tagesmudigkeit, der Vigilanz und der ¨Aufmerksamkeit vor und nach nCPAP-Therapie bei Schlafapnoesyndrom. Pneumologie 47:155–159
Crawford-Achour E, Dauphinot V, Martin MS et al (2015) Protective effect of long-term CPAP therapy on cognitive performance in elderly patients with severe OSA: the PROOF study. J Clin Sleep Med 11:519–524
Strohl KP, Brown DB, Collop N, George C, Grunstein R, Han F et al (2013) An official American Thoracic Society Clinical Practice Guideline: sleep apnea, sleepiness, and driving risk in noncommercial drivers. An update of a 1994 statement. Am J Respir Crit Care Med 187(11):1259–1266
Guilleminault C, Robinson A (1997) Sleep-disordered breathing and hypertension: past lessons, future directions. Sleep 20(9):806–811
Guillemineault, C. (1989). Clinical features and evaluation of obstructive sleep apnea. In M. H. Kryger, T. Roth, & W. C. Dement (Eds.), Principles and practice of sleep medicine (pp. 552–558). Philadelphia: Saunders
Yaouhi K, Bertran F, Clochon P, Mézenge F, Denise P, Foret J, Eustache F, Desgranges B (2009) A combined neuropsychological and brain imaging study of obstructive sleep apnea. J Sleep Res 18(1):36–48
Nardone R, Bergmann J, Brigo F, Höller Y, Schwenker K, Florea C, Kunz AB, Golaszewski S, Trinka E (2016) Cortical afferent inhibition reflects cognitive impairment in obstructive sleep apnea syndrome: a TMS study. Sleep Med 24:51–56
Aloia MS, Arnedt JT, Davis JD, Riggs RL, Byrd DESIREE (2004) Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review. J Int Neuropsychol Soc 10(5):772–785
Naegele B, Thouvard V, Pepin JL, Levy P, Bonnet C, Perret JE, Pellat J, Feuerstein C (1995) Deficits of cognitive executive functions in patients with sleep apnea syndrome. Sleep 18:43–52
Naegele B, Launois SH, Mazza S, Feuerstein C, Pepin JL, Levy P (2006) Which memory processes are affected in patients with obstructive sleep apnea? An evaluation of 3 types of memory. Sleep 29:533–544
Adams N, Strauss M, Schluchter M, Redline S (2011) Relation of measures of sleep-disordered breathing to neuropsychological functioning. Am J Respir Crit Care Med 163:1626–1631
Salorio CF, White DA, Piccirillo J, Duntley SP, Uhles ML (2002) Learning, memory, and executive control in individuals with obstructive sleep apnea syndrome. J Clin Exp Neuropsychol 24:93–100
Ferini-Strambi L, Baietto C, Di Gioia MR, Castaldi P, Castronovo C, Zucconi M, Cappa SF (2003) Cognitive dysfunction in patients with obstructive sleep apnea (OSA): partial reversibility after continuous positive airway pressure (CPAP). Brain Res Bull 61:87–92
Lee MM, Strauss ME, Adams N, Redline S (1999) Executive functions in persons with sleep apnea. Sleep Breath 3:13–16
Greenberg GD, Watson RK, Deptula D (1987) Neuropsychological dysfunction in sleep apnea. Sleep 10:254–262
Twigg GL, Papaioannou I, Jackson M, Ghiassi R, Shaikh Z, Jaye J, Graham KS, Simonds AK, Morrell MJ (2010) Obstructive sleep apnea syndrome is associated with deficits in verbal but not visual memory. Am J Respir Crit Care Med 182(1):98–103
Edwards KM, Kamat R, Tomfohr LM, Ancoli-Israel S, Dimsdale JE (2014) Obstructive sleep apnea and neurocognitive performance: the role of cortisol. Sleep Med 15(1):27–32
Lupien SJ, Fiocco A, Wan N, Maheu F, Lord C, Schramek T, Tu MT (2005) Stress hormones and human memory function across the lifespan. Psychoneuroendocrinology 30:225–242
Born J, Wagner U (2004) Memory consolidation during sleep: role of cortisol feedback. Ann N Y Acad Sci 1032:198–201
Delhikar N, Sommers L, Rayner G, Schembri R, Robinson SR, Wilson S, Jackson ML (2019) Autobiographical memory from different life stages in individuals with obstructive sleep apnea. J Int Neuropsychol Soc 25(3):266–274. https://doi.org/10.1017/S1355617718001091
Kotterba S, Rasche K, Widdig W, Duscha C, Blombach S, Schultze-Werninghaus G, Malin JP (1998) Neuropsychological investigations and event-related potentials in obstructive sleep apnea syndrome before and during CPAP-therapy. J Neurol Sci 159(1):45–50
Steven H, KleeBarry D, Garfinkel (1983) The computerized continuous performance task: a new measure of inattention. J Abnorm Child Psychol 11(4):487–495
Tombaugh TN (2004) Trail making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol 19:203–214
Wechsler D (1997) Wechsler adult intelligence scale, 3rd edn. Psychological Corporation, San Antonio
Teste Wisconsin de classificação decartas: Uma revisão sistemática de 1952 a 2009. Psico-USF 2; 16:107–16
Devita M, Montemurro S, Zangrossi A, Ramponi S, Marvisi M, Villani D, Raimondi MC, Merlo P, Rusconi ML, Mondini S (2017) Cognitive and motor reaction times in obstructive sleep apnea syndrome: a study based on computerized measures. Brain Cogn 117:26–32
Chou PS, Hsu CY, Wu MN, Liou LM, Lu SR, Liu CK, Lai CL (2016) Action-monitoring dysfunction in obstructive sleep apnea - a pilot study. PLoS One 11(6):e0157575
Eriksen, C. W. (1995). The flankers task and response competition: A useful tool for investigating a variety of cognitive problems. Visual Cognition, 2(2-3), 101-118.
