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Tucker A, Goldberg TE, Kim H. Biomarkers of sleep-wake disturbance as predictors of cognitive decline and accelerated disease progression. Expert Rev Mol Diagn 2024; 24:649-657. [PMID: 39129222 DOI: 10.1080/14737159.2024.2389307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024]
Abstract
INTRODUCTION In older adults, where sleep disturbances and cognitive impairment are common, mounting evidence suggests a potential connection between sleep and cognitive function, highlighting the significance of utilizing sleep as a biomarker for early detection of cognitive impairment to improve clinical outcomes in a noninvasive, cost-effective manner. AREAS COVERED This review describes the relationship between sleep and cognitive function in older adults, encompassing both subjective and objective measures of sleep quality, duration, architecture, and sleep-disordered breathing. The authors consider the directionality of the associations observed in prospective and cross-sectional studies, exploring whether sleep disturbances precede cognitive decline or vice versa. Furthermore, they discuss the potential bidirectional relationships between sleep and Alzheimer's disease (AD) risks in older adults while also examining the neurodegenerative pathways of this relationship. EXPERT OPINION Routine sleep monitoring in primary care settings has the potential to bolster early detection and treatment of sleep disturbance, and by extension, reduce the risk of dementia. Improving sleep assessment tools, such as wearables, provide scalable alternatives to traditional methods like polysomnography, potentially enabling widespread monitoring of sleep characteristics. Standardized measurement and inclusive participant recruitment are needed to enhance generalizability, while longitudinal studies are essential to understand the interaction between sleep and AD pathology.
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Affiliation(s)
- Aren Tucker
- Brain Aging and Mental Health Division, New York State Psychiatric Institute, New York, NY, USA
| | - Terry E Goldberg
- Brain Aging and Mental Health Division, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Psychology, New York, NY, USA
- Department of Anesthisiology, Columbia University Irving Medical Psychology, New York, NY, USA
| | - Hyun Kim
- Brain Aging and Mental Health Division, New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University Irving Medical Psychology, New York, NY, USA
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Macchitella L, Spaccavento S, Arigliani M, Giaquinto F, Turi M, Battista P, De Benedetto M, Leccese G, Aliani M, Angelelli P. Mind reading dysfunctions in patients with obstructive sleep apnoea: A neuropsychological approach. J Neuropsychol 2024. [PMID: 38956923 DOI: 10.1111/jnp.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 06/25/2024] [Indexed: 07/04/2024]
Abstract
Obstructive sleep apnoea syndrome (OSAS) is a prevalent sleep-related breathing disorder that has been extensively studied for its effects on cognitive functions. However, little attention has been given to investigating Mind Reading (MR) skills in patients with OSAS. In this study, we employed a neuropsychological approach to thoroughly assess various facets of MR skills in patients with OSAS. Forty-two patients with untreated moderate or severe OSAS (AHI ≥15; 30 men, 12 women) and 16 healthy controls (7 men and 9 women), matched by age, were enrolled. To assess MR skills, we used: (i) The Story-based Empathy Task (SET), which includes three experimental conditions: identifying intentions (SET-IA), emotional states (SET-EA), and a control condition for inferring causality reactions (SET-CI); (ii) the Ekman 60 Faces Test (Ek60), which measures emotion recognition from facial expressions. Our findings revealed that patients with OSAS exhibit deficits in emotion-related MR skills, while their ability to make inferences about the cognitive states of social partners remains largely preserved. This finding corroborates previous evidence indicating that social cognition, particularly MR skills, may be one of the cognitive domains affected by OSAS. It emphasizes the significance of investigating social cognition and the relationship between MR skills and social functioning as a new and intriguing area of research in patients with OSAS.
