Executive Dysfunction and Learning Effect after Continuous Positive Airway Pressure Treatment in Patients with Obstructive Sleep Apnea SyndromeSaunamäki T.a, c · Himanen S.-L.d, f · Polo O.b, e · Jehkonen M.a, c
Departments of aNeurology and Rehabilitation and bPulmonary Medicine, Tampere University Hospital, Departments of cPsychology, dPhysiology, and eRespiratory Diseases, University of Tampere, and fDepartment of Clinical Neurophysiology, Medical Imaging Centre, Pirkanmaa Hospital District, Tampere, Finland
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Aims: To assess the impact of continuous positive airway pressure (CPAP) treatment on executive dysfunction in patients with obstructive sleep apnea syndrome (OSAS). Methods: At baseline, 20 OSAS patients and 17 healthy controls underwent polysomnography and neuropsychological assessment focusing on executive functions. After at least 6 months of CPAP treatment, the patients returned for one more full-night polysomnography and neuropsychological control assessment, while the controls underwent a neuropsychological control assessment. Results: All patients and controls were working-age males. OSAS severity ranged from mild to severe. Before CPAP, patients showed poorer performance than controls in the copy of the Rey-Osterrieth Complex Figure Test, the Block Design, the Digit Symbol, the Trails B and the Intra-Extra Dimensional Set-Shifting task. Patients’ executive performance showed no improvement after CPAP, and it remained poorer than the performance of controls. In addition, patients showed no learning effect in the executive tests, whereas the controls did. Conclusion: Even long-term CPAP treatment does not seem to improve OSAS patients’ mental set-shifting performance or their visuospatial organizational skills. In addition, OSAS patients have impaired learning effect in executive tests.
© 2010 S. Karger AG, Basel
- Beebe DW, Groesz L, Wells C, Nichols A, McGee K: The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data. Sleep 2003;26:298–307.
- Aloia MS, Arnedt JT, Davis JD, Riggs RL, Byrd D: Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review. J Int Neuropsychol Soc 2004;10:772–785.
- Beebe DW, Gozal D: Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioural deficits. J Sleep Res 2002;11:1–16.
Lezak MD, Howieson DB, Loring DW: Neuropsychological Assessment. New York, Oxford University Press, 2004.
- Bédard MA, Montplaisir J, Malo J, Richer F, Rouleau I: Persistent neuropsychological deficits and vigilance impairment in sleep apnea syndrome after treatment with continuous positive airways pressure (CPAP). J Clin Exp Neuropsychol 1993;15:330–341.
- Feuerstein C, Naegelé B, Pépin JL, Lévy P: Frontal lobe-related cognitive functions in patients with sleep apnea syndrome before and after treatment. Acta Neurol Belg 1997;97:96–107.
- Naegelé B, Pépin JL, Lévy P, Bonnet C, Pellat J, Feuerstein C: Cognitive executive dysfunction in patients with obstructive sleep apnea syndrome (OSAS) after CPAP treatment. Sleep 1998;21:392–396.
- Saunamäki T, Himanen SL, Polo O, Jehkonen M: Executive dysfunction in patients with obstructive sleep apnea syndrome. Eur Neurol 2009;62:237–242.
- Ferini-Strambi L, Baietto C, Di Gioia MR, Castaldi P, Castronovo C, Zucconi M, Cappa SF: Cognitive dysfunction in patients with obstructive sleep apnea (OSA): partial reversibility after continuous positive airway pressure (CPAP). Brain Res Bull 2003;61:87–92.
- Felver-Gant JC, Bruce AS, Zimmerman M, Sweet LH, Millman RP, Aloia MS: Working memory in obstructive sleep apnea: construct validity and treatment effects. J Clin Sleep Med 2007;3:589–594.
- Lis S, Krieger S, Hennig D, Röder C, Kirsch P, Seeger W, Gallhofer B, Schulz R: Executive functions and cognitive subprocesses in patients with obstructive sleep apnoea. J Sleep Res 2008;17:271–280.
