Arousal threshold modifies the effect of CPAP on executive function among individuals with obstructive sleep apnoea
Year: 2024
Type: article
Abstract: Background Obstructive sleep apnoea (OSA) is associated with neurocognitive dysfunction. However, randomised trials evaluating the effects of continuous positive airway pressure (CPAP) on neurocognition in those without dementia do not show a benefit. We thus aimed to assess whether arousal threshold (ArTH) modifies the effect of CPAP on neurocognitive function. Methods We performed a secondary analysis of a randomised, sham-controlled trial (Apnea Positive Pressure Long-term Efficacy Study (APPLES); ClinicalTrials.gov : NCT00051363 ). ArTH was estimated from polysomnography using a translatable method. Neurocognitive outcomes included the Sustained Working Memory Test-Overall Mid-Day (SWMT-OMD) score (executive function, primary outcome), with the Pathfinder Number Test total time (attention) and Buschke Selective Reminding Test sum recall (learning and memory) as secondary outcomes. Generalised linear modelling assessed whether the effect of CPAP was modified by baseline ArTH (treatment×ArTH interaction). 833 participants with OSA (apnoea–hypopnoea index ≥10 events·h−1), available ArTH and outcomes were analysed (active CPAP n=437 and sham CPAP n=396). Results For executive function, the effect of CPAP treatment was modified by ArTH (pinteraction=0.042). Specifically, for every 1sdincrease in ArTH, the SWMT-OMD score improved by 0.091 (95% CI 0.003–0.178) in active compared to sham CPAP at 6 months; at ArTH 1sdabove the mean, SWMT-OMD improvements were nearly three times that in those with average ArTH (0.139 (95% CI 0.018–0.261)versus0.053 (95% CI −0.034–0.140), respectively). No effect modification was observed for attention (p=0.311) or learning and memory (p=0.744). Conclusion In OSA, a higher ArTH is associated with greater improvements in executive function following CPAP therapy.
Source: European Respiratory Journal
Authors: Andrey V. Zinchuk, Clete A. Kushida, Alexander Walker, Andrew Wellman, Ali Azarbarzin, Raichel M. Alex, Andrew W. Varga, Scott A. Sands, H. Klar Yaggi
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1372996723, G1472918012, G1764282814, G184555663, G18503489, G2226568297, G2440874276, Phenotyping Mechanistic Pathways for Adverse Health Outcomes in Sleep Apnea, Phenotyping hypoxia and arousal contributions to cardiovascular morbidity and mortality in patients with sleep apnea, Sleep apnea phenotyping for personalized therapy using clinical polysomnography, G4195896747, G4364488918, G4672916011, G5093897220, G5821624717, Effects of Successful OSA TreatmENT on Memory and AD BIomarkers in Older AduLts (ESSENTIAL), G6901066595, Novel physiologiC prEdictors of Positive Airway Pressure effectiveness: NICE-PAP study.
OpenAlex ID: W4404587021