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Affiliation(s)
- Luigi Macchitella
- Unit for Severe Disabilities in Developmental Age and Young Adults (Developmental Neurology and Neurorehabilitation), Associazione "La Nostra Famiglia" - IRCCS "E. Medea", Scientific Hospital for Neurorehabilitation, Brindisi, Italy
| | | | - Michele Arigliani
- Department of ENT (Otolaryngology), "V. Fazzi" Hospital, Lecce, Italy
| | - Francesco Giaquinto
- Lab of Applied Psychology and Intervention, Department of Human and Social Studies, University of Salento, Lecce, Italy
| | - Marco Turi
- Lab of Applied Psychology and Intervention, Department of Human and Social Studies, University of Salento, Lecce, Italy
| | | | | | - Giuliana Leccese
- Lab of Applied Psychology and Intervention, Department of Human and Social Studies, University of Salento, Lecce, Italy
| | - Maria Aliani
- IRCCS Istituti Clinici Scientifici Maugeri SpA SB, Bari, Italy
| | - Paola Angelelli
- Lab of Applied Psychology and Intervention, Department of Experimental Medicine, University of Salento, Lecce, Italy
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Olaithe M, Hagen EW, Barnet JH, Eastwood PR, Bucks RS. OSA-Onset: An algorithm for predicting the age of OSA onset. Sleep Med 2023; 108:100-104. [PMID: 37348284 DOI: 10.1016/j.sleep.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/24/2023]
Abstract
STUDY OBJECTIVES There is currently no way to estimate the period of time a person has had obstructive sleep apnoea (OSA). Such information would allow identification of people who have had an extended exposure period and are therefore at greater risk of other medical disorders; and enable consideration of disease chronicity in the study of OSA pathogenesis/treatment. METHOD The 'age of OSA Onset' algorithm was developed in the Wisconsin Sleep Cohort (WSC), in participants who had ≥2 sleep studies and not using continuous positive airway pressure (n = 696). The algorithm was tested in a participant subset from the WSC (n = 154) and the Sleep Heart Health Study (SHHS; n = 705), those with an initial sleep study showing no significant OSA (apnea-hypopnea index (AHI) < 15 events/hr) and later sleep study showing moderate to severe OSA (AHI≥15 events/hr). RESULTS Regression analyses were performed to identify variables that predicted change in AHI over time (BMI, sex, and AHI; beta weights and intercept used in the algorithm). In the WSC and SHHS subsamples, the observed years with OSA was 3.6 ± 2.6 and 2.7 ± 0.6 years, the algorithm estimated years with OSA was 10.6 ± 8.2 and 9.0 ± 6.2 years. CONCLUSIONS The OSA-Onset algorithm estimated years of exposure to OSA with an accuracy of between 6.6 and 7.8 years (mean absolute error). Future studies are needed to determine whether the years of exposure derived from the OSA-Onset algorithm is related to worse prognosis, poorer cognitive outcomes, and/or poorer response to treatment.
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Affiliation(s)
- Michelle Olaithe
- School of Psychological Science, University of Western Australia, Australia.
| | - Erica W Hagen
- School of Population Health Science, University of Wisconsin School of Medicine and Public Health, Wisconsin-Madison, USA
| | - Jodi H Barnet
- School of Population Health Science, University of Wisconsin School of Medicine and Public Health, Wisconsin-Madison, USA
| | - Peter R Eastwood
- Flinders Health and Medical Research Institute, College of Medicine & Public Health, Flinders University, South Australia, Australia
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Australia
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McCloskey LC. Mentation Tracks Severity but not Oxygenation in Obstructive Sleep Apnea. Percept Mot Skills 2023; 130:1139-1151. [PMID: 37051688 DOI: 10.1177/00315125231170025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
There is a rough consensus, after decades of research, that obstructive sleep apnea (OSA) is associated with mild cognitive impairments, especially in areas of executive functioning (EF), attention/working memory (A/WM), episodic memory (EM), and speed of speed of information processing (SIP). However, there is less consensus as to whether apnea severity matters for these impairments, which sleep variables matter most to which cognitive domains, whether common OSA comorbidities contribute to these determinations, or whether the apparent associations are really artifacts of these comorbidities. In this study, 40 participants with OSA submitted to polysomnography and to neuropsychological assessment with an expanded Halstead-Reitan Test Battery. Aggregates of tests to cover the four cognitive domains mentioned above were linearly regressed on the apnea-hypopnea index (AHI), the nadir of oxygen saturation (NOS), and hypertension and diabetes mellitus (scored present or absent). The AHI predicted both EF (p = .015; sr2 = .13) and A/WM (p = .023; sr2 = 11) in the primary analyses, and EM (p = .027; sr2 = .10) in the secondary analyses. Thus, AHI may affect EF, A/WM and perhaps EM beyond NOS and beyond two of OSA's most common comorbidities. Implications of these findings are discussed here.
