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Sleep apnea syndrome: Symptomatology, associated features, and neurocognitive correlates

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Abstract

This article reviews the essential features, types, prevalence, pathophysiology, and neuropsychological correlates associated with the sleep apnea syndrome. Persons who experience the intermittent hypoxia and fragmented sleep characteristic of the sleep apnea syndrome tend to exhibit moderate symptoms of diffuse cognitive dysfunction as well as multiple emotional and psychosocial sequela. It is concluded that more research is required in order to elucidate the relationship between the hypoxic parameters and neurocognitive deficits seen in the sleep apnea syndrome, and that neuropsychological assessment might represent a means whereby the effectiveness of various treatments for sleep apnea may be evaluated.

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References

  • Adams, K. M., Sawyer, J. D., and Kvale, P. A. (1980). Cerebral oxygenation and neuropsychological adaptation.Journal of Clinical Neuropsychology 2: 189–208.

    Google Scholar 

  • Anch, A. M., Browman, C. P., Mitler, M. M., and Walsh, J. K. (1988).Sleep: A Scientific Perspective, Prentice-Hall, Englewood Cliffs, NJ.

    Google Scholar 

  • Ancoli-Israel, S., Kripke, D. F., and Mason, W. (1987). Characteristics of obstructive and central sleep apnea in the elderly: An interim report.Biological Psychiatry 22: 741–750.

    PubMed  Google Scholar 

  • Ariagno, R., Nagel, L., and Guilleminault, C. (1980). Waking and ventilatory responses during sleep in infants near-miss for sudden infant death syndrome.Sleep 3: 351–359.

    PubMed  Google Scholar 

  • Arkinstall, W. W., Nermel, K., Klissouras, V., and Milic-Emili, J. (1974). Genetic differences in the ventilatory response to inhaled CO2.Journal of Applied Physiology 36: 6–11.

    PubMed  Google Scholar 

  • Blass, J. P., and Gibson, G. E. (1979). Consequences of mild, graded hypoxia.Advances in Neurology 26: 229–250.

    PubMed  Google Scholar 

  • Block, A. J., Berry, D., and Webb, W. (1986). Nocturnal hypoxemia and neuropsychological deficits in men who snore.European Journal of Respiratory Diseases Supplement 146: 405–408.

    PubMed  Google Scholar 

  • Bonora, M., St. John, W. M., and Bledsoe, T. A. (1985). Differential elevation by protriptyline and depression by diazepam of upper airway respiratory motor activity.American Review of Respiratory Diseases 131: 41–51.

    Google Scholar 

  • Browman, C. P., and Mitler, M. M. (1988). Hypersomnia and the perception of sleep-wake states: Some preliminary findings.Perceptual and Motor Skills 66: 463–470.

    PubMed  Google Scholar 

  • Cartwright, R. D. (1984). Effect of sleep position on sleep apnea severity.Sleep 7: 110–114.

    PubMed  Google Scholar 

  • Cherniak, N. S. (1981). Respiratory dysrhythmias during sleep.New England Journal of Medicine 305: 325–333.

    PubMed  Google Scholar 

  • Cirignotta, F., Zucconi, M., Mondin, S., Gerardi, R., and Lugaressi, E. (1989). Cerebral anoxic attacks in sleep apnea syndrome.Sleep 12: 400–404.

    PubMed  Google Scholar 

  • Davis, J. N., Giron, L. T., Stanton, E., and Maury, W. (1979). The effect of hypoxia on brain neurotransmitter systems.Advances in Neurology 26: 219–223.

    PubMed  Google Scholar 

  • Douglas, N. J., White, D. P. Rickett, C. K., Weil, J. V., and Zwillich, C. W. (1982). Respiration during sleep in normal man.Thorax 37: 840–844.

    PubMed  Google Scholar 

  • Erkinjuntti, T., Partinen, M., Sulkava, R., Telakivi, T., Salmi, T., and Tilvis, R. (1987). Sleep apnea in multi-infarct dementia and Alzheimer's disease.Sleep 10: 419–425.

