Current Neurology and Neuroscience Reports

, Volume 7, Issue 2, pp 161–166 | Cite as

Neurocognitive effects of obstructive sleep apnea syndrome

Article
First Online:

Abstract

The nature of the neurocognitive deficits found in obstructive sleep apnea is still debatable. What is the extent of higher executive versus alertness-based cognitive dysfunction? Are cognitive impairments caused by nighttime hypoxemia or daytime sleepiness? This paper demonstrates the importance of a sound theoretical neurocognitive framework to be able to answer these questions. A strategy to assess executive function is proposed and illustrated with well-known neuropsychological tests. It seems that the pervasive effects of decreased alertness on higher cognitive functioning were not fully taken into account in those studies in which executive dysfunction has been found and has been related to prefrontal lobe damage caused by intermittent hypoxemia. Therefore, a basal slowing in information processing, primarily due to sleepiness, may explain most of the neurocognitive deficits in sleep apnea. This conjecture appears to be in agreement with recent functional MRI studies indicating sleep loss as the primary cause of neurocognitive deficits, more so than hypoxemia.

Keywords

Obstructive Sleep Apnea Sleep Apnea Continuous Positive Airway Pressure Obstructive Sleep Apnea Syndrome Sleep Deprivation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Gottlieb DJ, Whitney CW, Bonekat WH, et al.: Relation of sleepiness to respiratory disturbance index: The Sleep Heart Health Study. Am J Respir Crit Care Med 1999, 159:502–507.PubMedGoogle Scholar
  2. 2.
    Young T, Palta M, Dempsey J, et al.: The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993, 328:1230–1235.PubMedCrossRefGoogle Scholar
  3. 3.
    Shamsuzzaman AS, Gersh BJ, Somers VK: Obstructive sleep apnea: implications for cardiac and vascular disease. JAMA 2003, 290:1906–1914.PubMedCrossRefGoogle Scholar
  4. 4.
    Bonnet MH, Arand DL: Clinical effects of sleep fragmentation versus sleep deprivation. Sleep Med Rev 2003, 7:297–310.PubMedCrossRefGoogle Scholar
  5. 5.
    Beebe DW, Gozal D: 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 2002, 11:1–16.PubMedCrossRefGoogle Scholar
  6. 6.
    Fulda S, Schulz H: Cognitive dysfunction in sleep-related breathing disorders: a meta-analysis. Sleep Res Online 2003, 5:19–51.Google Scholar
  7. 7.
    Verstraeten E, Cluydts R: Executive control of attention in sleep apnea patients: Theoretical concepts and methodological considerations. Sleep Med Rev 2004, 8:257–267.PubMedCrossRefGoogle Scholar
  8. 8.
    Aloia MS, Arnedt JT, Davis JD, et al.: Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review. J Int Neuropsychol Soc 2004, 10:772–785.PubMedCrossRefGoogle Scholar
  9. 9.
    Beebe DW, Groesz L, Wells C, et al.: The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data. Sleep 2003, 26:298–307.PubMedGoogle Scholar
  10. 10.
    Engleman H, Joffe D: Neuropsychological function in obstructive sleep apnoea. Sleep Med Rev 1999, 3:59–78.PubMedCrossRefGoogle Scholar
  11. 11.
    Fulda S, Schulz H: Cognitive dysfunction in sleep disorders. Sleep Med Rev 2001, 5:423–45.PubMedCrossRefGoogle Scholar
  12. 12.
    Mazza S, Pepin JL, Naegele B, et al.: Most obstructive sleep apnoea patients exhibit vigilance and attention deficits on an extended battery of tests. Eur Respir J 2005, 25:75–80.PubMedCrossRefGoogle Scholar
  13. 13.
    Harrison Y, Horne J: The impact of sleep deprivation on decision making: a review. J Exp Psychol 2000, 6:236–249.Google Scholar
  14. 14.
    Drummond SP, Brown GG, Stricker JL, et al.: Sleep deprivation-induced reduction in cortical functional response to serial subtraction. Neuroreport 1999, 10:3745–3748.PubMedCrossRefGoogle Scholar
  15. 15.