Tulek B, Atalay NB, Kanat F, Suerdem M (2013) Attentional control is partially impaired in obstructive sleep apnea syndrome. J Sleep Res 22(4):422–429
De Houwer J (2003) The extrinsic affective Simon task. Exp Psychol 50(2):77–85
Stroop JR (1935) Studies of interference in serial verbal reactions. J Exp Psychol 18:643–662
Zhang X, Wang Y, Li S, Huang X, Cui L (2002) Early detection of cognitive impairment in patients with obstructive sleep apnea syndrome: an event-related potential study. Neurosci Lett 325(2):99–102
Torelli F, Moscufo N, Garreffa G, Placidi F, Romigi A, Zannino S, Bozzali M, Fasano F, Giulietti G, Djonlagic I, Malhotra A, Marciani MG, Guttmann CR (2011) Cognitive profile and brain morphological changes in obstructive sleep apnea. Neuroimage 54(2):787–793
Macey PM, Kumar R, Woo MA, Valladares EM, Yan-Go FL, Harper RM (2008) Brain structural changes in obstructive sleep apnea. Sleep 31(7):967–977
Morrell MJ, McRobbie DW, Quest RA, Cummin AR, Ghiassi R, Corfield DR (2003) Changes in brain morphology associated with obstructive sleep apnea. Sleep Med 4(5):451–454
Joo EY, Tae WS, Lee MJ, Kang JW, Park HS, Lee JY, Suh M, Hong SB (2010) Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome. Sleep 33(2):235–241
Alchanatis M, Deligiorgis N, Zias N, Amfilochiou A, Gotsis E, Karakatsani A, Papadimitriou A (2004) Frontal brain lobe impairment in obstructive sleep apnea: a proton MR spectroscopy study. Eur Respir J 24(6):980–986
Castillo M, Kwock L, Mukherji SK (1996) Clinical applications of proton MR spectroscopy. AJNR Am J Neuroradiol 17:1–15
Rudkin TM, Arnold DL (1999) Proton magnetic resonance spectroscopy for the diagnosis and management of cerebral disorders. Arch Neurol 56:919–926
Zhang Q, Qin W, He X, Li Q, Chen B, Zhang Y, Yu C (2015) Functional disconnection of the right anterior insula in obstructive sleep apnea. Sleep Med 16(9):1062–1070
Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: population health perspective. Am J Respir Crit Care Med 165:1217–1239
Gasa M, Tamisier R, Launois SH, Sapene M, Martin F, Stach B, Grillet Y, Levy P, Pepin J-L (2013) Residual sleepiness in sleep apnea patients treated by continuous positive airway pressure. Journal of sleep research, 22(4), 389-397.
