Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art.

Isabella Pollicina,Vittoria Bannò,Angelo Cannavicci,Annalisa Pace,Giovanni Cammaroto,Paolo Murabito,Paola Di Mauro,Giuseppe Magliulo,Maria Rita Bianco,Giovanna Stilo,Claudio Vicini,Milena Di Luca,Ignazio La Mantia,Antonino Maniaci,Salvatore Cocuzza,Jerome R Lechien,Giannicola Iannella

doi:10.3390/bs11120180

Abstract

Background: Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete episodes of upper airway collapse with reduction or complete cessation of airflow. Although the connection remains debated, several mechanisms such as intermittent hypoxemia, sleep deprivation, hypercapnia disruption of the hypothalamic–pituitary–adrenal axis have been associated with poor neurocognitive performance. Different treatments have been proposed to treat OSAS patients as continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), surgery; however, the effect on neurocognitive functions is still debated. This article presents the effect of OSAS treatments on neurocognitive performance by reviewing the literature. Methods: We performed a comprehensive review of the English language over the past 20 years using the following keywords: neurocognitive performance and sleep apnea, neurocognitive improvement and CPAP, OSAS, and cognitive dysfunction. We included in the analysis papers that correlated OSA treatment with neurocognitive performance improvement. All validated tests used to measure different neurocognitive performance improvements were considered. Results: Seventy papers reported neurocognitive Performance improvement in OSA patients after CPAP therapy. Eighty percent of studies found improved executive functions such as verbal fluency or working memory, with partial neural recovery at long-term follow-up. One article compared the effect of MAD, CPAP treatment on cognitive disorders, reporting better improvement of CPAP and MAD than placebo in cognitive function. Conclusions: CPAP treatment seems to improve cognitive defects associated with OSA. Limited studies have evaluated the effects of the other therapies on cognitive function.

Highlights

Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterizedObstructive by partial orSleep complete episodesisofa upper airway collapse during the night.Apnearecurrent (OSA) syndrome respiratory sleep disorder characterizedOSA is a or frequent andrecurrent often underestimated pathology 2%night. and 5%of by partial complete episodes of upper airwayaffecting collapse between during the middle-aged populationOSAS with excessive daytime sleepiness occurred in of men and4%withof women [1,2,3]
Gozal et al asserted that intermittent hypoxia and sleep fragmentation is seen in OSA to lead to alterations in brain structure and function, which provides a link between sleep-disordered breathing and impairment neurocognitive domains [38]
Obstructive sleep apnea syndrome is strongly associated with cerebrovascular disorders, chronic neurodegenerative and inflammatory diseases, leading to a high risk of cognitive impairment in affected patients

Summary

Introduction

Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterizedObstructive by partial orSleep complete episodesisofa upper airway collapse during the night.Apnearecurrent (OSA) syndrome respiratory sleep disorder characterizedOSA is a or frequent andrecurrent often underestimated pathology 2%night. and 5%of by partial complete episodes of upper airwayaffecting collapse between during the middle-aged populationOSAS with excessive daytime sleepiness occurred in (range, is a frequent and often underestimated pathology affecting between 2% and 5% of middle3–18%) of men and4%with (range, 1–17%)of women [1,2,3]. Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterizedObstructive by partial orSleep complete episodesisofa upper airway collapse during the night. Apnearecurrent (OSA) syndrome respiratory sleep disorder characterized. OSAS with excessive daytime sleepiness occurred in (range, is a frequent and often underestimated pathology affecting between 2% and 5% of middle3–18%) of men and. Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete episodes of upper airway collapse with reduction or complete cessation of airflow. Different treatments have been proposed to treat OSAS patients as continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), surgery; the effect on neurocognitive functions is still debated. This article presents the effect of OSAS treatments on neurocognitive performance by reviewing the literature. We included in the analysis papers that correlated OSA treatment with neurocognitive performance improvement. All validated tests used to measure different neurocognitive performance improvements were considered

Methods

Results

Discussion

Conclusion