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VOLUME 34, ISSUE 03

OSA AND NEUROCOGNITIVE PERFORMANCE
The Association between Obstructive Sleep Apnea and Neurocognitive Performance—The Apnea Positive Pressure Long-term Efficacy Study (APPLES)

Stuart F. Quan, MD1,2; Cynthia S. Chan, BS3; William C. Dement, MD, PhD4; Alan Gevins, DSc3; James L. Goodwin, PhD1; Daniel J. Gottlieb, MD, MPH5; Sylvan Green, MD10; Christian Guilleminault, MD4; Max Hirshkowitz, PhD6; Pamela R. Hyde, MA4; Gary G. Kay, PhD7; Eileen B. Leary, RPSGT4; Deborah A. Nichols, MS4; Paula K. Schweitzer, PhD8; Richard D. Simon, MD9; James K. Walsh, PhD8; Clete A. Kushida, MD, PhD4

1Arizona Respiratory Center, University of Arizona, Tucson, AZ ; 2Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA ; 3The San Francisco Brain Research Institute and SAM Technology, San Francisco, CA ; 4Stanford University, Stanford, CA ; 5Boston University School of Medicine, Boston, MA ; 6Baylor College of Medicine and VA Medical Center, Houston, TX ; 7Cogscreen, LLC, Washington, DC ; 8St. Luke's Hospital, Chesterfield, MO ; 9St. Mary Medical Center, Walla Walla, WA ; 10College of Public Health, University of Arizona, Tucson, AZ



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Study Objectives:

To determine associations between obstructive sleep apnea (OSA) and neurocognitive performance in a large cohort of adults.

Study Design:

Cross-sectional analyses of polysomnographic and neurocognitive data from 1204 adult participants with a clinical diagnosis of obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES), assessed at baseline before randomization to either continuous positive airway pressure (CPAP) or sham CPAP.

Measurements:

Sleep and respiratory indices obtained by laboratory polysomnography and several measures of neurocognitive performance.

Results:

Weak correlations were found for both the apnea hypopnea index (AHI) and several indices of oxygen desaturation and neurocognitive performance in unadjusted analyses. After adjustment for level of education, ethnicity, and gender, there was no association between the AHI and neurocognitive performance. However, severity of oxygen desaturation was weakly associated with worse neurocognitive performance on some measures of intelligence, attention, and processing speed.

Conclusions:

The impact of OSA on neurocognitive performance is small for many individuals with this condition and is most related to the severity of hypoxemia.

Citation:

Quan SF; Chan CS; Dement WC; Gevins A; Goodwin JL; Gottlieb DJ; Green S; Guilleminault C; Hirshkowitz M; Hype PR; Kay GG; Leary EB; Nichols DA; Schweitzer PK; Simon RD; Walsh JK; Kushida CA. The association between obstructive sleep apnea and neurocognitive performance—the Apnea Positive Pressure Long-term Efficacy Study (APPLES). SLEEP 2011;34(3):303-314.

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