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Puech C, Badran M, Runion AR, Barrow MB, Cataldo K, Gozal D. Cognitive Impairments, Neuroinflammation and Blood-Brain Barrier Permeability in Mice Exposed to Chronic Sleep Fragmentation during the Daylight Period. Int J Mol Sci 2023; 24:9880. [PMID: 37373028 DOI: 10.3390/ijms24129880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic condition characterized by intermittent hypoxia (IH) and sleep fragmentation (SF). In murine models, chronic SF can impair endothelial function and induce cognitive declines. These deficits are likely mediated, at least in part, by alterations in Blood-brain barrier (BBB) integrity. Male C57Bl/6J mice were randomly assigned to SF or sleep control (SC) conditions for 4 or 9 weeks and in a subset 2 or 6 weeks of normal sleep recovery. The presence of inflammation and microglia activation were evaluated. Explicit memory function was assessed with the novel object recognition (NOR) test, while BBB permeability was determined by systemic dextran-4kDA-FITC injection and Claudin 5 expression. SF exposures resulted in decreased NOR performance and in increased inflammatory markers and microglial activation, as well as enhanced BBB permeability. Explicit memory and BBB permeability were significantly associated. BBB permeability remained elevated after 2 weeks of sleep recovery (p < 0.01) and returned to baseline values only after 6 weeks. Chronic SF exposures mimicking the fragmentation of sleep that characterizes patients with OSA elicits evidence of inflammation in brain regions and explicit memory impairments in mice. Similarly, SF is also associated with increased BBB permeability, the magnitude of which is closely associated with cognitive functional losses. Despite the normalization of sleep patterns, BBB functional recovery is a protracted process that merits further investigation.
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Affiliation(s)
- Clementine Puech
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, 400 N Keene St., Suite 010, Columbia, MO 65201, USA
| | - Mohammad Badran
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, 400 N Keene St., Suite 010, Columbia, MO 65201, USA
| | - Alexandra R Runion
- Undergraduate Student Research Program, University of Missouri, Columbia, MO 65201, USA
| | - Max B Barrow
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, 400 N Keene St., Suite 010, Columbia, MO 65201, USA
| | - Kylie Cataldo
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, 400 N Keene St., Suite 010, Columbia, MO 65201, USA
| | - David Gozal
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, 400 N Keene St., Suite 010, Columbia, MO 65201, USA
- Department of Medical Pharmacology and Physiology, School of Medicine, University of Missouri, Columbia, MO 65201, USA
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2
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Wu HM, Wang ZJ, Cheng CH, Su T, Wang J, Li YZ, Wang QJ, Han F, Chen R. Daytime Hypercapnia Impairs Working Memory in Young and Middle-Aged Patients with Obstructive Sleep Apnea Hypopnea Syndrome. Nat Sci Sleep 2023; 15:363-373. [PMID: 37220426 PMCID: PMC10200120 DOI: 10.2147/nss.s398440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose Obstructive sleep apnea hypopnea syndrome (OSAHS) can lead to cognitive impairment, though few studies have so far examined hypercapnia as its causal mechanism, due to the invasive nature of conventional arterial CO2 measurement. The study aims to investigate the effects of daytime hypercapnia on working memory in young and middle-aged patients with OSAHS. Patients and Methods This prospective study screened 218 patients and eventually recruited 131 patients (aged 25-60 years) with polysomnography (PSG)-diagnosed OSAHS. Using a cut-off of 45mmHg daytime transcutaneous partial pressure of carbon dioxide (PtcCO2), 86 patients were assigned into the normocapnic group and 45 patients into the hypercapnic group. Working memory was evaluated using the Digit Span Backward Test (DSB) and the Cambridge Neuropsychological Test Automated Battery. Results Compared with the normocapnic group, the hypercapnic group performed worse in verbal, visual, and spatial working memory tasks. PtcCO2≥45mmHg was an independent predictor for lower DSB scores (OR=4.057), lower accuracy in the immediate Pattern Recognition Memory (OR=2.600), delayed Pattern Recognition Memory (OR=2.766) and Spatial Recognition Memory (OR=2.722) tasks, lower Spatial Span scores (OR=4.795), and more between errors in the Spatial Working Memory task (OR=2.734 and 2.558, respectively). Notably, PSG indicators of hypoxia and sleep fragmentation did not predict task performance. Conclusion Hypercapnia may be plays an important role in working memory impairment in patients with OSAHS, perhaps more so than hypoxia and sleep fragmentation. Routine CO2 monitoring in these patients could prove of utility in clinical practices.