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Facial Emotion Recognition Deficit in Children with Moderate/Severe Obstructive Sleep Apnea. Brain Sci 2022; 12:brainsci12121688. [PMID: 36552148 PMCID: PMC9776404 DOI: 10.3390/brainsci12121688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Although previous studies have reported a facial expression classification deficit among adults with SDB, we do not know whether these findings can be generalized to children. In our study, children with sleep-disordered breathing (SDB) were divided into three groups: primary snoring (n = 51), mild obstructive sleep apnea (OSA) (n = 39), and moderate/severe OSA (n = 26). All participants, including 20 healthy controls, underwent an overnight polysomnography recording and the Emotional Expression Recognition Task. Psychosocial problems were evaluated using the parent-reported Strengths and Difficulties Questionnaire (SDQ). There was a borderline significant interaction between expression category and group on reaction times. Further analysis revealed that positive classification advantage (PCA) disappeared in the moderate/severe OSA group, whereas it persisted in the control, primary snoring, and mild OSA groups. Emotional symptoms were positively correlated with OAHI. In both the happy and sad conditions, RT was negatively related to age and body mass index (BMI) but was independent of the obstructive apnea-hypopnea index (OAHI), arterial oxygen (SaO2) and total sleep time. The accuracy of identifying a sad expression was negatively related to conduct problems. Children with moderate/severe OSA exhibited dysfunction in facial expression categorization, which could potentially affect social communication ability.
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Macchitella L, Romano DL, Marinelli CV, Toraldo DM, Arigliani M, De Benedetto M, Angelelli P. Neuropsychological and socio-cognitive deficits in patients with obstructive sleep apnea. J Clin Exp Neuropsychol 2021; 43:514-533. [PMID: 34212782 DOI: 10.1080/13803395.2021.1944609] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive deficits. We investigated the cognitive and socio-cognitive profiles of patients with severe OSA, controlling for potentially relevant mediating variables (i.e. age, body-mass index, cognitive reserve and depression). Moreover, we studied the neuropsychological profile of a high-risk OSA phenotype characterized by severe OSA and severe nocturnal hypoxemia.Method: We assessed 29 previously untreated severe OSA patients with a mean age of 55.6 (± 9.9 years) and a mean apnea-hypopnea index (AHI) of 53.1 (± 17.4). A control group of 34 healthy participants was also enrolled. Participants completed an extensive neuropsychological battery that included social cognition, a relatively new investigation area among OSA patients.Data analysis: Data were analyzed with a Bayesian approach. Specifically, Bayesian ANCOVA was used to investigate whether the grouping variable could predict test performance. Age, body-mass index, cognitive reserve and state of depression were added as covariates to the null model to weight the effects of these potential confounding factors. Three groups were analyzed: healthy controls (H), OSA with severe apnea and severe nocturnal oxygen desaturation (D+), and OSA with severe apnea non-desaturators (D-). Performances on the various neuropsychological tests were treated as the dependent variables.Results: The results indicate that non-verbal reasoning, the theory of mind skills, and mental shifting ability were impaired in OSA patients. Patients with severe nocturnal hypoxemia underperformed compared to patients with the same severity of apnea but non-desaturators. Additionally, we observed a trend toward a worse performance among OSA desaturator patients in the following abilities: constructional ability, short term verbal memory, phonological fluency, and the ability to inhibit automatic and dominant responses.Conclusion: The data suggest a key role of hypoxemia in affecting cognitive functioning in OSA patients. Executive functions and the concomitant involvement of social cognition are particularly affected.
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Affiliation(s)
- Luigi Macchitella
- Department of History, Society and Human Studies - Lab of Applied Psychology and Intervention, University of Salento, Lecce, Italy
| | - Daniele Luigi Romano
- Department of History, Society and Human Studies - Lab of Applied Psychology and Intervention, University of Salento, Lecce, Italy.,Department of Psychology and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Milan, Italy
| | - Chiara Valeria Marinelli
- Department of History, Society and Human Studies - Lab of Applied Psychology and Intervention, University of Salento, Lecce, Italy.,Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Michele Arigliani
- Department of ENT (Otolaryngology), "V. Fazzi" Hospital, Lecce, Italy
| | | | - Paola Angelelli
- Department of History, Society and Human Studies - Lab of Applied Psychology and Intervention, University of Salento, Lecce, Italy
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Shelton AR, Malow B. Neurodevelopmental Disorders Commonly Presenting with Sleep Disturbances. Neurotherapeutics 2021; 18:156-169. [PMID: 33403472 PMCID: PMC8116361 DOI: 10.1007/s13311-020-00982-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2020] [Indexed: 02/04/2023] Open
Abstract
There are multiple disorders of neurodevelopment that present with co-occurring sleep disturbances. Many of these neurodevelopmental disorders (NDD) include sleep disturbances in their diagnostic criteria. Neurobiological, genetic, and environmental factors overlap to cause different sleep disorders in individuals with NDD. Caregivers often present reporting either insomnia or hypersomnia, and based on the clinical history and findings from diagnostic tests, an appropriate diagnosis can be made. It is crucial that clinicians understand the different presentations of sleep disturbances in individuals with NDD.
