Neuropsychological Function in Obstructive Sleep Apnea Syndrome (OSAS) Compared to Chronic Obstructive Pulmonary Disease (COPD)

Roehrs, Timothy; Merrion, Martha; Pedrosi, Bonita; Stepanski, Edward J.; Zorick, Frank; Roth, Thomas

doi:10.1093/sleep/18.5.382

Cited by 84 publications

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“…The major neurocognitive manifestations of OSA include excessive daytime sleepiness (Roehrs et al, 1995), personality and psychosocial maladjustment patterns, and mental impairment in terms of thinking, perception, memory, communication, or the ability to learn new information (Kales et al, 1985;Gozal, 1998). The relative contributions of sleep fragmentation and deprivation and those of episodic hypoxemia to the neurocognitive deficits exhibited by OSA patients are unclear and cannot be elucidated in humans for obvious ethical reasons (Berry et al, 1986;Bedard et al, 1991;Morisson et al, 1998).…”

Section: Abstract: Sleep; Apoptosis; Intermittent Hypoxia; Immediatementioning

confidence: 99%

Behavioral and Anatomical Correlates of Chronic Episodic Hypoxia during Sleep in the Rat

2001

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The role played by chronic episodic hypoxia (EHYP) in the neurocognitive morbidity of obstructive sleep apnea (OSA) is unknown. Sleep recordings, Morris water maze experiments, and immunohistochemistry for NMDA NR1 glutamate receptor, c-fos protein, and apoptosis [nuclear immunoreactivity for single-stranded DNA and terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick end labeling assay] were conducted in EHYP-exposed Sprague Dawley male rats. Exposures consisted of up to14 d in an environmental chamber in which O 2 concentrations were cycled between 10 and 21% every 90 sec or 30 min during 12 hr of daylight. For the remaining 12 hr, EHYP rats breathed room air, while controls spent 14 d in room air. Although EHYP induced significant disruption of sleep architecture during the initial day of exposure, sleep patterns normalized thereafter. Marked increases in apoptosis occurred in the CA1 hippocampal region (sevenfold) and cortex (Cx; eightfold) after 1-2 d of EHYP but not in CA3 and were followed by decreases toward normoxic levels by 14 d. Double labeling for NMDA NR1 and c-fos revealed marked architectural disorganization in CA1 and Cx with increases in c-fos over time. Rats exposed to EHYP displayed significantly longer escape latencies and swim path lengths to escape a hidden platform during 12 training trials given over 2 d. Differences in the performances of EHYP and control rats, although reduced, persisted after 14 d of recovery. We conclude that EHYP is associated with marked cellular changes over time within neural regions associated with cognitive functions. Furthermore, EHYP impaired performance during acquisition of a cognitive spatial task without affecting sensorimotor function. Such changes may underlie components of the learning and memory impairments found in OSA.

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Section: Abstract: Sleep; Apoptosis; Intermittent Hypoxia; Immediatementioning

confidence: 99%

Behavioral and Anatomical Correlates of Chronic Episodic Hypoxia during Sleep in the Rat

2001

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“…Neurocognitive deficits, such as excessive daytime sleepiness, learning impairments, and an increased incidence of hyperactivity and aggressive behavior in children, particularly male children, comprise one of the primary morbidities associated with pediatric OSA (3)(4)(5)(6)(7)(8)(9). The IH and sleep fragmentation that are associated with OSA have both been proposed to contribute to the cognitive deficits found in OSA patients, necessitating the development of an appropriate animal model to explore the effects of IH on cognitive function (10 -12).…”

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confidence: 99%

Impaired Spatial Learning and Hyperactivity in Developing Rats Exposed to Intermittent Hypoxia

Row

2002

Pediatric Research

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Obstructive sleep apnea (OSA) is a frequent medical condition and is associated with cognitive impairments in adults and with hyperactivity and decreased school performance in children.In an adult rodent model, intermittent hypoxia (IH), such as occurs in OSA, is associated with neurodegenerative changes in the hippocampus and cortex and with spatial learning deficits. Because a unique developmental window of neural vulnerability to IH is present, we hypothesized that exposure to IH throughout the vulnerable ages would result in increased behavioral impairments in the juvenile rat. Rat pups were therefore exposed to either room air or IH beginning at postnatal (PN) d 10 until PN d 30. Learning and memory were assessed via a standard placetraining version of the Morris water maze beginning at PN d 25. Locomotor activity was assessed on PN d 29 and 30. Pups exposed to IH displayed significant spatial learning impairments, and exposed male rats but not female rats displayed increased locomotor activity in the open field. Collectively, these findings indicate that exposure to IH at an age that corresponds to the peak incidence of OSA in children induces substantial learning impairment and gender-dependent behavioral hyperactivity in the juvenile rat. We postulate that this novel experimental model may allow for future exploration of mechanisms underlying the neurobehavioral deficits of children with OSA. The clinical syndrome of OSA, a condition characterized by repeated episodes of upper airway obstruction during sleep, affects approximately 5% of the general population and approximately 2% of children (1, 2). Neurocognitive deficits, such as excessive daytime sleepiness, learning impairments, and an increased incidence of hyperactivity and aggressive behavior in children, particularly male children, comprise one of the primary morbidities associated with pediatric OSA (3-9). The IH and sleep fragmentation that are associated with OSA have both been proposed to contribute to the cognitive deficits found in OSA patients, necessitating the development of an appropriate animal model to explore the effects of IH on cognitive function (10 -12). Work from our laboratory has recently demonstrated that exposure to IH during sleep does not induce substantial sleep disturbances, and is associated with impaired spatial learning in the adult rat, as well as with increased apoptosis in the cortex and CA1 region of the hippocampus (13).It has become increasingly clear that the magnitude of neurobehavioral impairments in children with OSA is greater than that seen in adults for a comparable degree of sleep disordered breathing. In fact, while an apnea-hypopnea index of 20 events per hour of sleep is considered trivial in the adult patient, it represents a severe case of OSA in children. Furthermore, although rat pups Ͻ5 d of age are more resistant to the apoptotic events induced by IH in the hippocampus and cortex, there is a subsequent period of maximal vulnerability to IH which occurs between PN d 10 and 25, an age that corresp...