    PubMed  Google Scholar 

  • Findley, L. J., Unverzagt, M. E., and Suratt, P. M. (1988). Automobile accidents involving patients with obstructive sleep apnea.American Review of Respiratory Diseases 138: 337–340.

    Google Scholar 

  • Findley, L. J., Barth, J. T., Powers, D. C., Wilhort, S. C., Boyd, D. G., and Suratt, P. M. (1986). Cognitive impairment in patients with obstructive sleep apnea and associated hypoxemia.Chest 90: 686–690.

    PubMed  Google Scholar 

  • Fleming, J. A. E., Fleetham, J. A., Taylor, D. R., and Remick, R. A. (1985). A case report of obstructive sleep apnea in a patient with bipolar affective disorder.Canadian Journal of Psychiatry 30: 437–439.

    Google Scholar 

  • Fox, A. W., Monoson, P. K., and Morgan, C. D. (1989). Speech dysfunction of obstructive sleep apnea: A discriminant analysis of its descriptors.Chest 96: 589–595.

    PubMed  Google Scholar 

  • Gadoth, N., Bechar, M., Seggev, J., Kushnir, M., and Gilai, A. (1988). Abnormal obicularis oculi reflex response in sleep apnea secondary to acromegaly. Evidence of pontomedullary dysfunction in sleep apnea syndrome.Israeli Journal of Medical Science 24: 96–100.

    Google Scholar 

  • Gibson, G. E., and Duffy, T. E. (1981). Impaired synthesis of acetylcholine by mild hypoxic hypoxia or nitrous oxide.Journal of Neurochemistry 36: 28.

    PubMed  Google Scholar 

  • Gould, G. A., Whyte, K. F., Rhind, G. B., Airlie, M. A., Catteral, J. R., Shapiro, C. M., and Douglas, N. J. (1988). The sleep hypopnea syndrome.American Review of Respiratory Diseases 137: 895–898.

    Google Scholar 

  • Grant, I., Prigatano, G. P. Heaton, R. K., McSweeney, A. J., Wright, E. C., and Adams, K. M. (1987). Progressive neuropsychologic impairment and hypoxemia: Relationship in chronic pulmonary obstructive disease.Archives of General Psychiatry 44: 999–1006.

    PubMed  Google Scholar 

  • Greenberg, G. D., Watson, R. K., and Deptula, D. (1987). Neuropsychological dysfunction in sleep apnea.Sleep 10: 254–262.

    PubMed  Google Scholar 

  • Guilleminault, C. (1987). Obstructive sleep apnea: A review.Psychiatric Clinics of North America 10: 607–621.

    PubMed  Google Scholar 

  • Guilleminault, C., and Dement, W. C. (Eds.) (1977).Sleep Apnea Syndromes. Vol. 11, Liss, New York.

    Google Scholar 

  • Guilleminault, C., Tilkian, A., and Dement, W. C. (1976). The sleep apnea syndromes.Annual Review of Medicine 27: 465–484.

    PubMed  Google Scholar 

  • Guilleminault, C., Peraita, R., Souquet, M., and Dement, W. C. (1975). Apnea during sleep in infants: Possible relationship with sudden infant death syndrome.Science 190: 677–679.

    PubMed  Google Scholar 

  • Hess, C. W. (1989). Nichtepileptische Dammerzustande bei neuerologischen Krankheiten [Non-epileptic impaired consciousness in neurologic diseases].Schweizerische Rundschau fur Medizin Praxis 78: 808–811.

    PubMed  Google Scholar 

  • Hirshkowitz, M., Karacan, I., Gurakar, A., and Williams, R. L. (1989). Hypertension, erectile dysfunction, and occult sleep apnea.Sleep 12: 223–232.