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Affiliation(s)
- Hua-Man Wu
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Zigong First People’s Hospital, Zigong, Sichuan, People’s Republic of China
| | - Zhi-Jun Wang
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Chao-Hong Cheng
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Tong Su
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Jing Wang
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Ye-Zhou Li
- School of Medicine, the University of Manchester, Manchester, UK
| | - Qiao-Jun Wang
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Fei Han
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
| | - Rui Chen
- Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
- Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China
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3
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Abstract
Several studies have investigated the risk of dementia in posttraumatic stress disorder (PTSD) using a varying methodology. Epidemiological studies have found an increased risk of dementia with PTSD in Vietnam veterans as well as the general population. Laboratory studies reported the accelerated formation of β-amyloid and tau, which represent the primary pathology of Alzheimer's dementia in animal models of PTSD. These investigations were conducted against a background of cognitive impairment and atrophy of the hippocampus and certain cortical areas in patients with PTSD. Very few studies have investigated the pathological basis in humans for the reported association of PTSD with dementia. This important gap in the literature has recently been partly addressed by very few studies that estimated the burden of β-amyloid and tau. The PET studies did not show an association between PTSD and the specific pathology of Alzheimer's disease or signs of neurodegenerative diseases underlying other dementia syndromes. Another study demonstrated decreased plasma β-amyloid load and increased plasma β-amyloid 42/40 ratio in PTSD without PET evaluation. While PTSD is associated with an increased risk of dementia syndrome in general, there is no convincing evidence that it causes or accelerates the pathology of Alzheimer's disease, which causes the most common type of dementia. Factors that may account for the association between PTSD and a clinical diagnosis of dementia are discussed in this review.
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Affiliation(s)
- Alby Elias
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Christopher Rowe
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
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4
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Elias A, Cummins T, Tyrrell R, Lamb F, Dore V, Williams R, Rosenfeld J, Hopwood M, Villemagne VL, Rowe CC. Risk of Alzheimer’s Disease in Obstructive Sleep Apnea Syndrome: Amyloid-β and Tau Imaging. J Alzheimers Dis 2018; 66:733-741. [DOI: 10.3233/jad-180640] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alby Elias
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Tia Cummins
- The Florey Institute of Neuroscience and Mental Health
| | - Regan Tyrrell
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
| | - Fiona Lamb
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
| | | | | | - J.V. Rosenfeld
- Department of Neurosurgery, Monash University, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Victoria, Australia
| | - Victor L. Villemagne
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
| | - Christopher C. Rowe
- Department of Molecular Imaging and Therapy, Austin Health, The University of Melbourne, Victoria, Australia
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5
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Wszedybyl-Winklewska M, Wolf J, Szarmach A, Winklewski PJ, Szurowska E, Narkiewicz K. Central sympathetic nervous system reinforcement in obstructive sleep apnoea. Sleep Med Rev 2018; 39:143-154. [DOI: 10.1016/j.smrv.2017.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 01/30/2023]
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6
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Alex RM, Mousavi ND, Zhang R, Gatchel RJ, Behbehani K. Obstructive sleep apnea: Brain hemodynamics, structure, and function. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/jabr.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Raichel M. Alex
- Department of Bioengineering; University of Texas at Arlington; Arlington TX USA
| | | | - Rong Zhang
- Department of Neurology and Neurotherapeutics; University of Texas Southwestern Medical Center; Dallas TX USA
- Institute for Exercise and Environmental Medicine; Texas Health Hospital Dallas; Dallas TX USA
| | - Robert J. Gatchel
- Department of Psychology; University of Texas at Arlington; Arlington TX USA
| | - Khosrow Behbehani
- Department of Bioengineering; University of Texas at Arlington; Arlington TX USA
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7
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Otto MW, Eastman A, Lo S, Hearon BA, Bickel WK, Zvolensky M, Smits JAJ, Doan SN. Anxiety sensitivity and working memory capacity: Risk factors and targets for health behavior promotion. Clin Psychol Rev 2016; 49:67-78. [PMID: 27611632 DOI: 10.1016/j.cpr.2016.07.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 06/03/2016] [Accepted: 07/25/2016] [Indexed: 11/15/2022]
Abstract
Understanding the nature and influence of specific risk profiles is increasingly important for health behavior promotion. The purpose of this article is to document the value of two factors-anxiety sensitivity (AS) and working memory capacity (WMC)-for enhancing risk for the initiation and/or maintenance of a range of negative health behaviors. AS is a distress-related risk factor that potentiates avoidance/coping motivations for negative health behaviors. Stress provides the conditions for negative somatic and affective states, and AS amplifies the aversiveness of these experiences and correspondingly hinders adaptive functioning. In contrast, low WMC is hypothesized to exert its effect by decreasing the capacity to filter out current temptations, attenuating a focus on longer-term goals and impairing the application of relevant coping skills at times of stress. In this review, we provide conceptual models for the separate roles of high AS and low WMC in negative health behaviors, review the influence of these factors on specific health behavior exemplars (eating behaviors/obesity, physical activity, smoking, alcohol use, and sleep promotion), provide preliminary evidence for their value as independent treatment targets for health-behavior promotion, and encourage specific research directions in relation to these variables.
