Advertisement

Sleep and Breathing

, Volume 23, Issue 1, pp 41–48 | Cite as

Effects of CPAP therapy on cognitive and psychomotor performances in patients with severe obstructive sleep apnea: a prospective 1-year study

  • Renata PecoticEmail author
  • Ivana Pavlinac Dodig
  • Maja Valic
  • Tea Galic
  • Linda Lusic Kalcina
  • Natalija Ivkovic
  • Zoran Dogas
Sleep Breathing Physiology and Disorders • Original Article
  • 141 Downloads

Abstract

Study objectives

We prospectively investigated the effects of continuous positive airway pressure (CPAP) on long-term cognitive and psychomotor performances, and excessive daytime sleepiness in severe obstructive sleep apnea (OSA) patients.

Methods

A total of 40 patients were recruited and 23 patients with severe OSA fully completed the study protocol to investigate the effects of CPAP therapy on psychomotor performance at 1, 3, and 6 months and 1 year following initiation of the therapy. Psychomotor CRD-series tests measuring reaction times of light stimulus perception, solving simple arithmetic operations, and complex psychomotor limb coordination, were used in this study. The data collected following CPAP therapy were compared to baseline values prior to the CPAP treatment for each patient.

Results

All of the measured variables improved following CPAP treatment. However, the most pronounced effect was observed in improvement of reaction times to complex psychomotor limb coordination test (p < 0.05). Self-reported evaluation of excessive daytime sleepiness measured by Epworth Sleepiness Scale (ESS) showed significant decrease from 10.0 ± 1.1 before to 3.5 ± 0.5 (p < 0.001), after 1 year on CPAP therapy.

Conclusions

The CPAP therapy improved cognitive and psychomotor performance on CRD-series tests with the most significant improvement observed in complex psychomotor limb coordination of severe OSA patients.

Keywords

Obstructive sleep apnea Continuous positive airway pressure Cognitive Psychomotor Sleepiness 

Notes

Acknowledgments

The authors wish to thank Jelena Baricevic and Dijana Radanovic bacc. med. techn. for their technical assistance.

Funding

Croatian Science Foundation provided financial support in the form of grant #IP-11-2013-5935 funding.