    PubMed  Google Scholar 

  • Hoch, C. C., Reynolds, C. F., Kupfer, D. J., Houck, P. R., Berman, S. R., and Stack, J. A. (1986). Sleep-disordered breathing in normal and pathologic aging.Journal of Clinical Psychiatry 47: 499–503.

    PubMed  Google Scholar 

  • Hornbein, T. F., Townes, B. D., Schoene, R. B., Sutton, J. R., and Houston, C. S. (1989). The cost to the central nervous system of climbing to extremely high altitude.New England Journal of Medicine 321: 1714–1719.

    PubMed  Google Scholar 

  • Hudgel, D. W. (1989). Neuropsychiatric manifestations of obstructive sleep apnea: A review.International Journal of Psychiatry in Medicine 19: 11–22.

    PubMed  Google Scholar 

  • Kales, A., Caldwell, A. B., Cadieux, R. J., Vela-Bueno, A., Ruch, L. G., and Mayes, S. D. (1985a). Severe obstructive sleep apnea-I: Onset, clinical course, and characteristics.Journal of Chronic Diseases 38: 419–425.

    PubMed  Google Scholar 

  • Kales, A., Caldwell, A. B., Cadieux, R. J., Vela-Bueno, A., Ruch, L. G., and Mayes, S. D. (1985b). Severe obstructive sleep apnea—II: Associated psychopathology and psychosocial consequences.Journal of Chronic Diseases 38: 427–434.

    PubMed  Google Scholar 

  • Klonoff, H., Fleetham, J., Taylor, D. R., and Clark, C. (1987). Treatment outcome of obstructive sleep apnea: Psychological and neuropsychological concomitants.Journal of Nervous and Mental Diseases 175: 208–212.

    Google Scholar 

  • Knight, H., Millman, R. P., Gur, R. C., Saykin, A. J., Doherty, J. U., and Pack, A. I. (1987). Clinical significance of sleep apnea in the elderly.American Review of Respiratory Diseases 136: 845–850.

    Google Scholar 

  • Korobkin, R., and Guilleminault, C. (1979). Neurologic abnormalities in near miss for Sudden Infant Death Syndrome infants.Pediatrics 64: 369–378.

    PubMed  Google Scholar 

  • Lavie, P. (1983). Incidence of sleep apnea in a presumably healthy working population: a significant relationship with excessive daytime sleepiness.Sleep 6: 312–318.

    PubMed  Google Scholar 

  • Lezak, M. (1983).Neuropsychological Assessment (2nd ed.), Oxford University Press, New York.

    Google Scholar 

  • Manon-Espaillat, R., Gothe, B., Adams, N., Newman, C., and Ruff, R. (1988). Familial “sleep apnea plus” syndrome: Report of a family.Neurology 38: 190–193.

    PubMed  Google Scholar 

  • Martin, P. R., and Lefebvre, A. M. (1981). Surgical treatment of sleep-apnea-associated psychosis.Canadian Medical Association Journal 124, 978–980.

    PubMed  Google Scholar 

  • McCarty, G. E., and Holmes, M. D. (1985). Excessive daytime somnolence: A series of 100 patients.Military Medicine 150: 138–140.

    PubMed  Google Scholar 

  • McGinty, D. (1987). Sleep disorders in the elderly: Rationale for clinical awareness.Geriatrics 42: 61–62, 65–69, 72.

    Google Scholar 

  • McGinty, D. J., and Sterman, M. B. (1980). Sleep physiology, hypoxemia, and the sudden infant death syndrome.Sleep 3: 361–373.

    PubMed  Google Scholar 

  • McSweeney, A. J., Grant, I., Heaton, R. K., Prignatano, G. P., and Adams, K. M. (1985). Relationship of neuropsychological status to everyday functioning in healthy and chronically ill persons.Journal of Clinical and Experimental Neuropsychology 7: 281–291.

