Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES).

Abstract

STUDY OBJECTIVE:

To determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA).

DESIGN, SETTING, AND PARTICIPANTS:

The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducted at 5 U.S. university, hospital, or private practices. Of 1,516 participants enrolled, 1,105 were randomized, and 1,098 participants diagnosed with OSA contributed to the analysis of the primary outcome measures.

INTERVENTION:

Active or sham CPAP MEASUREMENTS: THREE NEUROCOGNITIVE VARIABLES, EACH REPRESENTING A NEUROCOGNITIVE DOMAIN: Pathfinder Number Test-Total Time (attention and psychomotor function [A/P]), Buschke Selective Reminding Test-Sum Recall (learning and memory [L/M]), and Sustained Working Memory Test-Overall Mid-Day Score (executive and frontal-lobe function [E/F])

RESULTS:

The primary neurocognitive analyses showed a difference between groups for only the E/F variable at the 2 month CPAP visit, but no difference at the 6 month CPAP visit or for the A/P or L/M variables at either the 2 or 6 month visits. When stratified by measures of OSA severity (AHI or oxygen saturation parameters), the primary E/F variable and one secondary E/F neurocognitive variable revealed transient differences between study arms for those with the most severe OSA. Participants in the active CPAP group had a significantly greater ability to remain awake whether measured subjectively by the Epworth Sleepiness Scale or objectively by the maintenance of wakefulness test.

CONCLUSIONS:

CPAP treatment improved both subjectively and objectively measured sleepiness, especially in individuals with severe OSA (AHI > 30). CPAP use resulted in mild, transient improvement in the most sensitive measures of executive and frontal-lobe function for those with severe disease, which suggests the existence of a complex OSA-neurocognitive relationship.

CLINICAL TRIAL INFORMATION:

Registered at clinicaltrials.gov. Identifier: NCT00051363.

CITATION:

Kushida CA; Nichols DA; Holmes TH; Quan SF; Walsh JK; Gottlieb DJ; Simon RD; Guilleminault C; White DP; Goodwin JL; Schweitzer PK; Leary EB; Hyde PR; Hirshkowitz M; Green S; McEvoy LK; Chan C; Gevins A; Kay GG; Bloch DA; Crabtree T; Demen WC. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). SLEEP 2012;35(12):1593-1602.

• Authors: Clete A Kushida, Deborah A Nichols, Tyson H Holmes, Stuart F Quan, James K Walsh, Daniel J Gottlieb, Richard D Simon Jr, Christian Guilleminault, David P White, James L Goodwin, Paula K Schweitzer, Eileen B Leary, Pamela R Hyde, Max Hirshkowitz, Sylvan Green, Linda K McEvoy, Cynthia Chan, Alan Gevins, Gary G Kay, Daniel A Bloch, Tami Crabtree, William C Dement
• Journal: Sleep (Sleep) Vol. 35 Issue 12 Pg. 1593-602 (Dec 01 2012) ISSN: 1550-9109 [Electronic] United States
• PMID: 23204602 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Cognition (physiology)
• Continuous Positive Airway Pressure
• Double-Blind Method
• Executive Function (physiology)
• Female
• Follow-Up Studies
• Humans
• Male
• Memory (physiology)
• Middle Aged
• Severity of Illness Index
• Sleep Apnea, Obstructive (psychology, therapy)
• Time Factors
• Treatment Outcome