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Affiliation(s)
- Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, USA.
| | - Abraham Eastman
- Department of Psychological and Brain Sciences, Boston University, USA
| | - Stephen Lo
- Department of Psychological and Brain Sciences, Boston University, USA
| | | | - Warren K Bickel
- Addiction Recovery Research Center, Virginia Tech Carilion Research Institute, USA
| | - Michael Zvolensky
- University of Houston, USA; The University of Texas MD Anderson Cancer Center, USA
| | - Jasper A J Smits
- Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin, USA
| | - Stacey N Doan
- Department of Psychology, Claremont McKenna College, USA
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8
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Zhou J, Camacho M, Tang X, Kushida CA. A review of neurocognitive function and obstructive sleep apnea with or without daytime sleepiness. Sleep Med 2016; 23:99-108. [PMID: 27288049 DOI: 10.1016/j.sleep.2016.02.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/07/2016] [Accepted: 02/04/2016] [Indexed: 02/05/2023]
Abstract
Excessive daytime sleepiness (EDS) and neurocognitive dysfunction are commonly observed in patients with obstructive sleep apnea (OSA), and these daytime functional deficits can be reversed partly or completely with treatment such as continuous positive airway pressure (CPAP). Although daytime sleepiness is a possible etiology for neurocognitive dysfunction in OSA patients, EDS is not universally present in all patients with OSA. The objective of this review is to summarize the relationship between neurocognitive function and EDS in OSA, as well as the difference in cognitive domains, improvement, and application of CPAP therapy between patients with and without EDS. Two authors independently searched PubMED/Medline, The Cochrane Library and Scopus through May 27, 2015. Sixty-five articles were included in this review. The literature demonstrated a wide range of neurocognitive deficits in OSA patients with EDS, but no more extensive and complex cognitive domains (eg, executive function) in patients without EDS. However, the current literature had very few studies with large sample sizes and extended follow-up that evaluated the effect of CPAP for OSA in patients with and without sleepiness. CPAP failed to improve cognitive dysfunction in OSA patients without EDS after short-term therapy. The evidence suggests that daytime sleepiness possibly relates to the domain and extent of cognitive impairments in OSA, and CPAP therapy has little effect on the improvement of cognitive deficits in OSA patients without EDS. We recommend that additional prospective studies be performed to further quantify the relationship between neurocognitive function in OSA patients with and without EDS.
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Affiliation(s)
- Junying Zhou
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China; Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA, USA
| | - Macario Camacho
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA, USA; Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, HI, USA
| | - Xiangdong Tang
- Sleep Medicine Center, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Clete A Kushida
- Department of Psychiatry and Behavioral Sciences, Division of Sleep Medicine, Stanford Hospital and Clinics, Redwood City, CA, USA.
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9
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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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10
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Palomares JA, Tummala S, Wang DJJ, Park B, Woo MA, Kang DW, St Lawrence KS, Harper RM, Kumar R. Water Exchange across the Blood-Brain Barrier in Obstructive Sleep Apnea: An MRI Diffusion-Weighted Pseudo-Continuous Arterial Spin Labeling Study. J Neuroimaging 2015; 25:900-5. [PMID: 26333175 DOI: 10.1111/jon.12288] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/17/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Obstructive sleep apnea (OSA) subjects show brain injury in sites that control autonomic, cognitive, and mood functions that are deficient in the condition. The processes contributing to injury may include altered blood-brain barrier (BBB) actions. Our aim was to examine BBB function, based on diffusion-weighted pseudo-continuous arterial spin labeling (DW-pCASL) procedures, in OSA compared to controls. METHODS We performed DW-pCASL imaging in nine OSA and nine controls on a 3.0-Tesla MRI scanner. Global mean gray and white matter arterial transient time (ATT, an index of large artery integrity), water exchange rate across the BBB (Kw, BBB function), DW-pCASL ratio, and cerebral blood flow (CBF) values were compared between OSA and control subjects. RESULTS Global mean gray and white matter ATT (OSA vs. controls; gray matter, 1.691 ± .120 vs. 1.658 ± .109 second, P = .49; white matter, 1.700 ± .115 vs. 1.650 ± .114 second, P = .44), and CBF values (gray matter, 57.4 ± 15.8 vs. 58.2 ± 10.7 ml/100 g/min, P = .67; white matter, 24.2 ± 7.0 vs. 24.6 ± 6.7 ml/100 g/min, P = .91) did not differ significantly, but global gray and white matter Kw (gray matter, 158.0 ± 28.9 vs. 220.8 ± 40.6 min(-1) , P = .002; white matter, 177.5 ± 57.2 vs. 261.1 ± 51.0 min(-1) , P = .006), and DW-pCASL ratio (gray matter, .727 ± .076 vs. .823 ± .069, P = .011; white matter, .722 ± .144 vs. .888 ± .100, P = .004) values were significantly reduced in OSA over controls. CONCLUSIONS OSA subjects show compromised BBB function, but intact large artery integrity. The BBB alterations may introduce neural damage contributing to abnormal functions in OSA, and suggest a need to repair BBB function with strategies commonly used in other fields.