    PubMed  Google Scholar 

  • Meyer, J. S., Ishakawa, Y., Hata, T., and Karacan, I. (1987). Cerebral blood flow in normal and abnormal sleep and dreaming.Brain Cognition 6: 266–294.

    Google Scholar 

  • Mosko, S., Zetin, M., Glen, S., Garber, D., DeAntonio, M., Sassin, J., McAnich, J., and Warren, S. (1989). Self-reported depressive symptomatology, mood ratings, and treatment outcome in sleep disorders patients.Journal of Clinical Psychology 45: 51–60.

    PubMed  Google Scholar 

  • Reynolds, C. F., Kupfer, D. J., and McEachran, A. B. (1984). Depressive psychopathology in male sleep apneics.Journal of Clinical Psychology 45: 287–290.

    Google Scholar 

  • Shepard, J. W. (1987). Cardiopulmonary disorders during sleep: Diagnosis and management.Geriatrics 42: 51–57.

    Google Scholar 

  • Shimada, M. (1981). Alteration of acetylcholine in mouse cortex in mild hypoxia.Journal of Neural Transmission 50: 233.

    PubMed  Google Scholar 

  • Sleep Disorders Classification Committee, Association of Sleep Disorder Centers (1979). Diagnostic classification of sleep and arousal disorders.Sleep 2: 5–137.

    Google Scholar 

  • Smallwood, R. G., Vitiello, M. V., Giblin, E. C., and Prinz, P. N. (1983). Sleep apnea: Relationship to age, sex, and Alzheimer's dementia.Sleep 6: 16–22.

    PubMed  Google Scholar 

  • Smith, J. S., and Brandon, S. (1970). Acute carbon monoxide poisoning—Three years experience in a defined population.Postgraduate Medicine 46: 65–70.

    Google Scholar 

  • Smith, P. L., Gold, A. R., Meyers, D. A., Haponik, E. F., and Blecker, E. R. (1985). Weight loss in mildly to moderately obese patients with obstructive sleep apnea.Annals of Internal Medicine 103: 850–855.

    PubMed  Google Scholar 

  • Stradling, J. R. (1986). Controversies in sleep-related breathing disorders.Lung 164: 17–31.

    PubMed  Google Scholar 

  • Strake, K. P., Saunders, N. A., Feldman, J. T., & Hallett, M. (1978). Obstructive sleep apnea in family members.New England Journal of Medicine 299: 969–973.

    PubMed  Google Scholar 

  • Strub, R. L., and Black, F. W. (1988)Neurobehavioral Disorders: A Clinical Approach, F. A. Davis, Philadelphia, PA.

    Google Scholar 

  • Telakivi, T., Kajaste, S., Partinen, M., Koskenvuo Salmi, T., and Kaprio, J. (1988). Cognitive function in middle-aged snorers and controls: Role of excessive daytime somnolence and sleep-related hypoxic events.Sleep 11: 454–462.

    PubMed  Google Scholar 

  • Townes, B. D., Hornbein, T. F., Schoene, R. B., Sarquist, F. H., and Grant, I. (1984). Human cerebral function at extreme altitude. In West, J. B., and Lahiri, S. (eds.),High Altitude and Man. American Physiological Society, pp. 31–36.

  • Veil, C. L., Bartoli, D., and Baurne, S. (1970). Bilan psychologique, socio-professional, psycho-pathologiquea a un an de distance de l'intoxication oxycarbone aigue.Annales Medico-Psychologique 128 (pt. 2): 343–398.

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, RP-10, School of Medicine, University of Washington Medical Center, 98195, Seattle, Washington

    Dennis A. Kelly, Keith H. Claypoole & David B. Coppel

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  1. Dennis A. Kelly
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Kelly, D.A., Claypoole, K.H. & Coppel, D.B. Sleep apnea syndrome: Symptomatology, associated features, and neurocognitive correlates. Neuropsychol Rev 1, 323–342 (1990). https://doi.org/10.1007/BF01109028

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