The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethics Committee of the University of Split School of Medicine (USSM)) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    American Academy of Sleep Medicine Aiawt, SOCIETY ESR, RESEARCH JSOS, SOCIETY LAS (2014) International Classification of Sleep Disorders – Third Edition (ICSD-3)Google Scholar
  2. 2.
    Decary A, Rouleau I, Montplaisir J (2000) Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsychological test battery. Sleep 23(3):369–381CrossRefGoogle Scholar
  3. 3.
    Aloia MS, Ilniczky N, Di Dio P, Perlis ML, Greenblatt DW, Giles DE (2003) Neuropsychological changes and treatment compliance in older adults with sleep apnea. J Psychosom Res 54(1):71–76CrossRefGoogle Scholar
  4. 4.
    Aloia MS, Arnedt JT, Davis JD, Riggs RL, Byrd D (2004) Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review. J Int Neuropsychol Soc : JINS 10(5):772–785.  https://doi.org/10.1017/S1355617704105134 CrossRefGoogle Scholar
  5. 5.
    Engleman HM, Douglas NJ (2004) Sleep. 4: sleepiness, cognitive function, and quality of life in obstructive sleep apnoea/hypopnoea syndrome. Thorax 59(7):618–622CrossRefGoogle Scholar
  6. 6.
    Bucks RS, Olaithe M, Eastwood P (2013) Neurocognitive function in obstructive sleep apnoea: a meta-review. Respirology 18(1):61–70.  https://doi.org/10.1111/j.1440-1843.2012.02255.x CrossRefGoogle Scholar
  7. 7.
    Stranks EK, Crowe SF (2016) The cognitive effects of obstructive sleep apnea: an updated meta-analysis. Arch Clin Neuropsychol 31(2):186–193.  https://doi.org/10.1093/arclin/acv087 Google Scholar
  8. 8.
    Knoepke CAM (2009) Proposed mechanism of cognitive dysfunction in obstructive sleep apnea. Primary Psychiatry 16(10):51–66Google Scholar
  9. 9.
    Verstraeten E, Cluydts R, Pevernagie D, Hoffmann G (2004) Executive function in sleep apnea: controlling for attentional capacity in assessing executive attention. Sleep 27(4):685–693Google Scholar
  10. 10.
    Grigg-Damberger M, Ralls F (2012) Cognitive dysfunction and obstructive sleep apnea: from cradle to tomb. Curr Opin Pulm Med 18(6):580–587.  https://doi.org/10.1097/MCP.0b013e328358be18 CrossRefGoogle Scholar
  11. 11.
    Kylstra WA, Aaronson JA, Hofman WF, Schmand BA (2013) Neuropsychological functioning after CPAP treatment in obstructive sleep apnea: a meta-analysis. Sleep Med Rev 17(5):341–347.  https://doi.org/10.1016/j.smrv.2012.09.002 CrossRefGoogle Scholar
  12. 12.
    Landry S, O'Driscoll DM, Hamilton GS, Conduit R (2016) Overnight motor skill learning outcomes in obstructive sleep apnea: effect of continuous positive airway pressure. J Clin Sleep Med : JCSM : Off Publ Am Acad Sleep Med 12(5):681–688.  https://doi.org/10.5664/jcsm.5794 Google Scholar
  13. 13.
    Karanovic N, Carev M, Kardum G, Pecotic R, Valic M, Karanovic S, Ujevic A, Dogas Z (2009) The impact of a single 24 h working day on cognitive and psychomotor performance in staff anaesthesiologists. Eur J Anaesthesiol 26(10):825–832.  https://doi.org/10.1097/EJA.0b013e32832bb6e4 CrossRefGoogle Scholar
  14. 14.
    Petri NM, Dropulic N, Kardum G (2006) Effects of voluntary fluid intake deprivation on mental and psychomotor performance. Croat Med J 47(6):855–861Google Scholar
  15. 15.
    Radic J, Ljutic D, Radic M, Kovacic V, Sain M, Dodig-Curkovic K (2011) Is there differences in cognitive and motor functioning between hemodialysis and peritoneal dialysis patients? Ren Fail 33(6):641–649.  https://doi.org/10.3109/0886022X.2011.586480 CrossRefGoogle Scholar
  16. 16.
    Galic T, Bozic J, Pecotic R, Ivkovic N, Valic M, Dogas Z (2016) Improvement of cognitive and psychomotor performance in patients with mild to moderate obstructive sleep apnea treated with mandibular advancement device: a prospective 1-year study. J Clin Sleep Med : JCSM : Off Publ Am Acad Sleep Med 12(2):177–186.  https://doi.org/10.5664/jcsm.5480 Google Scholar
  17. 17.
    Epstein LJ, Kristo D, Strollo PJ, Jr., Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5 (3):263–276Google Scholar
  18. 18.
    Pecotic R, Dodig IP, Valic M, Ivkovic N, Dogas Z (2012) The evaluation of the Croatian version of the Epworth Sleepiness Scale and STOP questionnaire as screening tools for obstructive sleep apnea syndrome. Sleep Breath 16(3):793–802.  https://doi.org/10.1007/s11325-011-0578-x CrossRefGoogle Scholar
  19. 19.
    Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J, Jr., Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28 (4):499–521Google Scholar
  20. 20.
    Drenovac M (2001) An analysis of some attributes of the dynamics of mental processing. Rev Psychol 8:61–67Google Scholar
  21. 21.
    Quan SF, Wright R, Baldwin CM, Kaemingk KL, Goodwin JL, Kuo TF, Kaszniak A, Boland LL, Caccappolo E, Bootzin RR (2006) Obstructive sleep apnea-hypopnea and neurocognitive functioning in the sleep heart health study. Sleep Med 7(6):498–507.  https://doi.org/10.1016/j.sleep.2006.02.005 CrossRefGoogle Scholar
  22. 22.
    Sforza E, Roche F (2012) Sleep apnea syndrome and cognition. Front Neurol 3:87.  https://doi.org/10.3389/fneur.2012.00087 CrossRefGoogle Scholar
  23. 23.
    Beebe DW, 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. J Sleep Res 11(1):1–16CrossRefGoogle Scholar
  24. 24.
    Ferini-Strambi L, Marelli S, Galbiati A, Castronovo C (2013) Effects of continuous positive airway pressure on cognition and neuroimaging data in sleep apnea. Int J Psychophysiol : Off J Int Org Psychophysiol 89(2):203–212.  https://doi.org/10.1016/j.ijpsycho.2013.03.022 CrossRefGoogle Scholar
  25. 25.
    Olaithe M, Bucks RS (2013) Executive dysfunction in OSA before and after treatment: a meta-analysis. Sleep 36(9):1297–1305.  https://doi.org/10.5665/sleep.2950 CrossRefGoogle Scholar
  26. 26.
    Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV (2004) Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 27(7):1255–1273CrossRefGoogle Scholar
  27. 27.
    George CF, Boudreau AC, Smiley A (1997) Effects of nasal CPAP on simulated driving performance in patients with obstructive sleep apnoea. Thorax 52(7):648–653CrossRefGoogle Scholar
  28. 28.
    Kushida CA, Nichols DA, Holmes TH, Quan SF, Walsh JK, Gottlieb DJ, Simon RD, Jr., 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, Dement WC (2012) Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the apnea positive pressure long-term efficacy study (APPLES). Sleep 35 (12):1593–1602. doi: https://doi.org/10.5665/sleep.2226
  29. 29.
    Munoz A, Mayoralas LR, Barbe F, Pericas J, Agusti AG (2000) Long-term effects of CPAP on daytime functioning in patients with sleep apnoea syndrome. Eur Respir J 15(4):676–681CrossRefGoogle Scholar
  30. 30.
    Landry S, Anderson C, Andrewartha P, Sasse A, Conduit R (2014) The impact of obstructive sleep apnea on motor skill acquisition and consolidation. J Clin Sleep Med : JCSM : Off Publ Am Acad Sleep Med 10(5):491–496.  https://doi.org/10.5664/jcsm.3692 Google Scholar
  31. 31.
    Mihalj M, Lusic L, Dogas Z (2016) Reduced evoked motor and sensory potential amplitudes in obstructive sleep apnea patients. J Sleep Res 25(3):287–295.  https://doi.org/10.1111/jsr.12368 CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neuroscience and Split Sleep Medicine CenterUniversity of Split School of MedicineSplitCroatia
  2. 2.Study of Dental Medicine and Department of NeuroscienceUniversity of Split School of MedicineSplitCroatia
  3. 3.Split Sleep Medicine CenterUniversity Hospital Split and University of Split School of MedicineSplitCroatia

Personalised recommendations