Neuro-cognition in patients of Obstructive Sleep Apnoea Syndrome
Rayees Ahmad Bhat 1,
Masood Tanvir 2,
Musharaf Bashir 1 * More Detail
1 Department of Physiology, GMC & SMHS hospital, Srinagar, Jammu and Kashmir, India
2 Department of Internal Medicine, GMC & SMHS hospital, Srinagar, Jammu and Kashmir, India
* Corresponding Author
J CLIN MED KAZ, Volume 1, Issue 51, pp. 44-49.
https://doi.org/10.23950/1812-2892-JCMK-00668
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ABSTRACT
Background: Obstructive Sleep Apnoea Hypoapnoea Syndrome (OSAHS) is known to be associated with impairment in neuro-cognitive functions. This impairment in cognition is associated with daytime sleepiness that results in occupational deficits and an increased risk of automobile accidents.
Objectives: The aim of the study was to assess Neuro-cognition in patients of Obstructive Sleep Apnoea Hypoapnoea Syndrome (OSAHS)
Material and methods: Our study was an observational cross-sectional study. Eligible patients (n=205) undergoing polysomnography were categorized into Snoring (n=105), Mild OSA (n=70), Moderate OSA (n=17) and Severe OSA (n=13) groups, based on Apnoea Hypoapnoea Index (AHI). The Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) Questionnaires were administered to assess their cognitive functions and the correlation between Questionnaire scores and severity of OSAS was determined.
Results: MMSE Questionnaire detected overall cognitive impairment in 22% of OSA patients while as MoCA Questionnaire detected overall cognitive impairment in 33% of the same OSA patients. The frequency of mild neurocognitive impairment as detected by MMSE Questionnaire increased progressively as the severity of OSA increased from Snoring(6.7%) to Mild OSA(17.1%), Moderate OSA(29.4%) and severe OSA(38.4%). MoCA Questionnaire demonstrated the same pattern except that it was more sensitive. It detected cognitive impairment of 12.4% in Snoring group, 27.1% in Mild OSA group, 41.2% in Moderate OSA group and 53.9% in Severe OSA group.
Conclusion: Neurocognitive impairment is common in patients with OSAHS. The MoCA is a more sensitive tool than MMSE for the assessment of mild cognitive impairment in OSAHS patients, whose performance on the MMSE is in the normal range.
REFERENCES
- Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. American Journal of Respiratory Critical Care Medicine. 2002; 165(9): 1217 – 39. https://doi.org/10.1164/rccm.2109080
- American Academy of Sleep Medicine Task Force. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep. 1999; 22(5):667-89. https://doi.org/10.1093/sleep/22.5.667
- Engleman H, Joffe D. Neuropsychological function in obstructive sleep apnoea. Sleep Medicine. 1999; 3(1):59-78. https://doi. org/10.1016/S1087-0792(99)90014-X
- TsaraV, Kaimakamis E, Serasli E, Katsarou Z, Christaki P. Health related of life in Greek patients with sleep apnea-hypopnea syndrome treated with continuous positive airway pressure. Sleep Medicine. 2009; 10(2):217-2
- https://doi.org/10.1016/j.sleep.2007.12.008 5. Avidan AY. Sleep disordered breathing in the geriatric patient population. Advances in Cell Aging and Gerontology. 2005; 17(1):79- 112. https://doi.org/10.1016/S1566-3124(04)17004-1
- Lim Wet al. Neuropsychological Effects of 2-Week Continuous Positive Airway Pressure Treatment and Supplemental Oxygen in Patients with Obstructive Sleep Apnea: A Randomized Placebo-Controlled Study. Journal of Clinical Sleep Medicine. 2007; 3(4):380- 86.
- Qureshi A, Ballard RD. Obstructive sleep apnea. The Journal of Allergy and Clinical Immunology. 2003; 112(4):643-51. https://doi.org/10.1016/j.jaci.2003.08.031
- Tsai, WH, Flemons WW, Whitelaw WA, Remmersa JE. Comparison of apnea–hypopnea indices derived from different definitions of hypopnea. American Journal of Respiratory and Critical Care Medicine. 1999; 159(1):43–48. https://doi.org/10.1164/ajrccm.159.1.9709017
- Andreou G, Galanopoulou G, Gourgoulianis A, Karapetsas A, Molyvas P.Cognitive status in Down syndrome individuals with sleep disordered breathing deficits (SDB). Brain and Cognition. 2002: 50(1):145 -49. https://doi.org/10.1016/S0278-2626(02)00019-2
- Beebe DW, Gozal D. Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. Journal Sleep Research. 2002; 11(6):1-16. https://doi.org/10.1046/j.1365-2869.2002.00289.x
- Ancoli – Israel S et al. Sleep-Disordered Breathing in Community-Dwelling Elderly. Sleep. 1991; 14(6): 486–495. https://doi.org/10.1093/sleep/14.6.486
- Durán J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea – hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70years. American Journal of Respiratory and Critical Care Medicine. 2001; 163(3):685-89. https://doi.org/10.1164/ajrccm.163.3.2005065
- Chen R et al. Neurocognitive impairment in Chinese patients with obstructive sleep apnoea hypoapnoea syndrome. Respirology. 2011; 16(5):842-48. https://doi.org/10.1111/j.1440-1843.2011.01979.x
- Damiani MF, Zito A, Carratù P, Falcone VA, Bega E, Scicchitano P, Ciccone MM, Resta O. Obstructive Sleep Apnea, Hypertension, and Their Additive Effects on Atherosclerosis. Biochem Res Int. 2015; 984193. https://doi.org/10.1155/2015/984193
- Bucks RS, Olaithe M, Eastwood P. Neurocognitive functions in obstructive sleep apnoea: a meta-review. Respirology. 2013; 18(1):61- 70. https://doi.org/10.1111/j.1440-1843.2012.02255.x
- Borges JG et al. Executive functioning in obstructive sleep apnea syndrome patients without comorbidities: focus on the fractionation of executive functions. J Clin Exp Neuropsychol. 2013; 35(10): 1094-107. https://doi.org/10.1080/13803395.2013.858661
- Gelir E, Başaran C, Bayrak S, Yağcıoğlu S, Budak MT, Fırat H, Ungan P. Electrophysiological assessment of the effects of obstructive sleep apnoea on cognition. PLoS One. 2014; 9(2):90647. https://doi.org/10.1371/journal.pone.0090647