Sleep apnea linked to cognitive difficulties

Patients with obstructive sleep apnea (OSA) may blame their daytime difficulties on simple sleepiness, but new research suggests that their brains may be to blame. Specifically, their cognitive challenges may be caused by structural deficits in gray matter, brought on by the intermittent oxygen deprivation that comes with OSA. The good news is that these deficits may be partially or fully reversible with early detection and treatment, according to Italian researchers.

“OSA patients demonstrate several neuropsychological impairments, but current knowledge of the brain structures affected by OSA is limited. This study provides the first evidence that structural brain abnormalities exist in regions susceptible to hypoxemia, and they can change with treatment,” said Vincenza Castronovo, Ph.D., clinical psychologist at the Sleep Disorders Center, Vita-Salute San Raffaele University and San Raffaele Scientific Institute in Milan, Italy.

The study was published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine

To determine whether there were quantifiable structural differences in the brains of OSA patients when compared to individuals without OSA, and whether any differences found could be reversed with treatment, researchers compared 17 treatment-naïve individuals with severe OSA and 15 age-matched controls. They gathered baseline measurements of brain anatomy using MRI, as well as individual performance on cognitive performance tests that assessed short- and long-term memory, executive functions, constructional abilities, vigilance, attention and abstract reasoning. The subjects also completed the Epworth Sleepiness Scale to assess daytime sleepiness and the Beck Depression Inventory to evaluate mood.

The researchers found significant reductions in gray matter (GM) between OSA and non-OSA subjects. Moreover, the specific locations of the deficits indicated that specific brain functions were more strongly affected than others, including executive function (which controls high-order brain functions such as problem-solving) and abstract reasoning.

“We found reduced GM in the OSA group when compared to the non-OSA group in several key regions of the brain,” said Dr. Castronovo. “Of particular note were the deficits in the left parahippocampal gyrus and in the left posterior-parietal cortex. We found that these two regions have significant bearing on abstract reasoning and executive function. Deficits in the left posterior-parietal cortex were also shown to be associated with daytime sleepiness.”

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