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Affiliation(s)
- Althea Robinson Shelton
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave South, Medical Center North A-0118, Nashville, TN, 37232, USA.
| | - Beth Malow
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave South, Medical Center North A-0118, Nashville, TN, 37232, USA
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Olaithe M, Pushpanathan M, Hillman D, Eastwood PR, Hunter M, Skinner T, James A, Wesnes KA, Bucks RS. Cognitive profiles in obstructive sleep apnea: a cluster analysis in sleep clinic and community samples. J Clin Sleep Med 2020; 16:1493-1505. [PMID: 32400387 PMCID: PMC7970596 DOI: 10.5664/jcsm.8564] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although cognitive dysfunction is a recognized consequence of untreated obstructive sleep apnea (OSA), the deficit pattern is heterogeneous. Understanding this heterogeneity may identify those at risk of cognitive deficits and guide intervention strategies. To facilitate understanding, we examined whether distinct profiles of neuropsychological performance were present in OSA and, if so, how they are related to other OSA features. METHODS We studied sleep clinic (n = 121) and community (n = 398) samples with moderate-severe OSA (apnea-hypopnea index ≥ 15 events/h). Attention and memory were assessed using the Cognitive Drug Research system. Sleep was assessed using polysomnography in the clinic sample and dual channel (flow, oximetry) portable monitoring in the community sample. Latent profile analysis was used to determine structure of cognitive clusters. Discriminant function analysis was used to examine associations between nocturnal and diurnal features of OSA and profile membership. RESULTS Both samples were best characterized by a 3-profile solution: (1) strong thinkers (performed well across most domains and showed greater cognitive reserve); (2) inattentive fast thinkers (strong processing speed but poor ability to maintain attention); and (3) accurate slow thinkers (strengths in maintaining attention but poor processing speed). Profile membership was associated with mean overnight oxygen saturation and cognitive reserve in the clinic sample and the presence of cardiovascular disease and/or diabetes in the community sample. CONCLUSIONS These findings help explain the diversity of outcomes in previous studies of cognitive dysfunction in OSA by demonstrating that individual differences in cognitive reserve, nocturnal oxygen saturation, and comorbidities affect how cognition is impacted by OSA.
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Affiliation(s)
- Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Maria Pushpanathan
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David Hillman
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Peter R. Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, Western Australia, Australia
- School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Alan James
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Busselton Population Medical Research Institute, Busselton, Western Australia, Australia
| | - Keith A. Wesnes
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
- Department of Psychology, Northumbria University, Newcastle, United Kingdom
| | - Romola S. Bucks
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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9
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Guo J, Ma Y, Liu Z, Wang F, Hou X, Chen J, Hong Y, Xu S, Liu X. Performance of facial expression classification tasks in patients with obstructive sleep apnea. J Clin Sleep Med 2020; 16:523-530. [PMID: 32003740 DOI: 10.5664/jcsm.8256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES People show a facial recognition speed advantage, termed positive classification advantage (PCA), when judging whether a facial expression is happy compared to angry or sad. This study investigated emotional face recognition by patients with obstructive sleep apnea (OSA) with impaired neurocognition. METHODS Thirty-four patients with OSA and 26 healthy control patients who underwent 1 night of polysomnographic evaluation before recruitment were asked to complete an emotion recognition task. Accuracy rates and reaction times were recorded and analyzed using repeated-measures analysis of variance. RESULTS When participants were asked to classify positive (happy) versus negative (sad) emotional expressions, the phenomenon of PCA disappeared. Importantly, however, compared with the control patients who showed PCA, patients with OSA identified sad faces faster but were similar in processing happy faces. CONCLUSIONS In accordance with previous studies that showed depressive emotion in patients with OSA, our results indicate that patients with OSA show negative bias in facial expression recognition, which might lead to decline in ability of social communication.