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Affiliation(s)
- Jose A Palomares
- Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA
| | - Sudhakar Tummala
- Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA
| | - Danny J J Wang
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA.,Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA
| | - Bumhee Park
- Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA
| | - Mary A Woo
- UCLA School of Nursing, University of California, Los Angeles, Los Angeles, CA
| | - Daniel W Kang
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Ronald M Harper
- Department of Neurobiology, University of California, Los Angeles, Los Angeles, CA.,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California, Los Angeles, Los Angeles, CA.,Department of Radiological Sciences, University of California, Los Angeles, Los Angeles, CA.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA.,Brain Research Institute, University of California, Los Angeles, Los Angeles, CA
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11
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Topchiy I, Amodeo DA, Ragozzino ME, Waxman J, Radulovacki M, Carley DW. Acute exacerbation of sleep apnea by hyperoxia impairs cognitive flexibility in Brown-Norway rats. Sleep 2014; 37:1851-61. [PMID: 25364080 DOI: 10.5665/sleep.4184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To determine whether learning deficits occur during acute exacerbation of spontaneous sleep related breathing disorder (SRBD) in rats with high (Brown Norway; BN) and low (Zucker Lean; ZL) apnea propensity. DESIGN Spatial acquisition (3 days) and reversal learning (3 days) in the Morris water maze (MWM) with polysomnography (12:00-08:00): (1) with acute SRBD exacerbation (by 20-h hyperoxia immediately preceding reversal learning) or (2) without SRBD exacerbation (room air throughout). SETTING Randomized, placebo-controlled, repeated-measures design. PARTICIPANTS 14 BN rats; 16 ZL rats. INTERVENTIONS 20-h hyperoxia. MEASUREMENTS AND RESULTS Apneas were detected as cessation of respiration ≥ 2 sec. Swim latency in MWM, apnea indices (AI; apneas/hour of sleep) and percentages of recording time for nonrapid eye movement (NREM), rapid eye movement (REM), and total sleep were assessed. Baseline AI in BN rats was more than double that of ZL rats (22.46 ± 2.27 versus 10.7 ± 0.9, P = 0.005). Hyperoxia increased AI in both BN (34.3 ± 7.4 versus 22.46 ± 2.27) and ZL rats (15.4 ± 2.7 versus 10.7 ± 0.9) without changes in sleep stage percentages. Control (room air) BN and ZL rats exhibited equivalent acquisition and reversal learning. Acute exacerbation of AI by hyperoxia produced a reversal learning performance deficit in BN but not ZL rats. In addition, the percentage of REM sleep and REM apnea index in BN rats during hyperoxia negatively correlated with reversal learning performance. CONCLUSIONS Acute exacerbation of sleep related breathing disorder by hyperoxia impairs reversal learning in a rat strain with high apnea propensity, but not a strain with a low apnea propensity. This suggests a non-linear threshold effect may contribute to the relationships between sleep apnea and cognitive dysfunctions, but strain-specific differences also may be important.
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Affiliation(s)
- Irina Topchiy
- Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL ; Department of Biobehavioral and Health Sciences, University of Illinois at Chicago, Chicago, IL
| | - Dionisio A Amodeo
- Department of Psychology, University of Illinois at Chicago, Chicago, IL
| | | | - Jonathan Waxman
- Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL
| | - Miodrag Radulovacki
- Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL ; Department of Pharmacology, University of Illinois at Chicago, Chicago, IL
| | - David W Carley
- Center for Narcolepsy, Sleep and Health Research, University of Illinois at Chicago, Chicago, IL ; Department of Medicine, University of Illinois at Chicago, Chicago, IL ; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL ; Department of Biobehavioral and Health Sciences, University of Illinois at Chicago, Chicago, IL
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12
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The Role of Severity of Obstructive Sleep Apnea Measured by Apnea–Hypopnea Index in Predicting Compliance With Pressure Therapy, a Meta-analysis. Am J Ther 2014; 21:260-4. [DOI: 10.1097/mjt.0b013e318249a09d] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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13
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Andreou G, Vlachos F, Makanikas K. Effects of chronic obstructive pulmonary disease and obstructive sleep apnea on cognitive functions: evidence for a common nature. SLEEP DISORDERS 2014; 2014:768210. [PMID: 24649370 PMCID: PMC3932644 DOI: 10.1155/2014/768210] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 10/09/2013] [Accepted: 10/31/2013] [Indexed: 12/16/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea syndrome (OSAS) show similar neurocognitive impairments. Effects are more apparent in severe cases, whereas in moderate and mild cases the effects are equivocal. The exact mechanism that causes cognitive dysfunctions in both diseases is still unknown and only suggestions have been made for each disease separately. The primary objective of this review is to present COPD and OSAS impact on cognitive functions. Secondly, it aims to examine the potential mechanisms by which COPD and OSAS can be linked and provide evidence for a common nature that affects cognitive functions in both diseases. Patients with COPD and OSAS compared to normal distribution show significant deficits in the cognitive abilities of attention, psychomotor speed, memory and learning, visuospatial and constructional abilities, executive skills, and language. The severity of these deficits in OSAS seems to correlate with the physiological events such as sleep defragmentation, apnea/hypopnea index, and hypoxemia, whereas cognitive impairments in COPD are associated with hypoventilation, hypoxemia, and hypercapnia. These factors as well as vascocerebral diseases and changes in systemic hemodynamic seem to act in an intermingling and synergistic way on the cause of cognitive dysfunctions in both diseases. However, low blood oxygen pressure seems to be the dominant factor that contributes to the presence of cognitive deficits in both COPD and OSAS.
