Arousal threshold modifies the effect of CPAP on executive function among individuals with obstructive sleep apnea.

Autor:	Zinchuk AV; Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA andrey.zinchuk@yale.edu., Kushida CA; SUNY Upstate Medical University, Syracuse, NY, USA., Walker A; Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford Hospital and Clinics, Stanford, CA, USA., Wellman A; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Azarbarzin A; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Alex RM; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA., Varga AW; Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, New York., Sands SA; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.; Co-last authors., Yaggi HK; Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut.; Co-last authors.
Jazyk:	angličtina
Zdroj:	The European respiratory journal [Eur Respir J] 2024 Nov 21. Date of Electronic Publication: 2024 Nov 21.
DOI:	10.1183/13993003.01183-2024
Abstrakt:	Arousal Threshold Modifies the Effect of CPAP on Executive Function Among Individuals with Obstructive Sleep Apnea. Background: Obstructive Sleep Apnea (OSA) is associated with neurocognitive dysfunction. However, randomized 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 randomized, sham-controlled trial, Apnea Positive Pressure Long-term Efficacy Study. ArTH was estimated from polysomnography using a translatable method (Sands et al ., SLEEP 2018). Neurocognitive outcomes included the Sustained Working Memory Test-Overall-Mid-Day score (SWMT-OMD, 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. Generalized linear modeling assessed whether the effect of CPAP was modified by baseline ArTH (treatment-by-ArTH interaction). 833 participants with OSA, [apnea-hypopnea index (AHI) ≥10 events/h], available ArTH, and outcomes were analyzed (CPAP n=437, Sham n=396). Results: For executive function, the effect of CPAP treatment was modified by ArTH (p-interaction=0.042). Specifically, for every 1 sd increase in ArTH, the SWMT-OMD score improved by 0.10 95% CI (0.01, 0.18) in active compared to sham CPAP at 6 months; At ArTH 1 sd above the mean SWMT-OMD improvements were nearly three times that in those with average ArTH (0.139 [0.018, 0.261] versus 0.053 [-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. (Copyright ©The authors 2024. For reproduction rights and permissions contact permissions@ersnet.org.)
Databáze:	MEDLINE
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