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Affiliation(s)
- Junfeng Guo
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Rehabilitation, Weihai Municipal Hospital, Shandong University, Shandong, China
| | - Yingjuan Ma
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Anti-Ageing, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Anti-Aging Monitoring Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Zhenhua Liu
- Center of Sleep Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Fumin Wang
- Center of Sleep Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Xunyao Hou
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Anti-Ageing, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Anti-Aging Monitoring Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Jian Chen
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Anti-Ageing, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Anti-Aging Monitoring Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Yan Hong
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Anti-Ageing, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Anti-Aging Monitoring Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Song Xu
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Anti-Ageing, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Anti-Aging Monitoring Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
| | - Xueping Liu
- Department of Senile Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Department of Anti-Ageing, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.,Anti-Aging Monitoring Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China
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Kemstach VV, Korostovtseva LS, Golovkova-Kucheriavaia MS, Bochkarev MV, Sviryaev YV, Alekhin AN. [Obstructive sleep apnea syndrome and cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:90-95. [PMID: 32105275 DOI: 10.17116/jnevro202012001190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sleep-disordered breathing is associated with sleep fragmentation and reduced blood oxygenation due to apnea and hypopnea episodes. Multiple studies indicate that obstructive sleep apnea syndrome (OSAS) can have negative impact on cognitive functioning, primarily executive functions, attention, and episodic memory. The attention is also focused on cognition in patients with neurologic and psychiatric comorbidities. There are different explanatory models, which show the mechanisms of OSAS influence on cognition. However, it is still unclear how the initial severity of the disease and clinical outcomes interrelate, and which factors play role in the compensation of cognitive dysfunction. Better understanding of these issues is crucial for the prevention of cognitive impairment and rehabilitation of cognitive functioning.
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Affiliation(s)
- V V Kemstach
- Herzen Russian State Pedagogical University, St. Petersburg, Russia
| | | | | | - M V Bochkarev
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Yu V Sviryaev
- Almazov National Medical Research Centre, St. Petersburg, Russia; Institute of the Evolutionary Physiology and Biochemistry n.a. I.M. Sechenov, St. Petersburg, Russia
| | - A N Alekhin
- Herzen Russian State Pedagogical University, St. Petersburg, Russia
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Yerlikaya D, Emek-Savaş DD, Bircan Kurşun B, Öztura İ, Yener GG. Electrophysiological and neuropsychological outcomes of severe obstructive sleep apnea: effects of hypoxemia on cognitive performance. Cogn Neurodyn 2018; 12:471-480. [PMID: 30250626 DOI: 10.1007/s11571-018-9487-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 05/03/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a sleep disorder characterized with upper airway obstructions. Some studies showed cognitive and electrophysiological changes in patients with OSAS; however, contradictory results were also reported. The purpose of the present study was twofold: (1) to investigate cognitive changes in severe OSAS patients by using neuropsychological tests and electrophysiological methods together, (2) to investigate influence of hypoxemia levels on cognition. Fifty-four severe OSAS patients and 34 age-, gender- and education matched healthy subjects were participated. OSAS patients were further divided into two subgroups according to minimum oxygen saturation levels. All participants underwent a detailed neuropsychological test battery. A classical visual oddball task was used to elicit ERP P300 and mean P300 amplitudes were measured from Fz, Cz and Pz electrode sites. OSAS patients showed reduced mean P300 amplitudes up to 43-51% on all electrode sites compared to healthy controls. Subgroup analysis revealed significant differences in neuropsychological test scores between healthy controls and high hypoxemia OSAS group, as well as between low and high hypoxemia groups. Moreover, both low and high hypoxemia OSAS groups had lower P300 amplitudes compared with healthy controls. P300 amplitudes showed a gradual decline in parallel with increasing hypoxemia severity; however, the difference between high and low hypoxemia OSAS groups did not reach significance. Moderate correlations were found between sleep parameters, neuropsychological test scores and P300 amplitudes. These results suggest that electrophysiological measures could be better indicators of cognitive changes than neuropsychological tests in OSAS, particularly in mildly affected patients.
