Alterações cognitivas na SAOS

Abstract

ResumoAlterações da cognição e do desempenho estão bem estabelecidas em pacientes com SAOS, causando um impacto significativo sobre a qualidade de vida e o risco de acidentes nesses indivíduos. Tais alterações são mais profundas nos quadros mais graves de SAOS, o que explica a aparente discrepância na frequência e gravidade desse prejuízo entre estudos com pacientes de clínicas de sono e estudos de base populacional. Vários aspectos podem estar comprometidos, incluindo o processamento cognitivo, a atenção sustentada, as funções executivas e a memória. Entretanto, os mecanismos causais desses déficits não estão inteiramente elucidados, e existem controvérsias, particularmente em relação à contribuição relativa da hipóxia intermitente e da interrupção do sono presentes na SAOS. O impacto da sonolência diurna sobre o desempenho desses pacientes nos diversos testes cognitivos também ainda deve ser determinado, assim como o possível efeito de comorbidades frequentes, incluindo o diabete melito, a hipertensão arterial sistêmica, a doença cardiovascular e a obesidade. Existem evidências convincentes de que o tratamento com CPAP produz uma significativa melhora do desempenho e da cognição, sobretudo nos portadores de SAOS moderada e grave, embora sejam necessários mais estudos acerca do seu impacto a longo prazo.Descritores: Apneia do sono tipo obstrutiva; Cognição; Função executiva; Memória; Pressão positiva contínua nas vias aéreas. AbstractCognitive and performance impairment is well established in patients with obstructive sleep apnea syndrome (OSAS), having a significant impact on the quality of life and the risk of accidents in these individuals. The severity of the impairment correlates with that of the OSAS, which explains the apparent discrepancy between studies using patients from sleep clinics and population-based studies in terms of the reported frequency and severity of such impairment. Cognitive processing, sustained attention, executive functioning, and memory have all been reported to be impaired in OSAS. However, the causal mechanisms of these deficits have not been entirely clarified, and the relative contribution of intermittent hypoxia and sleep disruption in OSAS is particularly controversial. The potential effect of daytime sleepiness on the performance of these patients on various cognitive tests has yet to be determined, as does that of common comorbidities, such as diabetes, systemic arterial hypertension, cardiovascular disease, and obesity. There is compelling evidence that CPAP treatment can improve performance and cognition, particularly in mild to moderate cases, although further studies on the long-term impact of this type of treatment are still needed.Keywords: Sleep apnea, obstructive; Cognition; Executive function; Memory; Continuous positive airway pressure. IntroduçãoAs alterações cognitivas na SAOS podem ser múltiplas e variadas, incluindo déficit do processamento cognitivo, de memória, de atenção e das funções executivas.(1,2) Os acidentes de trânsito e de trabalho, importantes marc...

<p>Abnormal resting-state functional connectivity of amygdala subregions in patients with obstructive sleep apnea</p>

“…Additionally, OSA is a multisystem chronic disease that is often associated with a variety of other diseases, such as cardiovascular disease,6 hypertension, stroke, chronic kidney disease,7 depression,8 anxiety, insomnia, and even Alzheimer’s disease (AD) 9. Furthermore, cognitive dysfunction has been observed in patients with OSA, including deficits in attention, memory, executive functions, emotion, visuospatial function,10 psychomotor speed, fine coordination, and language ability 11,12. The cognitive impairment observed in OSA patients is generally believed to be caused by adverse effects of long-term exposure to chronic intermittent hypoxia13 and sleep fragmentation.…”

“…Furthermore, aberrant spontaneous brain activity in the whole brain or regional areas has been confirmed through resting-state functional magnetic resonance imaging (rs-fMRI) methods in patients with OSA 21–26. Published studies have identified that OSA patients have impaired attention, memory, emotion, and executive functions, which are correlated with multiple brain regions including the amygdala, insular cortex, cingulate cortex, frontal regions, thalamus, temporal region, hippocampus, cerebellum, and precuneus 10,27…”

Improved prediction of CPAP failure using T90, age and gender

“…Central nervous system symptoms, with excessive daytime sleepiness being the main clinical symptom (Dostálová et al, 2012;Tóthová et al, 2015), severely limit everyday life activities and, in some cases, leads to disability. In older SAS patients especially, associated memory problems and depression can further worsen the quality of life (Bruin and Bagnato, 2010;Onen and Onen, 2010).…”

Fluid Redistribution in Sleep Apnea: Therapeutic Implications in Edematous States

“…Individuals with SA usually present witnessed episodes of snoring, choking, and are more likely to suffer from daytime sleepiness ( 1 ), depression ( 2 , 3 ) and are at increased risk of motor vehicle crash ( 4 ), and occupational accidents ( 5 ). Other important adverse consequences of SA include neuropsychiatric disorders, such as cognitive impairment ( 6 ), abnormal sympathetic activity ( 7 ), and cardiovascular abnormalities such as hypertension ( 8 ), stroke, and arterial obstruction ( 9 ).…”