- Sánchez AI, Martínez P, Miró E, Bardwell WA, Bueal-Casal G: CPAP and behavioural therapies in patients with obstructive sleep apnea: effects on daytime sleepiness, mood, and cognitive function. Sleep Med Rev 2009;13:223–233.
- Engleman HM, Martin SE, Kingshott RN, Mackay TW, Deary IJ, Douglas NJ: 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.
- Bardwell WA, Ancoli-Israel S, Berry CC, Dimsdale JE: Neuropsychological effects of one-week continuous positive airway pressure treatment in patients with obstructive sleep apnea: a placebo-controlled study. Psychosom Med 2001;63:579–584.
- Henke KG, Grady JJ, Kuna ST: Effect of nasal continuous positive airway pressure on neuropsychological function in sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001;163:911–917.
- Lim W, Bardwell WA, Loredo JS, Kim EJ, Ancoli-Israel S, Morgan EE, Heaton RK, Dimsdale JE: Neuropsychological effects of 2-week continuous positive airway pressure treatment and supplemental oxygen in patients with obstructive sleep apnea: an randomized placebo-controlled study. J Clin Sleep Med 2007;3:380–386.
- 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.
- Engleman HM, Martin SE, Deary IJ, Douglas NJ: Effect of CPAP therapy on daytime function in patients with mild sleep apnoea/hypopnoea syndrome. Thorax 1997;52:114–119.
- Barnes M, Houston D, Worsnop CJ, Neill AM, Mykytyn IJ, Kay A, Trinder J, Saunders NA, McEvoy RD, Pierce RJ: A randomized controlled trial of continuous positive airway pressure in mild obstructive sleep apnea. Am J Respir Crit Care Med 2002;165:773–780.
- McMahon JP, Foresman BH, Chisholm RC: The influence of CPAP on the neurobehavioral performance of patients with obstructive sleep apnea hypopnea syndrome: a systematic review. WMJ 2003;102:36–43.
American Academy of Sleep Medicine: International Classification of Sleep Disorders. Diagnostic and Coding Manual, ed 2. Westchester, 2005.
- Johns MW: A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 1991;14:540–545.
Rechtschaffen A, Kales A (eds): A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Washington, US Public Health Service, US Government Printing Office, 1968.
Iber C, Ancoli-Israel S, Chesson A, Quan SF, for the American Academy of Sleep Medicine: The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications, ed 1. Westchester, American Academy of Sleep Medicine, 2007.
- American Sleep Disorders Association: EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 1992;15:173–184.
Ward LC, Ryan JJ: Validity and time saving in the selection of short forms of the Wechsler Adult Intelligence Scale-Revised.Psychol Assess 1996;8:69–72.
Wechsler D: The Wechsler Adult Intelligence Scale-Revised. New York, Psychological Corporation, 1981.
Osterrieth PA: Le test de copie d’une figure complexe. Arch Psychol 1944;30:206–356.
Armitage SG: An analysis of certain psychological tests used for the evaluation of brain injury. Psychol Monogr 1946;60:91–96.
Heaton RK, Cheleme G, Talley J, Kay G, Curtiss G: Wisconsin Card Sorting Test Manual. Odessa, Psychological Assessment Resources, 1993.
- Lojander J, Kajaste S, Maasilta P, Partinen M: Cognitive function and treatment of obstructive sleep apnea syndrome. J Sleep Res 1999;8:71–76.
Burgess PW: Assessment of executive function; in Halligan PW, Kischka U, Marshall JC (eds): Handbook of Clinical Neuropsychology. Oxford, Oxford University Press, 2003, pp 302–321.
- Salorio CF, White DA, Piccirillo J, Duntley SP, Uhles ML: Learning, memory, and executive control in individuals with obstructive sleep apnea syndrome. J Clin Exp Neuropsychol 2002;24:93–100.
- Walker MP: The role of sleep in cognition and emotion. Ann NY Acad Sci 2009;1156:168–197.
- Verstraeten E: Neurocognitive effects of obstructive sleep apnea syndrome. Curr Neurol Neurosci Rep 2007;7:161–166.
- Caples SM, Carcia-Touchard A, Somers VK: Sleep-disordered breathing and cardiovascular risk. Sleep 2007;30:291–303.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.