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Affiliation(s)
- Deniz Yerlikaya
- 1Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey
| | - Derya Durusu Emek-Savaş
- 1Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey.,2Department of Psychology, Faculty of Letters, Dokuz Eylül University, 35160 Izmir, Turkey.,3Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
| | - Behice Bircan Kurşun
- 4Department of Neurology, Dokuz Eylül University Medical School, 35340 Izmir, Turkey
| | - İbrahim Öztura
- 4Department of Neurology, Dokuz Eylül University Medical School, 35340 Izmir, Turkey
| | - Görsev G Yener
- 1Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey.,4Department of Neurology, Dokuz Eylül University Medical School, 35340 Izmir, Turkey.,5Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, 35340 Izmir, Turkey
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13
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Henneghan AM, Carter P, Stuifbergan A, Parmelee B, Kesler S. Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10 years following chemotherapy. Psychooncology 2018; 27:1937-1943. [PMID: 29683228 DOI: 10.1002/pon.4745] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6 months to 10 years post chemotherapy. METHODS Women 21 to 65 years old with a history of non-metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated. RESULTS Ninety women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs = -0.37 to -0.49, Ps < .00049), but not objective cognitive performance of verbal fluency, memory, or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance. CONCLUSIONS Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia Carter
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | | | - Brennan Parmelee
- School of Nursing, University of Texas Health Science Center Houston, Houston, TX, USA
| | - Shelli Kesler
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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14
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Bueno VF, da Silva MA, Alves TM, Louzã MR, Pompéia S. Fractionating Executive Functions of Adults With ADHD. J Atten Disord 2017; 21:944-955. [PMID: 25104788 DOI: 10.1177/1087054714545537] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the performance of adults with ADHD considering the fractionation of executive functions into six different domains. METHOD Participants were adult ADHD patients who were not under the acute effects of medication ( n = 48). Their performance was compared with that of a healthy control group ( n = 20) of comparable age, education, and nonverbal intelligence quotient. The cognitive domains assessed were executive shifting, updating, inhibition of prepotent responses, dual-task performance, planning, and access to long-term memory. We also assessed the symptoms of inattention, hyperactivity/impulsivity, anxiety, and depression by validated questionnaires. RESULTS Compared with controls, patients reported more symptoms related to ADHD, anxiety and depression symptoms and were impaired in the shifting cost measure and phonemic fluency (measure of access to long-term memory). CONCLUSION ADHD in adults selectively impaired executive shifting and access to long-term memory, domains that may alter performance in a wide range of daily tasks.
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15
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Bucks RS, Olaithe M, Rosenzweig I, Morrell MJ. Reviewing the relationship between OSA and cognition: Where do we go from here? Respirology 2017; 22:1253-1261. [PMID: 28779504 DOI: 10.1111/resp.13140] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/07/2017] [Accepted: 05/29/2017] [Indexed: 12/14/2022]
Abstract
Obstructive sleep apnoea (OSA) is a disorder of breathing during sleep resulting in temporary reduction in cerebral oxygenation and sleep disruption. A growing body of research reveals a relatively consistent pattern of deficits in cognition, particularly in attention, episodic memory, and executive function, which are partially remediated by treatment. This is where the consensus ends. Despite a number of competing explanations regarding how OSA affects cognition, reliable evidence is hard to find, which may relate to the many, common conditions co-morbid with OSA or to the methodological challenges in this field. This paper reviews the evidence for cognitive impairment in OSA, the proposed models of cognitive harm, the impact of co-morbidities and the many methodological and theoretical challenges of exploring the effect of OSA on cognition. To overcome some of these challenges, we end by proposing a number of future directions for the field, including suggesting some core design elements for future studies.
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Affiliation(s)
- Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, London, UK
| | - Mary J Morrell
- Academic Unit of Sleep and Ventilation, National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, UK
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16
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Olaithe M, Bucks RS, Hillman DR, Eastwood PR. Cognitive deficits in obstructive sleep apnea: Insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev 2017; 38:39-49. [PMID: 28760549 DOI: 10.1016/j.smrv.2017.03.005] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 11/19/2022]
Abstract
Obstructive sleep apnea (OSA) is a nocturnal breathing disorder that is associated with cognitive impairment. The primary determinants of cognitive deficits in OSA are thought to be sleep disruption and blood gas abnormalities. Cognitive impairment is also seen in other disorders that are characterised primarily by sleep disturbance (e.g., sleep restriction/deprivation, insomnia) or hypoxia/hypercarbia (e.g., chronic obstructive pulmonary disease (COPD)). Assessment of the cognitive deficits observed in these other disorders could help better define the mechanisms underlying cognitive deficits in OSA. This study utilised meta-review methodology to examine the findings from systematic reviews and meta-analyses of the effects of untreated OSA, COPD, insomnia, and sleep deprivation on cognitive function in adults, compared with norms or controls. Eighteen papers met inclusion criteria: seven in OSA, two in insomnia, five in COPD, and four in sleep deprivation. OSA and COPD were both accompanied by deficits in attention, memory, executive function, psychomotor function, and language abilities, suggesting that hypoxia/hypercarbia may be an important determinant of deficits in these domains in OSA. Both OSA and sleep deprivation studies were accompanied by deficits in attention and memory, suggesting that short-term sleep disturbance in OSA may contribute to deficits in these domains. Visuospatial deficits were unique to OSA, suggesting the contribution of a mechanism other than sleep disturbance and hypoxia/hypercarbia to this problem. Our findings suggest that the cognitive deficits associated with untreated OSA are multidimensional, with different physiological disturbances responsible for differing cognitive problems.
