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Hypoxemia correlates with attentional dysfunction in patients with obstructive sleep apnea

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Abstract

Purpose

Obstructive sleep apnea is associated with cognitive impairment, but whether hypoxemia or repeated arousals and sleepiness are the underlying mechanism is controversial. Studies using a wide range of attention and executive functions tests in patients with severe sleep apnea are lacking.

Methods

In a prospective cohort study, 40 patients aged 30–70 years, diagnosed with obstructive sleep apnea (apnea-hypopnea index ≥5) were recruited. Patients with known cardiovascular, pulmonary, psychiatric, or neurological disease, and or patients receiving anti-psychotic, sedatives, or stimulant medications were excluded. Patients underwent full overnight polysomnography including continuous oxygen saturation measurements followed by extensive neuropsychological testings in attention and executive function domains. The correlation between sleep apnea severity and patients’ performance on the neuropsychological tests was examined.

Results

The patients’ performance on measures of attention and executive function was significantly worse compared to the average in a normal population. Attention, as reflected by the number of omissions and by the reaction time on the Conners’ Continuous Performance Test correlated significantly with the apnea-hypopnea index (r = 0.6, p < 0.001 and r = 0.48, p = 0.003, respectively) and with parameters of hypoxemia, namely the average SpO2 (r = −0.51, p = 0.002 and r = −0.39, p = 0.02, respectively) and the percent time spent with SpO2 < 90% (r = 0.57, p < 0.001 and r = 0.39, p = 0.02, respectively), but not with the degree of sleepiness. Executive dysfunction did not correlate with sleep parameters.

Discussion

Attention is the predominant cognitive function affected in patients with obstructive sleep apnea and correlates primarily with nocturnal hypoxemia rather than daytime sleepiness or sleep fragmentation. Executive functions, while below average in some patients, do not correlate with polysomnographic parameters.

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Conflict of interest

The authors declare they have no conflicts of interest.

Author information

Authors and Affiliations

  1. The Institute of Pulmonary Medicine, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel, 70300

    Isaac Shpirer

  2. The Department of Pediatrics, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel, 70300

    Arnon Elizur

  3. The Sleep Laboratory, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel, 70300

    Isaac Shpirer & Arnon Elizur

  4. Memory and Attention Unit, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel, 70300

    Ran Shorer, Ruth Bernstein Peretz, Jose M. Rabey & Michael Khaigrekht

  5. Department of Neurology, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel, 70300

    Ran Shorer, Ruth Bernstein Peretz, Jose M. Rabey & Michael Khaigrekht

Authors
  1. Isaac Shpirer
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  2. Arnon Elizur
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  3. Ran Shorer
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  4. Ruth Bernstein Peretz
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  5. Jose M. Rabey
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  6. Michael Khaigrekht
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Corresponding author

Correspondence to Arnon Elizur.

Additional information

Isaac Shpirer and Arnon Elizur contributed equally to this study.

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Shpirer, I., Elizur, A., Shorer, R. et al. Hypoxemia correlates with attentional dysfunction in patients with obstructive sleep apnea. Sleep Breath 16, 821–827 (2012). https://doi.org/10.1007/s11325-011-0582-1

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  • DOI: https://doi.org/10.1007/s11325-011-0582-1

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