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“…Contudo, os pacientes com SAOS apresentaram maior disfunção nos testes de atenção sustentada, reconhecidamente mais afetado pela sonolência. (29) Na tentativa de explicar a relação entre hipoxemia e disfunção cognitiva e neurocomportamental, foi proposto um modelo teórico que costuma ser designado por modelo pré-frontal. Segundo esse modelo, as alterações do sono, a hipercapnia e a hipóxia intermitente observadas nos pacientes com SAOS gerariam estresse ao nível celular e bioquímico, resultando em desequilíbrio homeostático e alteração da viabilidade neuronal e glial em determinadas regiões do cérebro, primariamente no córtex pré-frontal, o que estaria de acordo com algumas das evidências descritas em modelos animais.…”

Section: Estudos Clínicosunclassified

Alterações cognitivas na SAOS

Bruin

Bagnato

2010

J. bras. pneumol.

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ResumoAlterações da cognição e do desempenho estão bem estabelecidas em pacientes com SAOS, causando um impacto significativo sobre a qualidade de vida e o risco de acidentes nesses indivíduos. Tais alterações são mais profundas nos quadros mais graves de SAOS, o que explica a aparente discrepância na frequência e gravidade desse prejuízo entre estudos com pacientes de clínicas de sono e estudos de base populacional. Vários aspectos podem estar comprometidos, incluindo o processamento cognitivo, a atenção sustentada, as funções executivas e a memória. Entretanto, os mecanismos causais desses déficits não estão inteiramente elucidados, e existem controvérsias, particularmente em relação à contribuição relativa da hipóxia intermitente e da interrupção do sono presentes na SAOS. O impacto da sonolência diurna sobre o desempenho desses pacientes nos diversos testes cognitivos também ainda deve ser determinado, assim como o possível efeito de comorbidades frequentes, incluindo o diabete melito, a hipertensão arterial sistêmica, a doença cardiovascular e a obesidade. Existem evidências convincentes de que o tratamento com CPAP produz uma significativa melhora do desempenho e da cognição, sobretudo nos portadores de SAOS moderada e grave, embora sejam necessários mais estudos acerca do seu impacto a longo prazo.Descritores: Apneia do sono tipo obstrutiva; Cognição; Função executiva; Memória; Pressão positiva contínua nas vias aéreas. AbstractCognitive and performance impairment is well established in patients with obstructive sleep apnea syndrome (OSAS), having a significant impact on the quality of life and the risk of accidents in these individuals. The severity of the impairment correlates with that of the OSAS, which explains the apparent discrepancy between studies using patients from sleep clinics and population-based studies in terms of the reported frequency and severity of such impairment. Cognitive processing, sustained attention, executive functioning, and memory have all been reported to be impaired in OSAS. However, the causal mechanisms of these deficits have not been entirely clarified, and the relative contribution of intermittent hypoxia and sleep disruption in OSAS is particularly controversial. The potential effect of daytime sleepiness on the performance of these patients on various cognitive tests has yet to be determined, as does that of common comorbidities, such as diabetes, systemic arterial hypertension, cardiovascular disease, and obesity. There is compelling evidence that CPAP treatment can improve performance and cognition, particularly in mild to moderate cases, although further studies on the long-term impact of this type of treatment are still needed.Keywords: Sleep apnea, obstructive; Cognition; Executive function; Memory; Continuous positive airway pressure. IntroduçãoAs alterações cognitivas na SAOS podem ser múltiplas e variadas, incluindo déficit do processamento cognitivo, de memória, de atenção e das funções executivas.(1,2) Os acidentes de trânsito e de trabalho, importantes marc...

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Neuropsychological Function in Obstructive Sleep Apnea Syndrome (OSAS) Compared to Chronic Obstructive Pulmonary Disease (COPD)

Cited by 84 publications

References 0 publications

Behavioral and Anatomical Correlates of Chronic Episodic Hypoxia during Sleep in the Rat

Behavioral and Anatomical Correlates of Chronic Episodic Hypoxia during Sleep in the Rat

Impaired Spatial Learning and Hyperactivity in Developing Rats Exposed to Intermittent Hypoxia

Alterações cognitivas na SAOS

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