Effect of Nasal Continuous Positive Airway Pressure on Neuropsychological Function in Sleep Apnea–Hypopnea Syndrome

Abstract

A placebo-controlled, partial cross-over, double-blind, randomized study was performed with 46 adults with sleep apnea-hypopnea syndrome (SAHS) to determine the effect of therapeutic and subtherapeutic (0-1 cm H(2)O) nasal continuous positive airway pressure (CPAP) treatment on polysomnographic and neuropsychological testing. The following neuropsychological tests were administered: Geriatric Depression Scale, Trail Making A and B, Digit Span Test Forward and Backward, Epworth Sleepiness Scale, SteerClear, Digit Symbol, Controlled Oral Word Association, and Complex Figure Recall. Compared with results without CPAP, subtherapeutic CPAP did not affect any measured polysomnographic parameter. Comparison of neuropsychological test results obtained between the initial periods of effective treatment (Group 1, 16.1 d; Group 2, 19.6 d; p = NS) in all subjects showed significant improvements in Digit Symbol, Digit Span Backward, and Complex Figure tests. However, there were no group differences in changes in test results during the period when one group was on effective CPAP and the other on ineffective CPAP (Group 1, 16.1 d; Group 2, 13.9 d; p = NS). The results indicate the feasibility and importance of using ineffective CPAP as a placebo treatment and the importance of including a placebo control in studies evaluating the effect of treatment on neuropsychological function in SAHS.

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea

“…However, although the mean variation in the PC20 did not reach statistical significance, 55% of patients who received sham‐CPAP showed a decrease in the BHR. On the other hand, in patients with OSAS, it has been observed a significant difference after using sham‐CPAP both in the degree of daytime hypersomnia and in several polysomnographic parameters: While hypersomnia improved 42, the quality of the sleep became worse (decreased sleep efficiency, increased time in stage 1 NREM sleep, and prolonged latency to REM sleep) 43. Therefore, taking into account the existing correlations between sleep quality, daytime hypersomnia, quality of life, and asthma control 44, 45, and the potential effect of sham‐CPAP in BHR 34, it cannot be excluded that subtherapeutic CPAP pressures, used as a placebo in asthmatic patients with OSAS, may have relevant effects on asthma outcomes that would distort the results of a controlled study.…”

Nasal CPAP Improves the Quality of Life and Lessens the Depressive Symptoms in Patients with Obstructive Sleep Apnea Syndrome

“…After skepticism was expressed concerning the effectiveness of nasal CPAP because of a lack of randomized controlled trials (33), several randomized placebo-controlled studies were reported (17,18,34,35). Most of these demonstrated the clinical effectiveness of nasal CPAP in terms of EDS (17,18), QOL (34), and cardiovascular complications (35). Henke et al (34) compared the effectiveness of therapeutic and subtherapeutic (placebo) CPAP for improving neuropsychological functions in patients with OSAS, finding no intergroup differences in changes in routine clinical test results during a period when one group received effective CPAP and the other received ineffective CPAP.…”

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

“…[48][49][50][51] In addition, a recent case study has reported that suicidal ideation and depression were rapidly resolved in a patient with severe OSA after initiation of CPAP treatment. 52 Conversely, a number of studies have reported that CPAP does not affect depression scores in patients with OSA [53][54][55][56] ; however, a comprehensive meta-analysis has revealed that all of these negative studies investigated patients who had mild depression at baseline or excluded patients with major depressive disorder. 26 This study design may have skewed the study outcomes toward a negative result, as it has been reported previously that patients with OSA and more severe mood disorders receive the greatest benefit from CPAP.…”