Quan SF, Budhiraja R, Kushida CA. Associations Between Sleep Quality, Sleep Architecture and Sleep Disordered Breathing and Memory After Continuous Positive Airway Pressure in Patients with Obstructive Sleep Apnea in the Apnea Positive Pressure Long-term Efficacy Study (APPLES).
ACTA ACUST UNITED AC 2018;
11:231-238. [PMID:
30746040 PMCID:
PMC6361302 DOI:
10.5935/1984-0063.20180037]
[Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective
The role of sleep architecture in consolidation of memory has not been
extensively investigated. In this study, the association of continuous
positive airway pressure (CPAP) and sleep architecture and quality, and
sleep disordered breathing on changes in memory are explored during the
course of a 6 month clinical trial of CPAP or sham CPAP (APPLES).
Methods
848 participants had polysomnographic and memory assessments (Buschke
Selective Reminding Test [Buschke] and Digit Symbol Substitution Test
[DSST]) at baseline, CPAP/Sham CPAP titration, and the 2 and 6 month time
points. Half were assigned to the CPAP and Sham CPAP groups respectively.
Changes in performance on the Buschke and the DSST were analyzed over the
course of the study between CPAP and Sham CPAP as well as in relationship to
changes in sleep architecture, sleep quality and sleep disordered breathing
(SDB).
Results
Sleep architecture, sleep quality and SDB improved in the CPAP group at 6
months; performance on the Buschke and DSST improved equally in both CPAP
and Sham CPAP groups. There also were no significant correlations between
changes in the amount or percentage of sleep stages between baseline and the
6 months, and corresponding changes in either the Buschke or the DSST.
However, when stratified by the upper quartile and lower 3 quartiles,
greater changes in the Buschke occurred over 6 months in the top quartile of
total sleep time (5.7±7.3 vs. 4.0±6.8,
p≤0.01) and amount of N3 sleep (55.9±7.7 vs.
53.6±8.9 min, p≤0.01). Those with more %N3 at
6 months scored better on the Buschke as well (55.9±7.8 vs.
53.6±8.9, p≤0.01). Borderline improvement in
the DSST over 6 months was observed in the top quartiles of amount of N3 and
%N3. Those in the top quartile of the amount of REM and %REM also showed
greater improvement in the Buschke after 6 months. No differences were
observed for the AHI, but those in the top quartile of oxygen desaturation
had worse scores on the Buschke at 6 months. CPAP/Sham CPAP adherence did
not impact 6 month Buschke or DSST performance.
Conclusions
CPAP improved long-term sleep duration, quality and architecture, but did not
memory. However, large changes in REM and N3 sleep as well as moderate
amounts of nocturnal hypoxemia are associated with changes in assessments of
memory.
Collapse