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Affiliation(s)
- Georgia Andreou
- Department of Special Education, University of Thessaly, Argonafton & Filellinon, 38221 Volos, Greece
| | - Filippos Vlachos
- Department of Special Education, University of Thessaly, Argonafton & Filellinon, 38221 Volos, Greece
| | - Konstantinos Makanikas
- Department of Special Education, University of Thessaly, Argonafton & Filellinon, 38221 Volos, Greece
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14
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Vijayan VK. Morbidities associated with obstructive sleep apnea. Expert Rev Respir Med 2013; 6:557-66. [PMID: 23134249 DOI: 10.1586/ers.12.44] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Obstructive sleep apnea (OSA)-induced biological changes include intermittent hypoxia, intermittent hypercapnia, intrathoracic pressure changes, sympathetic activation and sleep fragmentation. OSA can cause metabolic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress and hypercoagulation, and neurohumoral changes. There is evidence suggesting that OSA is independently associated with metabolic syndrome. OSA has been shown to increase the risk for systemic hypertension, pulmonary vascular disease, ischemic heart disease, cerebral vascular disease, congestive heart failure and arrhythmias. Although there are evidences accumulating that there may be a causal relationship between OSA and cardiovascular disorders, there is a need for more data from randomized controlled intervention trials to confirm this relationship. Many risk factors of OSA (age, male gender and obesity) are also known risk factors for cardiovascular disease. Severe OSA-hypopnea significantly increases the risk of fatal and nonfatal cardiovascular events in both men and women, and continuous positive airway pressure treatment reduces this risk in both. Neurocognitive consequences of OSA include daytime sleepiness, loss of alertness, memory deficit, reduced vigilance, impaired executive function, increased risk for automobile and occupational accidents, and decreased quality of life.
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Affiliation(s)
- Vannan Kandi Vijayan
- Bhopal Memorial Hospital and Research Centre, Indian Council of Medical Research, Bhopal, India.
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Prilipko O, Huynh N, Schwartz S, Tantrakul V, Kushida C, Paiva T, Guilleminault C. The effects of CPAP treatment on task positive and default mode networks in obstructive sleep apnea patients: an fMRI study. PLoS One 2012; 7:e47433. [PMID: 23227139 PMCID: PMC3515559 DOI: 10.1371/journal.pone.0047433] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 09/17/2012] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Functional magnetic resonance imaging studies enable the investigation of neural correlates underlying behavioral performance. We investigate the effect of active and sham Continuous Positive Airway Pressure (CPAP) treatment on working memory function of patients with Obstructive Sleep Apnea Syndrome (OSAS) considering Task Positive and Default Mode networks (TPN and DMN). METHODS An experiment with 4 levels of visuospatial n-back task was used to investigate the pattern of cortical activation in 17 men with moderate or severe OSAS before and after 2 months of therapeutic (active) or sub-therapeutic (sham) CPAP treatment. RESULTS Patients with untreated OSAS had significantly less deactivation in the temporal regions of the DMN as compared to healthy controls, but activation within TPN regions was comparatively relatively preserved. After 2 months of treatment, active and sham CPAP groups exhibited opposite trends of cerebral activation and deactivation. After treatment, the active CPAP group demonstrated an increase of cerebral activation in the TPN at all task levels and of task-related cerebral deactivation in the anterior midline and medial temporal regions of the DMN at the 3-back level, associated with a significant improvement of behavioral performance, whereas the sham CPAP group exhibited less deactivation in the temporal regions of Default Mode Network and less Task Positive Network activation associated to longer response times at the 3-back. CONCLUSION OSAS has a significant negative impact primarily on task-related DMN deactivation, particularly in the medial temporal regions, possibly due to nocturnal hypoxemia, as well as TPN activation, particularly in the right ventral fronto-parietal network. After 2 months of active nasal CPAP treatment a positive response was noted in both TPN and DMN but without compete recovery of existing behavioral and neuronal deficits. Initiation of CPAP treatment early in the course of the disease may prevent or slow down the occurrence of irreversible impairment.
