期刊
EBIOMEDICINE
卷 7, 期 -, 页码 221-229出版社
ELSEVIER
DOI: 10.1016/j.ebiom.2016.03.020
关键词
Obstructive sleep apnea; Continuous Positive Airway Pressure; Neuroimaging; Cognition
资金
- Wellcome Trust [103952/Z/14/Z] Funding Source: Medline
- Department of Health [08/56/02] Funding Source: Medline
- National Institute for Health Research [08/56/02] Funding Source: researchfish
Background: Obstructive sleep apnea (OSA) is a chronic, multisystem disorder that has a bidirectional relationship with several major neurological disorders, including Alzheimer's dementia. Treatment with Continuous Positive Airway Pressure (CPAP) offers some protection from the effects of OSA, although it is still unclear which populations should be targeted, for how long, and what the effects of treatment are on different organ systems. We investigated whether cognitive improvements can be achieved as early as one month into CPAP treatment in patients with OSA. Methods: 55 patients (mean (SD) age: 47.6 (11.1) years) with newly diagnosed moderate-severe OSA (Oxygen Desaturation Index: 36.6 (252) events hour, Epworth sleepiness score (ESS): 12.8 (4.9)) and 35 matched healthy volunteers were studied. All participants underwent neurocognitive testing, neuroimaging and polysomnography. Patients were randomized into parallel groups: CPAP with best supportive care (BSC), or BSC alone for one month, after which they were re-tested. Findings: One month of CPAP with BSC resulted in a hypertrophic trend in the right thalamus [mean difference (%): 4.04, 95% Cl: 1.47 to 6.61], which was absent in the BSC group [-2.29,95% Cl: -4.34 to -0.24]. Significant improvement was also recorded in ESS, in the CPAP plus BSC group, following treatment [mean difference (%): 27.97, 95% Cl: 36.75 to 19.19 vs 246,95% Cl: 5.23 to 10.15; P = 0.012], correlated to neuroplastic changes in brainstem (r = 037; P = 0.05), and improvements in delayed logical memory scores 157.20,95% Cl: 42.94 to 71A6 vs 23A1, 95% Cl: 17.17 to 29.65; P 0.037]. Interpretation: One month of CPAP treatment can lead to adaptive alterations in the neurocognitive architecture that underlies the reduced sleepiness, and improved verbal episodic memory in patients with OSA. We propose that partial neural recovery occurs during short periods of treatment with CPAP. (C) 2016 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.orgllicenses,/by/4.0/).
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