Correction to: Effects of surgery for obstructive sleep apnea on cognitive function and driving performance

Sleep and Breathing - A correction to this paper has been published: https://doi.org/10.1007/s11325-021-02344-w     

Relationship between inflammation and cognitive function in obstructive sleep apnea

Objectives  Obstructive sleep apnea (OSA) can have adverse effects on cognitive functioning, mood, and cardiovascular functioning. OSA brings with it disturbances in sleep architecture, oxygenation, sympathetic nervous system function, and inflammatory processes. It is not clear which of these mechanisms is linked to the decrease in cognitive functioning. This study examined the effect of inflammatory parameters on cognitive dysfunction. Materials and methods  Thirty-nine patients with untreated sleep apnea were evaluated by polysomnography and completed a battery of neuropsychological tests. After the first night of evaluation in the sleep laboratory, blood samples were taken for analysis of interleukin 6, tumor necrosis factor-α (TNF-α), and soluble TNF receptor 1 (sTNF-R1). Results  sTNF-R1 significantly correlated with cognitive dysfunction. In hierarchical linear regression analysis, measures of obstructive sleep apnea severity explained 5.5% of the variance in cognitive dysfunction (n.s.). After including sTNF-R1, percentage of variance explained by the full model increased more than threefold to 19.6% (F = 2.84, df = 3, 36, p = 0.05). Only sTNF-R1 had a significant individual relationship with cognitive dysfunction (β = 0.376 t = 2.48, p = 0.02). Conclusions  sTNF-R1 as a marker of chronic inflammation may be associated with diminished neuropsychological functioning in patients with OSA.     

Effects of somatotropic axis on cognitive dysfunction of obstructive sleep apnea

Purpose

Obstructive sleep apnea (OSA) is associated with a variety of neuroendocrine disorders and may lead to many complications, including cognitive dysfunction. The aim of this study was to assess the change of somatotropic axis and to detect the relation between somatotropic axis hormone and cognitive dysfunction.

Methods

Sixty-six patients with OSA and 16 healthy controls were enrolled in this cross-sectional study. Cognitive function assessment using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) and polysomnography were performed on all individuals. Blood samples were taken the next morning following the polysomnography and the level of serum growth hormone-releasing hormone (GHRH) and growth hormone (GH) were analyzed by enzyme-linked immunosorbent assay.

Results

Compared with the control group, OSA patients showed significantly lower serum GH level (p?<?0.05), whereas no statistical significance of GHRH level was found. In addition, lower MMSE and MoCA scores were found only in the severe OSA patients when compared with the controls. Furthermore, in severe OSA patients with cognitive dysfunction (MMSE score?<?27 and MoCA score?<?26), serum GHRH and GH levels were significantly lower than those without cognitive dysfunction. Logistic analysis revealed that cognitive dysfunction in severe OSA patients was associated with micro-arousal index and the level of serum GHRH and GH.

Conclusion

Decreased serum GH and GHRH levels were found among severe OSA patients with cognitive dysfunction who were overweight, which might promote the occurrence of cognitive dysfunction.

     

Impact of obstructive sleep apnea on right ventricular global function: sleep apnea and myocardial performance index

BACKGROUND: Obstructive sleep apnea (OSA) is characterized by repetitive upper airway obstructions during sleep, and it might cause cardiovascular complications such as heart failure, arrhythmias, myocardial infarction, systemic and pulmonary hypertension. OBJECTIVES: To determine right ventricular diameters and myocardial performance index (MPI) reflecting ventricular global function in uncomplicated OSA patients. METHODS: 49 subjects without hypertension, diabetes mellitus, or any cardiac or pulmonary disease referred for evaluation of OSA had overnight polysomnography and complete echocardiographic assessment. According to the apnea-hypopnea index (AHI), subjects were divided into three groups: group 1: control subjects (AHI <5, n = 20), group 2: patients with mild OSA (AHI: 5-14, n = 11), and group 3: moderate-severe OSA (AHI > or = 15, n = 18). Right ventricular free wall diameter was measured by M mode, and right ventricular MPI was calculated as (isovolumic contraction time + isovolumic relaxation time)/pulmonary ejection time. RESULTS: There were no differences of age, body mass index, heart rates, systolic and diastolic blood pressures among the groups (p > 0.05). Right ventricular end-diastolic and end-systolic diameters were not statistically different between the groups, and were within normal limits. Also, right ventricular free wall diameter was not significantly different between the groups of control, mild OSA and moderate-severe OSA (6.7 +/- 0.9, 6.9 +/- 1.0, 7.1 +/- 1.1 mm, p > 0.05). Right ventricular diastolic dysfunction was shown only in group 3 patients. Right ventricular MPI was statistically higher in group 3 (0.62 +/- 0.18) than in group 2 patients (0.50 +/- 0.10), and group 1 patients (0.48 +/- 0.08, p < 0.001). CONCLUSIONS: It was suggested that patients with moderate-severe OSA had a right ventricular global dysfunction, in addition to the presence of a diastolic dysfunction.     