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Affiliation(s)
- Olga Prilipko
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
| | - Nelly Huynh
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
| | | | - Visasiri Tantrakul
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
| | - Clete Kushida
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
| | | | - Christian Guilleminault
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, California, United States of America
- * E-mail:
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Lehmann P, Eling P, Kastrup A, Grothues O, Hildebrandt H. Self-reported sleep problems, but not fatigue, lead to decline in sustained attention in MS patients. Mult Scler 2012; 19:490-7. [PMID: 22933623 DOI: 10.1177/1352458512457719] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE According to the compensation theory, fatigue in MS results from efforts to compensate for a reduction in capacity due to demyelination or neurodegeneration. Recently, it has been argued that fatigue may result from poor sleep. Both explanations predict a worsening of fatigue and a cognitive decline during sustained attention tasks (higher fatigability). METHOD We compared MS patients with and without self-reported cognitive fatigue, in three sessions with a two-back working memory task, registering hits and response latencies as well as changes in fatigue. In the two breaks between the sessions, either a video instruction to relax or a stimulating video was presented. Subsequently, patients were divided into those with and those without self-reported sleep problems and the analyses were repeated. RESULTS Patients with fatigue performed worse than healthy controls, irrespective of task duration and type of video during the break. The task-related increase of fatigue also did not differ between the groups and no differential effect of the videos was observed in the MS patients with fatigue. In contrast, patients with sleep problems did show a performance decline as predicted by the compensation theory. CONCLUSION MS patients with fatigue were impaired in working memory, but did not show greater fatigability, whereas MS participants with self-reported sleep problems showed fatigability, which could be improved with a restorative rest period. Our data therefore do not support the compensation theory of fatigue, and we argue that sleep problems and fatigue in MS patients differ with respect to their functional consequences.
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Affiliation(s)
- Pia Lehmann
- Department of Neurology, Klinikum Bremen-Ost, Bremen, Germany
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Harper RM, Kumar R, Macey PM, Ogren JA, Richardson HL. Functional neuroanatomy and sleep-disordered breathing: implications for autonomic regulation. Anat Rec (Hoboken) 2012; 295:1385-95. [PMID: 22851218 DOI: 10.1002/ar.22514] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 04/18/2012] [Indexed: 11/05/2022]
Abstract
A major concern with sleep-disordered breathing conditions, which include obstructive sleep apnea (OSA), central apnea, and congenital central hypoventilation syndrome (CCHS), is the high incidence of accompanying autonomic dysfunction and metabolic disorders. Patients with OSA show exaggerated sympathetic tone, leading to hypertension, cardiac arrhythmia, profuse sweating, impaired cerebral perfusion, and stroke. In addition, OSA appears in 86% of obese Type II diabetic patients, suggesting common deleterious processes. Autonomic deficiencies also appear in CCHS patients, who are often hypoglycemic. The impaired autonomic control may stem from injury to central sympathetic and parasympathetic regulatory areas resulting from apnea-related inflammation, hypoxia, or perfusion-related consequences in OSA, and genetic mutation repercussions in CCHS. Disturbed sleep organization from apnea arousals may also disrupt hormonal release. Brain areas affected in both OSA and CCHS include cortical and limbic regions that influence hypothalamic-regulated sympathetic control and hormone release, essential for glycemic regulation, as well as parasympathetic nuclei influencing the pancreas and other viscera, and raphé serotonergic sites, important for thermal and vascular regulation. Brain injury and altered functional responses appear in OSA and CCHS, assessed with magnetic resonance imaging techniques, in areas which show regional gray matter loss, alterations of free water within tissue, loss of axonal integrity, and disruption of functional responses to autonomic and ventilatory challenges. Evaluation of neural injury and distortion in functional signals to autonomic challenges in localized brain areas can provide insights into common pathological mechanisms for dysregulation of hormonal release and autonomic processes in sleep-disordered breathing and metabolic disorders.
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Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California, USA.
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18
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Kumar R, Chavez AS, Macey PM, Woo MA, Yan-Go FL, Harper RM. Altered global and regional brain mean diffusivity in patients with obstructive sleep apnea. J Neurosci Res 2012; 90:2043-52. [PMID: 22715089 DOI: 10.1002/jnr.23083] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/27/2012] [Accepted: 04/13/2012] [Indexed: 12/30/2022]
Abstract
Obstructive sleep apnea (OSA) is a common and progressive disorder accompanied by severe cardiovascular and neuropsychological sequelae, presumably induced by brain injury resulting from the intermittent hypoxia and cardiovascular processes accompanying the syndrome. However, whether the predominant brain tissue pathology is acute or chronic in newly-diagnosed, untreated OSA subjects is unclear; this assessment is essential for revealing pathological processes. Diffusion tensor imaging (DTI)-based mean diffusivity (MD) procedures can detect and differentiate acute from chronic pathology and may be useful to reveal processes in the condition. We collected four DTI series from 23 newly-diagnosed, treatment-naïve OSA and 23 control subjects, using a 3.0-Tesla magnetic resonance imaging scanner. Mean diffusivity maps were calculated from each series, realigned, averaged, normalized to a common space, and smoothed. Global brain MD values for each subject were calculated using normalized MD maps and a global brain mask. Mean global brain MD values and smoothed MD maps were compared between groups by using analysis of covariance (covariate: age). Mean global brain MD values were significantly reduced in OSA compared with controls (P = 0.01). Multiple brain sites in OSA, including medullary, cerebellar, basal ganglia, prefrontal and frontal, limbic, insular, cingulum bundle, external capsule, corpus callosum, temporal, occipital, and corona radiata regions showed reduced regional MD values compared with controls. The results suggest that global brain MD values are significantly reduced in OSA, with certain regional sites especially affected, presumably a consequence of axonal, glial, and other cell changes in those areas. The findings likely represent acute pathological processes in newly-diagnosed OSA subjects.
