Examining the Relationship Between CPAP Adherence and Attention/executive functioning Among OSA-Diagnosed Older Adults

Abstract

<h3>Introduction</h3> BACKGROUND: Obstructive sleep apnea (OSA) is a treatable respiratory condition that becomes more prevalent with age. The extant literature suggests OSA is associated with domain-general cognitive dysfunction, though attention/executive skills may be disproportionately affected (Stranks & Crowe, 2016). Meta-analytic data further suggest that treatment with continuous positive airway pressure (CPAP) can result in small to medium improvements in executive function (Olaithe & Bucks, 2013). However, the relationship between CPAP adherence and executive dysfunction <i>in older adults</i> is less clear – an important target of investigation given mounting evidence demonstrating a link between OSA and age-related cognitive decline, including Alzheimer's disease (Mullins et al., 2020). Accordingly, the current study examined the relationship between self-reported CPAP adherence and attention/executive function, namely basic attention span and executive control, in a mixed clinical sample of older adults with OSA. <h3>Methods</h3> METHODS: Data were obtained from the McLean Hospital Neuropsychology Data Repository, which is a comprehensive, archival dataset comprised of patients who completed a neuropsychological evaluation as part of routine clinical care. The current study examined a transdiagnostic subset of older adults aged 50+ years with OSA. Data were analyzed using univariate general linear models, with self-reported CPAP adherence (i.e., no CPAP vs full/partial adherence) as a fixed factor, performance on each condition of the WAIS-IV Digit Span task as outcome variables, and age as a covariate. <h3>Results</h3> RESULTS: Of the sample used (N=52), 52% were either fully or partially CPAP compliant (n=27), whereas 48% were entirely non-compliant (n=25). Significant performance differences (p<.05) were observed on the digit span backwards task (p=.025), with the full/partial CPAP adherence group (M=53.07, SD=10.183) performing better than the no CPAP (M=47.44, SD=6.764) group. <h3>Conclusions</h3> DISCUSSION: These results suggest that at least some degree of CPAP treatment adherence amongst OSA-diagnosed older adults may improve working memory cognitive processes, compared to non-compliancy. <h3>Limitations</h3> Further research should consider methods for accurately quantifying OSA severity and CPAP treatment (i.e., partial versus full compliancy), distinguishing OSA diagnosis/treatment between different age demographics (i.e., middle adults versus older adults), determining possible relationships between time of diagnosis and initiating treatment/non-treatment, and controlling for co-occurring variables that impact sleep and cognitive functioning (i.e., medication side effects, comorbid vascular and respiratory conditions, psychiatric comorbidities). Future studies should also consider examining larger, age-specific OSA populations, with a more extensive examination of neurocognitive functioning across domains that have been suggested to be strongly influenced by working memory processes (e.g., attention, learning/memory, executive functioning). <h3>Funding</h3> N/A