Influence of obstructive sleep apnea on left ventricular mass and global function: sleep apnea and myocardial performance index

Obstructive sleep apnea (OSA) is associated with cardiovascular mortality and morbidity. It may predispose patients to left ventricular hypertrophy and heart failure. The aim of this study was to determine the left ventricular mass (LVM) and myocardial performance index (MPI) reflecting left ventricular global function in uncomplicated OSA patients. Sixty-four subjects without hypertension, diabetes mellitus, and any cardiac or pulmonary disease referred for evaluation of OSA underwent overnight polysomnography and complete echocardiographic assessment. According to the apnea hypopnea index (AHI), subjects were divided into three groups: group 1, control subjects with nonapneic snorers (AHI < 5, n = 18); group 2, patients with mild to moderate OSA (AHI: 5–30, n = 25); and group 3, severe OSA (AHI > 30, n = 21). Basic echocardiographic measurements, LVM, and LVM index were measured. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler echocardiography. There were no significant differences in age, sex, body mass index, heart rate, and systolic and diastolic blood pressure among the three groups. Left atrium, interventricular septum, left ventricular posterior wall, left ventricular end-diastolic and end-systolic diameters, LVM mass, and LVM index were not significantly different among the three groups. Left ventricular MPI was significantly higher in severe OSA patients (0.64 ± 0.18) than in controls (0.49 ± 0.18; P < 0.05). There was no significant difference between controls (0.49 ± 0.18) and mild to moderate OSA (0.61 ± 0.16; P = 0.08) and between mild to moderate OSA (0.61 ± 0.16) and severe OSA (0.64 ± 0.18; P = 0.84). The present study demonstrates that patients with severe OSA have global left ventricular dysfunction.     

阻塞性睡眠呼吸暂停综合征患者认知功能障碍与信使分子一氧化氮的关系

目的探讨阻塞性睡眠呼吸暂停综合征(OSAS)认知功能障碍的生化机制。方法对2005年3月至11月兰州大学第一医院呼吸科经多导睡眠图确诊的OSAS患者18例及健康体检者14名进行睡眠检测及记忆测试,用镉分光比色法测定血清一氧化氮(NO)浓度,并比较NO与缺氧指标、记忆分数的关系。结果OSAS组视觉再认、数字符号得分显著低于对照组(视觉再认:OSAS组5.33±1.57,对照组8.57±1.91;数字符号:OSAS组6.89±1.23,对照组9.07±1.00;P<0.01);血清NO浓度明显增高[OSAS组(8.10±1.57)mmol/L,对照组(5.61±2.22)mmol/L,P<0.01];NO浓度与缺氧指标、视觉再认、数字符号有显著相关性(P<0.05),与记忆商无相关性。结论高水平NO损害神经系统,造成记忆能力下降,可能是OSAS患者认知功能受损的生化基础。     

Taste disturbance after palatopharyngeal surgery for obstructive sleep apnea

Taste disorder is a rare complication of uvulopalatopharyngoplasty, and may have a significant impact on quality of life. Herein, we report a case of obstructive sleep apnea syndrome in a 51-year-old man who experienced taste disturbance after palatopharyngeal surgery using electrocautery for developing a uvulopalatal flap. Gustatory function test using three-drop-method with solutions of highest concentration was implemented to assess the deficiency of four basic tastes. The results showed deficit of sweet taste associated with phantom of bitter taste. The patient reported constant spontaneous bitter taste and dysgeusia in sweet taste with poor quality of life at the 2-year follow-up. We suggest that patients are informed of the potential for taste impairment from palatopharyngeal surgery, as well as reducing the use of electrocautery in developing uvulopalatal flap to reduce damage to taste function.     