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Affiliation(s)
- Rajesh Kumar
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, California, USA
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Prilipko O, Huynh N, Schwartz S, Tantrakul V, Kim JH, Peralta AR, Kushida C, Paiva T, Guilleminault C. Task positive and default mode networks during a parametric working memory task in obstructive sleep apnea patients and healthy controls. Sleep 2011; 34:293-301A. [PMID: 21358846 DOI: 10.1093/sleep/34.3.293] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Functional magnetic resonance imaging (fMRI) studies enable the investigation of neural correlates underlying behavioral performance. We investigate the working memory (WM) function of patients with untreated obstructive sleep apnea (OSA) from the view point of task positive and default mode networks (TPN and DMN, respectively) and compare the results to those of healthy controls (HC). METHODS A parametric fMRI experiment with 4 levels of visuospatial N-back task was used to investigate the pattern of cortical activation in 17 men with untreated moderate or severe OSA and 7 age-matched HC. Categorical and parametrical analysis of the data was performed. Multiple regression analysis of fMRI data of OSA patients was performed with AHI, nocturnal desaturation time, and BMI as covariates. RESULTS OSA patients demonstrate compensatory spatial recruitment of the TPN (maximal at 3-back) and of the DMN (maximal at 2-back). HC had a different patten of spatial recruitment and deactivation of the DMN at the maximal load of task (3-back). Nocturnal desaturation had significant positive correlation with BOLD signal in bilateral frontal, temporal, and occipital regions, and negative correlations in bilateral frontal and left parietal regions; whereas BMI showed only negative correlations with BOLD signal, predominantly in the PFC. AHI was positively correlated with BOLD signal in bilateral frontal regions. CONCLUSION Both TPN and DMN are affected in OSA patients, with nocturnal desaturation affecting both networks; whereas BMI appears to be the major negative factor influencing the TPN and has a significant negative correlation with behavioral performance.
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Affiliation(s)
- Olga Prilipko
- Stanford University Sleep Clinic and Center for Human Sleep Research, Redwood City, CA, USA.
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20
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Cognitive recovery following positive airway pressure (PAP) in sleep apnea. PROGRESS IN BRAIN RESEARCH 2011; 190:71-88. [PMID: 21531245 DOI: 10.1016/b978-0-444-53817-8.00004-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep disorder that is characterized by repeated episodes of complete or partial cessation of breathing while sleeping. These recurrent breathing events result in fragmented sleep and recurrent hypoxemia. Distressing daytime sequelae reported by OSAHS patients include excessive daytime sleepiness, self-reported changes in mood, and cognitive problems. It has been well established that OSAHS can negatively impact functioning in multiple cognitive domains, such as attention and memory. In this chapter, neurobehavioral deficits in OSAHS are discussed, and proposed models of cognitive dysfunction are summarized. Current studies examining cognitive recovery with positive airway pressure treatment are presented. It appears that the cognitive dysfunction of OSAHS is not likely to be due to a single mediating mechanism, nor is it pervasive across all patients. Future research should attempt to identify these moderators for cognitive dysfunction in OSAHS and to highlight the mechanisms of dysfunction by cognitive domain.
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21
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Executive function in patients with obstructive sleep apnea treated with continuous positive airway pressure. J Int Neuropsychol Soc 2010; 16:1077-88. [PMID: 20735887 DOI: 10.1017/s1355617710000901] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by disrupted breathing and hypoxemia during sleep, daytime sleepiness, and changes in cognition and mood. One important question is regarding the reversibility of cognitive deficits after treatment with continuous positive airway pressure (CPAP). Here, we report the outcomes of CPAP treatment as measured by tests of attention and executive function. Thirty-seven individuals with moderate to severe OSA and compliant on CPAP treatment were studied with working memory tasks, neuropsychological testing, and overnight polysomnographic sleep study and compared to 27 healthy controls. CPAP improved the respiratory disturbance index, minimum and mean oxygen saturation (SpO2), subjective sleep quality, and daytime sleepiness ratings compared to pre-treatment values. In terms of current neurocognitive function, treated individuals with OSA performed at a comparable level to controls on basic working memory storage functions but still showed a significant reduction on tests of working memory requiring the central executive. The OSA group also performed worse on neuropsychological measures of complex attention, executive function, and psychomotor speed. While CPAP is an effective treatment for OSA in terms of ameliorating breathing disruption and oxygen desaturation during sleep, as well as daytime sleepiness, some cognitive deficits may be more resistant to treatment.