Blackwell T, Yaffe K, Ancoli-Israel S, Redline S, Ensrud KE, Stefanick ML et al (2011) Associations between sleep architecture and sleep-disordered breathing and cognition in older community-dwelling men: the Osteoporotic Fractures in Men Sleep Study. J Am Geriatr Soc 59(12):2217–2225
Watson R, Greenberg G, Deptula D (1985) Neuropsychological deficits in sleep apnea. Sleep Res 14:136
Park B, Palomares JA, Woo MA, Kang DW, Macey PM, Yan-Go FL, Harper RM, Kumar R (2016) Disrupted functional brain network organization in patients with obstructive sleep apnea. Brain Behav 6(3):e00441
Santarnecchi E, Sicilia I, Richiardi J, Vatti G, Polizzotto NR, Marino D, Rocchi R, van de Ville D, Rossi A (2013) Altered cortical and subcortical local coherence in obstructive sleep apnea: a functional magnetic resonance imaging study. J Sleep Res 22:337–347
Zhang Q, Wang D, Qin W, Li Q, Chen B, Zhang Y, Yu C (2013) Altered resting-state brain activity in obstructive sleep apnea. Sleep 36:651–659B
Peng DC, Dai XJ, Gong HH, Li HJ, Nie X, Zhang W (2014) Altered intrinsic regional brain activity in male patients with severe obstructive sleep apnea: a resting-state functional magnetic resonance imaging study. Neuropsychiatr Dis Treat 10:1819–1826
Weng HH, Tsai YH, Chen CF, Lin YC, Yang CT, Tsai YH, Yang CY (2014) Mapping gray matter reductions in obstructive sleep apnea: an activation likelihood estimation meta-analysis. Sleep 37(1):167–175
Werli KS, Otuyama LJ, Bertolucci PH, Rizzi CF, Guilleminault C, Tufik S, Poyares D (2016) Neurocognitive function in patients with residual excessive sleepiness from obstructive sleep apnea: a prospective, controlled study. Sleep Med 26:6–11
Canessa N, Castronovo V, Cappa SF, Aloia MS, Marelli S, Falini A, Alemanno F, Ferini-Strambi L (2011) Obstructive sleep apnea: brain structural changes and neurocognitive function before and after treatment. Am J Respir Crit Care Med 183(10):1419–1426
Sloan K, Craft S, Walsh JK (1989) Neuropsychological function in obstructive sleep apnea with and without hypoxemia. Sleep Res 18:304
Cooke JR, Ayalon L, Palmer BW, Loredo JS, Corey-Bloom J, Natarajan L, Liu L, Ancoli-Israel S (2009) Sustained use of CPAP slows deterioration of cognition, sleep, and mood in patients with Alzheimer’s disease and obstructive sleep apnea: a preliminary study. J Clin Sleep Med 5(4):305–309
Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Chertkow H (2005) The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 53(4):695–699
Raven JC (1947) Guide to using coloured progressive matrices: set A, Ab, B. Board and Book Forms, London
Spreen, O., & Benton, A.L. (1969, 1977). Neurosensory Center Comprehensive Examination for Aphasia (NCCEA). Victoria: University of Victoria Neuropsychology Laboratory
Osterrieth PA (1944) Le test de copie d'une figure complexe. Arch Sci Psychol 30:206–356
Shulman KI (2000) Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry 15(6):548–561
Wechsler D (2001) Echelle Clinique de me’moire de Wechsler, 3rd edn. ECPA Editions, Paris
Schmidt, M. (1996). Rey auditory verbal learning test: A handbook (p. 1996). Los Angeles, CA: Western Psychological Services.
Hannay, H. J., & Levin, H. S. (1985). Selective reminding test: an examination of the equivalence of four forms. Journal of Clinical and Experimental Neuropsychology, 7(3), 251-263.
Benedict RHB, Schretlen D, Groninger L, Brandt J (1998) Hopkins verbal learning test--revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol 12:43–55
Kopelman M, Wilson B, Baddeley A (1989) The autobiographical memory interview: a new assessment of autobiographical and personal semantic memory in amnesic patients. J Clin Exp Neuropsychol 11(5):724–744
Williams JMG, Broadbent K (1986) Autobiographical memory in suicide attempters. J Abnorm Psychol 95(2):144–149
Gronwall DM (1977) Paced auditory serial-addition task: a measure of recovery from concussion. Percept Mot Skills 44(2):367–373
Zimmermann P, B Fimm - Psytest, Wuerselen, Germany, (1995) Test battery for attention performance (TAP). 79. Silva-Filho JH, Pasian SR, Humberto JSM. (2011)
Tombaugh TN, Kozak J, Rees L (1999) Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol 14(2):167–177
Sternberg S (1969) Memory-scanning: mental processes revealed by reaction-time experiments. Am Sci 57(4) WINTER 1969:421–445
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Caporale, M., Palmeri, R., Corallo, F. et al. Cognitive impairment in obstructive sleep apnea syndrome: a descriptive review. Sleep Breath 25, 29–40 (2021). https://doi.org/10.1007/s11325-020-02084-3
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DOI: https://doi.org/10.1007/s11325-020-02084-3