Respiratory muscle function during obstructive sleep apnea

Obstructive sleep apnea (OSA) is characterized by recurrent upper airway obstruction during sleep. Inspiratory muscles may be subjected to potentially fatiguing loads during an obstructive apnea and this may be related to the termination of obstructive apnea. We have measured transdiaphragmatic pressure (Pdi) and breathing patterns in six male patients with OSA during sleep to characterize respiratory muscle function in OSA and determine whether apnea termination is consistently related to a pressure time index of the diaphragm (PTI) associated with respiratory muscle fatigue. There was a large intersubject variability in Pdi generation during apnea. No consistent level of PTI was associated with apnea termination. During prolonged apneas, the respiratory duty cycle plateaued, which is suggestive of an inhibitory reflex possibly mediated by chest wall afferents. There were intersubject differences in both inspiratory and expiratory muscle recruitment during apnea. In the majority of patients, the diaphragm appeared to be the primary inspiratory muscle during apnea, but in some it appeared to be the intercostal/accessory muscles. The majority of patients demonstrated an increase in gastric pressure and inward abdominal movement during the expiratory phases of an apnea, consistent with abdominal muscle recruitment stimulated by increased ventilatory drive.     

Comparison of cognitive performance among different age groups in patients with obstructive sleep apnea

The aim of this study was to evaluate the effect of obstructive sleep apnea syndrome on the cognitive performance of young and middle-aged patients. Patients were divided into two groups, one consisting of 30 patients less than 50 years of age and the other consisting of 28 patients 50 years and over. Normal subjects were similarly divided into two groups, composed of 17 younger and 24 older controls. Patients and controls were examined with all-night polysomnography and subsequently underwent cognitive testing via attention–alertness tests. Comparing young to middle-aged patients, there were statistically significant differences in cognitive performance, especially in attention tests. Younger patients’ cognitive performance was similar to their age-matched controls, while middle-aged patients showed cognitive decline in comparison with their age-matched controls. Although we studied only two age groups using 50 years of age as a cut-off, we could demonstrate that cognitive deterioration of untreated sleep apnea patients is age dependent, and several factors may contribute to this effect including brain hypoxia, sleep fragmentation, or comorbidities. Aging patients with sleep apnea demonstrate cognitive decline, while younger patients with the same disease severity are (somehow) able to compensate for this effect.     

阻塞性睡眠呼吸暂停低通气综合征对机动车驾驶影响的研究现状

阻塞性睡眠呼吸暂停低通气综合征（OSAHS）可损害反应速度、警觉性等认知功能。研究发现OSAHS驾驶员发生机动车事故的机率明显高于非OSAHS驾驶员；经过有效治疗OSAHS患者事故风险回复至非OSAHS人群的水平；商业驾驶员中嗜睡发生率、OSAHS患病率显著高于普通人群。因此，在机动车驾驶人员中，积极预防、发现、诊断和治疗OSAHS，对驾驶员个人健康和安全、对社会交通安全均有重要价值。     

Excessive daytime sleepiness in obstructive sleep apnea: implications for driving licenses

Sleep and Breathing - Excessive daytime sleepiness (EDS) while driving is a major international public health issue resulting in a more than doubled risk of motor vehicle accidents (MVAs)....     

阻塞性睡眠呼吸暂停综合征与认知功能损害

阻塞性睡眠呼吸暂停综合征(OSAS)患者认知功能的损害普遍存在,不同程度的影响了患者的生存质量。这个常见的OSAS合并症却经常被漏诊,使患者得不到及时的诊断和治疗。认知功能损害的机制主要与睡眠间歇低氧和睡眠结构紊乱有关,间歇低氧引发的炎症和氧化应激反应对认知功能相关部位的中枢神经损伤是认知功能障碍的解剖学基础。充分治疗OSAS对认知功能的改善有益,提倡对患者的早期诊断和治疗。     