    Turkington PM, Sircar M, Saralaya D, Elliott MW: Time course of changes in driving simulator performance with and without treatment in patients with sleep apnoea hypopnoea syndrome. Thorax 2004, 59:56–59.PubMedCrossRefGoogle Scholar
  16. 16.
    Engleman HM, Martin SE, Kingshott RN, et al.: Randomised placebo controlled trial of daytime function after continuous positive airway pressure (CPAP) therapy for the sleep apnoea/hypopnoea syndrome. Thorax 1998, 53:341–345.PubMedGoogle Scholar
  17. 17.
    Jenkinson C, Davies RJ, Mullins R, Stradling JR: Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 1999, 353:2100–2105.PubMedCrossRefGoogle Scholar
  18. 18.
    Lamphere J, Roehrs T, Wittig R: Recovery of alertness after CPAP in apnea. Chest 1989, 96:1364–1367.PubMedGoogle Scholar
  19. 19.
    Engleman HM, Cheshire KE, Deary IJ, Douglas NJ: Daytime sleepiness, cognitive performance and mood after continuous positive airway pressure for the sleep apnoea/hypopnoea syndrome. Thorax 1993, 48:911–914.PubMedCrossRefGoogle Scholar
  20. 20.
    Engleman HM, Kingshott RN, Wraith PK, et al.: Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome. Am J Respir Crit Care Med 1999, 159:461–467.PubMedGoogle Scholar
  21. 21.
    Patel SR, White DP, Malhotra A, et al.: Continuous positive airway pressure therapy for treating sleepiness in a diverse population with obstructive sleep apnea: results of a meta-analysis. Arch Intern Med 2003, 163:565–571.PubMedCrossRefGoogle Scholar
  22. 22.
    George CF, Boudreau AC, Smiley A: Effects of nasal CPAP on simulated driving performance in patients with obstructive sleep apnoea. Thorax 1997, 52:648–653.PubMedCrossRefGoogle Scholar
  23. 23.
    Hack M, Davies RJ, Mullins R, et al.: Randomised prospective parallel trial of therapeutic versus subtherapeutic nasal continuous positive airway pressure on simulated steering performance in patients with obstructive sleep apnoea. Thorax 2000, 55:224–231.PubMedCrossRefGoogle Scholar
  24. 24.
    Mazza S, Pépin JL, Naegelé B, et al.: Driving ability in sleep apnoea patients before and after CPAP treatment: evaluation on a road safety platform. Eur Respir J 2006, 28:1020–1028.PubMedCrossRefGoogle Scholar
  25. 25.
    Engleman HM, Martin SE, Deary IJ, Douglas NJ: Effect of continuous positive airway pressure treatment on daytime function in sleep apnoea/hypopnoea syndrome. Lancet 1994, 343:572–575.PubMedCrossRefGoogle Scholar
  26. 26.
    Henke KG, Grady JJ, Kuna ST: Effect of nasal continuous positive airway pressure on neuropsychological function in sleep apnea-hypopnea syndrome. A randomized, placebo-controlled trial. Am J Respir Crit Care Med 2001, 163:911–917.PubMedGoogle Scholar
  27. 27.
    Krieger J, Kurtz D, Petiau C, et al.: Long-term compliance with CPAP therapy in obstructive sleep apnea patients and in snorers. Sleep 1996, 19:S136–S143.PubMedGoogle Scholar
  28. 28.
    Kribbs NB, Pack AI, Kline LR, et al.: Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 1993, 147:887–895.PubMedGoogle Scholar
  29. 29.
    Weaver TE, Kribbs NB, Pack AI, et al.: Night-to-night variability in CPAP use over the first three months of treatment. Sleep 1997, 20:278–283.PubMedGoogle Scholar
  30. 30.
    Kribbs NB, Pack AI, Kline LR, et al.: Effects of one night without nasal CPAP treatment on sleep and sleepiness in patients with obstructive sleep apnea. Am Rev Respir Dis 1993, 147:1162–1168.PubMedGoogle Scholar
  31. 31.
    Bédard MA, Montplaisir J, Richer F, et al.: Obstructive sleep apnea syndrome: pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychol 1991, 13:950–964.PubMedGoogle Scholar
  32. 32.
    Naëgelé B, Thouvard V, Pépin JL, et al.: Deficits of cognitive executive functions in patients with sleep apnea syndrome. Sleep 1995, 18:43–52.PubMedGoogle Scholar
  33. 33.
    Kim HC, Young T, Matthews CG, et al.: Sleep-disordered breathing and neuropsychological deficits: a population-based study. Am J Respir Crit Care Med 1997, 156:1813–1819.PubMedGoogle Scholar