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Affiliation(s)
- Michelle Olaithe
- School of Psychological Science, University of Western Australia, Perth, Australia; Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Perth, Australia.
| | - Romola S Bucks
- School of Psychological Science, University of Western Australia, Perth, Australia
| | - David R Hillman
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Perth, Australia
| | - Peter R Eastwood
- Centre for Sleep Science, School of Anatomy, Physiology and Human Biology, Perth, Australia
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17
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Yılmaz Z, Voyvoda N, İnan E, Şirinocak PB, Terzi R. Factors affecting executive functions in obstructive sleep apnea syndrome and volumetric changes in the prefrontal cortex. SPRINGERPLUS 2016; 5:1934. [PMID: 27872798 PMCID: PMC5101245 DOI: 10.1186/s40064-016-3609-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE Obstructive sleep apnea syndrome (OSAS) is associated with cognitive changes and executive functions are among the cognitive domains most affected. However, it is not completely understood which of the factor(s) among hypoxemia, repeated arousal, and sleepiness affect the executive functions. This study aims to evaluate the possible relationship between the executive functions and nocturnal parameters, Epworth Sleepiness Scale (ESS) scores, and prefrontal cortex (PFC) volumes. PATIENTS AND METHODS A total of 28 patients aged between 18 and 60 years who were newly diagnosed with OSAS were included in this study. The Wisconsin Card Sorting Test (WCST) and Stroop test which were used in the evaluation of executive functions were applied to all patients. Cranial magnetic resonance imaging (MRI) and volumetric measurements of the PFC were performed. Polysomnography (PSG), WCST, Stroop test, and cranial MRI were also applied to the control group which consisted of age- and education status-matched 15 healthy subjects. The correlation of WCST and Stroop tests and PFC volume, PSG parameters, and ESS scale was examined. RESULTS The WCST-6 test scores were statistically significantly higher in the patient group (p = 0.022; p < 0.05). Additionally, the Stroop test 5 (p = 0.043) and Stroop test-5 correction (p = 0.005) measurements were statistically significantly higher in the patient group (p < 0.05). A negative and statistically significant correlation was found between the WCST-4 and WCST-10 and ESS measurements in the patient group (r -0.452; p 0.016; p < 0.05; r -0.437; p 0.020; p < 0.05). However, there was no correlation between the PSG parameters and WCST and Stroop test scores. No statistically significant differences in the MRI volumetric measurements of the PFC were found between the patient and control groups. CONCLUSIONS Impairment in the attentive and executive functions in OSAS is evident. The most influential factor is excessive daytime sleepiness, rather than hypoxemia and severity of the disease.
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Affiliation(s)
- Zahide Yılmaz
- Clinic of Neurology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Nuray Voyvoda
- Clinic of Radiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | - Eda İnan
- Clinic of Psychiatry, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
| | | | - Rabia Terzi
- Clinical of Physical Medicine and Rehabilitation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey
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18
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Davies CR, Harrington JJ. Impact of Obstructive Sleep Apnea on Neurocognitive Function and Impact of Continuous Positive Air Pressure. Sleep Med Clin 2016; 11:287-98. [PMID: 27542875 DOI: 10.1016/j.jsmc.2016.04.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There is evidence that obstructive sleep apnea (OSA) can negatively impact attention, memory, learning, executive function, and overall intellectual function in adults and children. Imaging techniques, including MRI, MR diffusion tensor imaging, MR spectroscopy, and fMRI, have provided additional insight into the anatomic and functional underpinnings of OSA-related cognitive impairment. Both animal and human studies have looked to elucidate the separate effects of oxygen desaturation and sleep fragmentation on independent aspects of cognition. Data from animal models point to neuro-inflammation and oxidative stress as driving factors of cognitive impairment.