老年阻塞性睡眠呼吸暂停合并认知功能障碍患者睡眠及脑功能状态特点

目的 探讨老年阻塞性睡眠呼吸暂停(OSA)合并认知功能障碍患者睡眠及脑功能状态特点。方法 招募2022年2月至2023年10月在广西壮族自治区人民医院广西睡眠呼吸疾病诊疗中心就诊的OSA老年患者102例。采集患者多导睡眠监测参数、脑功能状态数据,使用焦虑自评量表(SAS)、抑郁自评量表(SDS)和症状自评量表(SCL90)评估患者的情绪状态,通过匹兹堡睡眠量表(PSQI)评估患者的睡眠质量,用简易智力状态检查量表(MMSE)评估老年人群认知功能损伤程度等。根据MMSE评分将患者分为OSA合并认知功能障碍组(<27分,60例)和单纯OSA组(≥27分,42例),比较两组间多导睡眠监测指标以及脑功能状态指标,分析MMSE评分与脑功能状态、多导睡眠监测指标以及其他量表评分的相关性。结果 OSA合并认知功能障碍组的SDS、SCL90和PSQI评分均显著高于单纯OSA组(P<0.05),MMSE评分(包括定向力、记忆力、回忆能力、语言能力、注意力和计算力评分)及饮酒人数占比显著低于单纯OSA组(P<0.05)。OSA合并认知功能障碍组N2期占比和N2期睡眠时间高于单纯OSA组,...     

Combined effect of obstructive sleep apnea and chronic smoking on cognitive impairment

Objectives

Little is known about combined effect of obstructive sleep apnea (OSA) and chronic smoking on cognitive impairment. We aimed to determine whether smoking synergizes with OSA in deteriorating cognitive function and whether smoking cessation contributes to cognitive benefits.

Methods

One hundred and eighteen male patients were enrolled in the study and asked to complete neurocognitive function tests including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), clock drawing test (CDT), and verbal fluency test (VFT). Variables of those neurocognitive function tests were analyzed with two factors: OSA and smoking.

Results

After adjustment of potential confounding factors, an OSA-by-smoking interaction was found in CDT-C scores and a main smoking effect were showed in MoCA scores. Smoking patients with OSA had the worst performance in the four tests compared with the other three groups (smoking patients without OSA, non-smoking patients with and without OSA). Ex-smokers with OSA tended to perform better than current smokers, but still worse than never-smokers with OSA in those tests.

Conclusion

The results suggested that the coexistence of OSA and chronic smoking resulted in more pronounced cognitive deficits than either factor along. Smoking cessation may benefit cognitive function to some extents in patients with OSA.

     

老年重度阻塞性睡眠呼吸暂停综合征患者同型半胱氨酸水平与认知功能的关系

目的探讨老年重度阻塞性睡眠呼吸暂停综合征（obstructive sleep apnea syndrome, OSAS）患者同型半胱氨酸（homocysteine, HCY）水平与认知功能的关系。 方法选取浙江医院2017年10月至2018年4月收治的老年重度OSAS患者30例（OSAS组）以及同期老年健康体检健康者30例（对照组）,两组患者均行多导睡眠图（polysomnography, PSG）监测,并行血浆HCY测定及简易智力状态检查量表（mini mental state examination, MMSE）评分。比较两组对象睡眠呼吸暂停低通气指数（apnea hypopnea index, AHI）、最低氧饱和度（minimum oxygen saturation, LSO₂）、平均氧饱和度（mean oxygen saturation, MSO₂）、MMSE评分及HCY水平,并作相关性分析。组间比较采用t检验,相关关系采用Pearson相关分析。 结果OSAS组患者AHI及HCY水平均显著高于对照组健康者（t=29.169、4.132,均P<0.01）,LSO₂、MSO₂、MMSE评分均显著低于对照组健康者（t=11.045、11.521、6.774,均P<0.01）。OSAS患者AHI、LSO₂、MSO₂与MMSE评分和HCY水平均无明显相关性（r=0.163、0.265、0.161,0.142、0.027、0.076;均P>0.05）,MMSE评分与HCY水平亦无明显相关性（r=0.203,P>0.05）。 结论老年OSAS患者的认知障碍是由多因素、多环节导致的,HCY水平升高可能是其危险因素之一。