  34. 34.
    Redline S, Strauss ME, Adams N, et al.: Neuropsychological function in mild sleep-disordered breathing. Sleep 1997, 20:160–167.PubMedGoogle Scholar
  35. 35.
    Lee MM, Strauss ME, Adams N, Redline S: Executive functions in persons with sleep apnea. Sleep Breath 1999, 3:13–16.PubMedCrossRefGoogle Scholar
  36. 36.
    Verstraeten E, Cluydts R, Pevernagie D, Hoffmann G: Executive function in sleep apnea: controlling for attentional capacity in assessing executive attention. Sleep 2004, 27:685–693.PubMedGoogle Scholar
  37. 37.
    Baddeley A: Working memory. Science 1992, 255:556–559.PubMedCrossRefGoogle Scholar
  38. 38.
    D’Esposito M, Detre JA, Alsop DC, et al.: The neural basis of the central executive system of working memory. Nature 1995, 378:279–281.PubMedCrossRefGoogle Scholar
  39. 39.
    Baddeley A: Exploring the central executive. Q J Exp Psychol A 1996, 49:5–28.CrossRefGoogle Scholar
  40. 40.
    Lehto J: Are executive function tests dependent on working memory capacity? Q J Exp Psychol A 1996, 49:29–50.CrossRefGoogle Scholar
  41. 41.
    Borak J, Cieslicki JK, Koziej M, et al.: Effects of CPAP treatment on psychological status in patients with severe obstructive sleep apnoea. J Sleep Res 1996, 5:123–127.PubMedCrossRefGoogle Scholar
  42. 42.
    Morris N, Jones DM: Memory updating in working memory: the role of the central executive. Br J Psychol 1990, 81:111–121.Google Scholar
  43. 43.
    Henik A: Paying attention to the Stroop effect? J Int Neuropsychol Soc 1996, 2:467–470.PubMedGoogle Scholar
  44. 44.
    Abramczyk RR, Jordan DE, Hegel M: “Reverse” Stroop effect in the performance of schizophrenics. Percept Mot Skills 1983, 56:99–106.PubMedGoogle Scholar
  45. 45.
    Buchanan RW, Strauss ME, Kirkpatrick B, et al.: Neuropsychological impairments in deficit vs. nondeficit forms of schizophrenia. Arch Gen Psychiatry 1994, 51:804–811.PubMedGoogle Scholar
  46. 46.
    Durmer JS, Dinges DF: Neurocognitive consequences of sleep deprivation. Semin Neurol 2005, 25:117–129.PubMedCrossRefGoogle Scholar
  47. 47.
    O’Donoghue FJ, Briellmann RS, Rochford PD, et al.: Cerebral structural changes in severe obstructive sleep apnea. Am J Respir Crit Care Med 2005, 171:1185–1190.PubMedCrossRefGoogle Scholar
  48. 48.
    Robbins J, Redline S, Ervin A, et al.: Associations of sleep-disordered breathing and cerebral changes on MRI. J Clin Sleep Med 2005, 1:159–165.PubMedGoogle Scholar
  49. 49.
    Ayalon L, Ancoli-Israel S, Klemfuss Z, et al.: Increased brain activation during verbal learning in obstructive sleep apnea. NeuroImage 2006, 31:1817–1825.PubMedCrossRefGoogle Scholar
  50. 50.
    Thomas RJ, Rosen BR, Stern CE, et al.: Functional imaging of working memory in obstructive sleep-disordered breathing. J Appl Physiol 2005, 98:2226–2234.PubMedCrossRefGoogle Scholar
  51. 51.
    Jansen GF, Krins A, Basnyat B: Cerebral vasomotor reactivity at high altitude in humans. J Appl Physiol 1999, 86:681–686.PubMedGoogle Scholar
  52. 52.
    Van Dongen HP, Baynard MD, Maislin G, Dinges DF: Systematic interindividual differences in neurobehavioral impairment from sleep loss: evidence of trait-like differential vulnerability. Sleep 2004, 27:423–433.PubMedGoogle Scholar
  53. 53.
    Mu Q, Mishory A, Johnson KA, et al.: Decreased brain activation during a working memory task at rested baseline is associated with vulnerability to sleep deprivation. Sleep 2005, 28:433–446.PubMedGoogle Scholar
  54. 54.
    Alchanatis M, Zias N, Deligiorgis N, et al.: Sleep apnea-related deficits and intelligence: an implication of cognitive reserve theory. J Sleep Res 2005, 14:69–75.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2007

Authors and Affiliations

  1. 1.Department of PsychologySwansea UniversitySwanseaUK

Personalised recommendations