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Affiliation(s)
- Charles R Davies
- Carle Neuroscience Institute, Carle Foundation Hospital, College of Medicine, University of Illinois at Urbana-Champaign, 602 West University Avenue, Urbana, IL 61801, USA.
| | - John J Harrington
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, 985990 Nebraska Medical Center, Omaha, NE 68159-5990, USA
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19
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Olaithe M, Eastwood PR, Bucks RS, Deacon NL, Malhotra A, Kumar VHS, Zuo L, Chuang CC, Schotland H. Commentaries on Viewpoint: Hypercapnia is more important than hypoxia in the neuro-outcomes of sleep-disordered breathing. J Appl Physiol (1985) 2016; 120:1487-8. [PMID: 27306842 DOI: 10.1152/japplphysiol.00327.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- M Olaithe
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - P R Eastwood
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - R S Bucks
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Naomi L Deacon
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Atul Malhotra
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Vasantha H S Kumar
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Li Zuo
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Chia-Chen Chuang
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
| | - Helena Schotland
- University of Western AustraliaUniversity of California, San DiegoUniversity at BuffaloThe Ohio State University College of MedicineUniversity of Michigan
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20
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Krysta K, Bratek A, Zawada K, Stepańczak R. Cognitive deficits in adults with obstructive sleep apnea compared to children and adolescents. J Neural Transm (Vienna) 2016; 124:187-201. [PMID: 26729362 PMCID: PMC5281652 DOI: 10.1007/s00702-015-1501-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/22/2015] [Indexed: 12/26/2022]
Abstract
Obstructive sleep apnea (OSA) can negatively affect the patient's physical and psychological functioning, as well as their quality of life. A major consequence of OSA is impaired cognitive functioning. Indeed, several studies have shown that OSA mainly leads to deficits in executive functions, attention, and memory. As OSA can present in all age groups, these associated cognitive deficits have been observed in adults, as well as in children and adolescents. However, these cognitive deficits may have a different clinical picture in young patients compared to adults. In this review, we analyze the most affected cognitive domains in adults and children/adolescents with OSA, as evaluated by neuropsychological and neuroimaging studies. We found that deficits in working memory, attention, or executive functions cognitive domains are found in both adults and children with OSA. However, children with OSA also show changes in behavior and phonological processing necessary for proper development. Moreover, we examine the possible OSA treatments in children and adults that can have a positive influence on cognition, and therefore, improve patients' general functioning and quality of life.
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Affiliation(s)
- Krzysztof Krysta
- Department of Psychiatry and Psychotherapy, Medical University of Silesia, ul. Ziołowa 45/47, 60-635, Katowice, Poland.
| | - Agnieszka Bratek
- Department of Psychiatry and Psychotherapy, Medical University of Silesia, ul. Ziołowa 45/47, 60-635, Katowice, Poland
| | - Karolina Zawada
- Department of Pneumonology, Medical University of Silesia, ul. Medyków 14, 40-752, Katowice, Poland
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21
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Lanini J, Galduróz JCF, Pompéia S. Acute personalized habitual caffeine doses improve attention and have selective effects when considering the fractionation of executive functions. Hum Psychopharmacol 2016; 31:29-43. [PMID: 26621326 DOI: 10.1002/hup.2511] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 08/02/2015] [Accepted: 10/19/2015] [Indexed: 01/15/2023]
Abstract
Caffeine is widely used, often consumed with food, and improves simple and complex/executive attention under fasting conditions. We investigated whether these cognitive effects are observed when personalized habitual doses of caffeine are ingested by caffeine consumers, whether they are influenced by nutriments and if various executive domains are susceptible to improvement. This was a double-blind, placebo-controlled study including 60 young, healthy, rested males randomly assigned to one of four treatments: placebo fasting, caffeine fasting, placebo meal and caffeine meal. Caffeine doses were individualized for each participant based on their self-reported caffeine consumption at the time of testing (morning). The test battery included measures of simple and sustained attention, executive domains (inhibiting, updating, shifting, dual tasking, planning and accessing long-term memory), control measures of subjective alterations, glucose and insulin levels, skin conductance, heart rate and pupil dilation. Regardless of meal intake, acute habitual doses of caffeine decreased fatigue, and improved simple and sustained attention and executive updating. This executive effect was not secondary to the habitual weekly dose consumed, changes in simple and sustained attention, mood, meal ingestion and increases in cognitive effort. We conclude that the morning caffeine "fix" has positive attentional effects and selectively improved executive updating whether or not caffeine is consumed with food.
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Affiliation(s)
- Juliana Lanini
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
| | | | - Sabine Pompéia
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Brazil
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22
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Torabi-Nami M, Mehrabi S, Borhani-Haghighi A, Derman S. Withstanding the obstructive sleep apnea syndrome at the expense of arousal instability, altered cerebral autoregulation and neurocognitive decline. J Integr Neurosci 2015; 14:169-93. [DOI: 10.1142/s0219635215500144] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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