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Sweet LH, Jerskey BA, Aloia MS. Default network response to a working memory challenge after withdrawal of continuous positive airway pressure treatment for obstructive sleep apnea. Brain Imaging Behav 2010; 4:155-63. [PMID: 20502992 DOI: 10.1007/s11682-010-9095-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Lower working memory performance and altered brain activity have been reported in studies of obstructive sleep apnea (OSA) patients. However, little is known about the effect of treatment of OSA on brain function, particularly effects on default network processing. We previously reported increased brain response to a working memory challenge in active regions and decreased response in relatively deactivated a priori regions of interest (ROIs) following withdrawal of continuous positive airway pressure (CPAP) treatment. This follow-up analysis was conducted to examine the effects of CPAP withdrawal on default network processing using empirically defined ROIs analyses (i.e., in ROIs exhibiting significant deactivation in the sample). Ten OSA patients performed a 2-Back working memory task during functional magnetic resonance imaging in two separate conditions, following regular CPAP use, and after two nights of CPAP withdrawal. Eleven clusters of significant 2-Back-related deactivation consistent with the default network were identified and further examined for CPAP withdrawal effects. Significant further deactivation relative to the treatment adherent baseline was observed in the majority of these ROIs during the withdrawal condition. The magnitude of deactivation during withdrawal was significantly associated with better working memory performance in the posterior cingulate and right postcentral gyrus, and greater sleepiness in the left and right medial frontal gyrus. Results suggest that default network functions are further suspended as a result of a shifting of attention towards a more difficult active task in the context of lowered attentional capacity related to sleepiness.
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Affiliation(s)
- Lawrence H Sweet
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA.
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Abstract
Sleepiness has long been recognized as a presenting symptom in obstructive sleep apnea syndrome, but persistent neurocognitive injury from sleep apnea has been appreciated only recently. Although therapy for sleep apnea markedly improves daytime symptoms, cognitive impairments may persist despite long-term therapy with continuous positive airway pressure. We know now that certain groups of neurons, typically those that are more metabolically active, are more vulnerable to injury than others. Animal models of sleep apnea oxygenation patterns have been instrumental in elucidating mechanisms of injury. The hypoxia/reoxygenation events result in oxidative, inflammatory, and endoplasmic reticulum stress responses in susceptible neural groups. With molecular pathways being fleshed out in animal models, it is time to carefully and systematically examine neural injury in humans and test the applicability of findings from animal models. To succeed, however, we cannot view sleep apnea as an isolated process. Rather, injury in sleep apnea is more likely the consequence of overlapping injuries from comorbid conditions. The progress in elucidating mechanisms of neural injury is palpable, and it now seems we indeed are closer to developing therapies to prevent and treat neural injury in obstructive sleep apnea.
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Affiliation(s)
- Diane C Lim
- Center for Sleep and Neurobiology, University of Pennsylvania School of Medicine, Translational Research Building, Room 2115, 125 South 31st Street, Philadelphia, PA, 19104, USA
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Fulda S, Schulz H. How treatment affects cognitive deficits in patients with sleep disorders: methodological issues and results. PROGRESS IN BRAIN RESEARCH 2010; 185:69-90. [PMID: 21075234 DOI: 10.1016/b978-0-444-53702-7.00005-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sleep disorders are frequently associated with impaired performance although the type and extent of cognitive deficits varies widely between different types of sleep disorders. Treatment is expected to ameliorate these deficits. However, cognitive functioning and its change with treatment depend on numerous factors. In this chapter we discuss methodological issues, including test selection, and person-specific, task-specific and environmental factors that influence cognitive functioning. In addition, features of study design and sampling strategies are discussed. The chapter ends with a short overview of routes by which treatment may affect cognition in sleep-disordered patients.
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Aloia MS, Sweet LH, Jerskey BA, Zimmerman M, Arnedt JT, Millman RP. Treatment effects on brain activity during a working memory task in obstructive sleep apnea. J Sleep Res 2009; 18:404-10. [PMID: 19765205 DOI: 10.1111/j.1365-2869.2009.00755.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Positive airway pressure (PAP) is the most common form of treatment for obstructive sleep apnea (OSA). Treatment adherence is notoriously low, and holidays from treatment are common. To date, there is no literature on the effects of acute withdrawal from PAP treatment on the brain activity of individuals with OSA. Nine participants with OSA performed a 2-Back verbal working memory paradigm during repeated functional magnetic resonance imaging (FMRI). Counterbalanced FMRI sessions were under conditions of PAP treatment (at least one consecutive week) or non-treatment (for two consecutive nights). Treatment effects on 2-Back-related brain activity were significant, with greater deactivation in the right posterior insula and overactivation in the right inferior parietal lobule. The observed responses to PAP treatment withdrawal were more extreme in all regions of interest, such that 2-Back-related activity increased and 2-Back-related deactivation decreased further relative to the 0-Back control task. The withdrawal of PAP treatment in effectively treated individuals with OSA might result in the need to reallocate resources in order to perform at the same cognitive level.
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Affiliation(s)
- Mark S Aloia
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206, USA.
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