The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment

Abstract

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive disturbances. One of the neuropsychological processes most investigated in OSA patients is attention, but the results have been controversial. Here, we update the attention profile of OSA patients with the final aim to improve attention assessment, with a possible impact on clinical and medical-legal practices, in terms of which attention subdomains and parameters need consideration and which one is a high-risk OSA phenotype for attention dysfunctions. Method: For this purpose, we assessed 32 previously untreated OSA patients (26 men and 6 women) under 65 years of age (mean age 53.2 ± 7.3; mean education level 10.4 ± 3.4 years) suffering from moderate to severe sleep apnea and hypopnea (mean apnea-hypopnea index (AHI) 45.3 ± 22.9, range 16.1–69.6). A control group of 34 healthy participants matched with OSA patients for age, education level, and general cognitive functioning were also enrolled. The OSA patients and healthy participants were tested through an extensive computerized battery (Test of Attentional Performance, TAP) that evaluated intensive (i.e., alertness and vigilance) and selective (i.e., divided and selective) dimensions of attention and returned different outcome parameters (i.e., reaction time, stability of performance, and various types of errors). Data analysis: The data were analyzed by ANCOVA which compared the speed and accuracy performance of the OSA and control participants (cognitive reserve was treated as a covariate). The possible mechanisms underlying attention deficits in OSA patients were examined through correlation analysis among AHI, oxygenation parameters, sleepiness scores, and TAP outcomes and by comparing the following three phenotypes of patients: severe OSA and severe nocturnal desaturators (AHI++D+), severe OSA nondesaturators (AHI++D−), and moderate OSA nondesaturators (AHI+D−). Results: The results suggest that the OSA patients manifest deficits in both intensive and selective attention processes and that reaction time (RT) alone is ineffective for detecting and characterizing their problems, for which error analysis and stability of performance also have to be considered. Patients with severe OSA and severe hypoxemia underperformed on alertness and vigilance attention subtests. Conclusions: The data suggest the importance of evaluating attention deficits among OSA patients through several parameters (including performance instability). Moreover, the data suggest a multifaceted mechanism underlying attention dysfunction in OSA patients.

Assessment of Psychological Health Status in Geriatric Patients with Obstructive Sleep Apnea

“…This result may be justified as; the increase in Apnea Hypopnea Index with aging may be related to the increase in weight and the total number of respiratory arousals was significantly decreased in the elderly with OSA. The result of this study is in agreement with a study done in Japan by Hongyo et al, (2016) 19 and in Brazil by Zhao, Viana, Ma & Capasso, (2018) 20 who found that the severity of OSA in elderly patients increased with aging.…”

“…This result may be justified as; EDS is a common complaint in patients with OSA. This result agrees with a study done in Turkey by Balcan & Ozsancak Ugurlu, (2017) 16 and In Italy by Angelelli et al, (2020) 17 who found that most of the studied elders were sleepy. In contrast, a study was done in France by Sforza, Pichot, Martin, Barthelemy & Roche, (2016) 18 reported that only 15% of the patients had excessive daytime sleepiness.…”

Psychological Well-Being in Obstructive Sleep Apnea Syndrome Associated With Obesity: The Relationship With Personality, Cognitive Functioning, and Subjective and Objective Sleep Quality

“…Also, frequent awakenings, episodes of oxyhemoglobin desaturation, and fluctuations of heart-rate, systemic and pulmonary artery pressure are observed. Affected individuals generally report to suffering from excessive daytime sleepiness, sleep fragmentation, and drowsiness, together with decreased energy, reduced level of concentration and alertness, and overall cognitive difficulties (i.e., Akashiba et al, 2002;Zhou et al, 2016;Simões et al, 2018;Angelelli et al, 2020). Crucially, these symptoms impact negatively on individuals' efficacy in daily-life activities, such as working, driving, social interaction, and they increase the risk of (work-or road-) accidents (Vaessen et al, 2015).…”

Screening Severe Obstructive Sleep Apnea in Children with Snoring

“…A substantial volume of evidence has linked pediatric OSA and cardiovascular/metabolic dysfunctions [ 1 , 2 ]. Some research has also suggested a connection between pediatric OSA and neurocognitive/behavioral impairment, but the results are still inconsistent and inconclusive [ 3 ]. Adenotonsillectomy remains the preferred treatment for pediatric OSA [ 4 , 5 ]; however, older children have been reported to have less satisfactory surgical outcomes [ 6 ].…”