Obstructive Sleep Apnea Risk Is Associated with Cognitive Impairment after Controlling for Mild Traumatic Brain Injury History: A Chronic Effects of Neurotrauma Consortium Study

Abstract

The contribution of sleep disturbance to persistent cognitive symptoms following a mild traumatic brain injury (mTBI) remains unclear. Obstructive sleep apnea (OSA) is very common, yet its relationship between risk factors for developing OSA and cognitive performance in those with history of mTBI has not been investigated. The current study examined OSA risk levels and its association with cognitive performance in 391 combat-exposed, post-911 veterans and service members (median age = 37 years) enrolled in the Chronic Effects of Neurotrauma Consortium (CENC) prospective multi-center study. Participants included those with and without mTBI ( n = 326 and 65, respectively). When using clinical cut-offs, those with history of mTBI were more likely to be categorized as high risk for OSA (mTBI positive = 65% vs. mTBI negative = 51%). After adjustment for TBI status and demographic variables, increased OSA risk was significantly associated with worse performance on measures of complex processing speed and executive functioning ( Wechsler Adult Intelligence Scale Fourth Edition Coding, Trail Making Test, part B) and greater symptom burden (Neurobehavioral Symptom Inventory). Thus, OSA, a modifiable behavioral health factor, likely contributes to cognitive performance following mTBI. Accordingly, OSA serves as a potential point of intervention to improve clinical and cognitive outcomes after injury.

Effects of Neurofeedback on Cognitive Function, Productive Activity, and Quality of Life in Patients With Traumatic Brain Injury: A Randomized Controlled Trial

“…Fourth, this study did not investigate several covariates (eg, psychiatric and sleep disturbance symptoms) that may influence cognitive function. 65,66 Therefore, these findings should be interpreted with caution. Lastly, the control group design is not structurally equivalent to that of the 2 intervention groups with respect to time and attention from the care team; therefore, this study may overestimate the therapeutic effect of NFB.…”

Health Conditions Among Special Operations Forces Versus Conventional Military Service Members: A VA TBI Model Systems Study

“…Our finding of an increased prevalence of OSA in SOF personnel may seem counterintuitive at first, given strong associations of OSA with obesity and advanced age. However, there is a growing body of evidence linking OSA to mild TBI, with recent studies showing the estimated prevalence in this population ranges between 65% and 75% 34,35. This finding may also relate to the high rates of chronic pain in SOF personnel relative to CF personnel, as fragmented sleep and hypoxemia in OSA may increase sensitivity to pain while also aggravating systemic inflammation 36.…”

“…However, there is a growing body of evidence linking OSA to mild TBI, with recent studies showing the estimated prevalence in this population ranges between 65% and 75%. 34,35 This finding may also relate to the high rates of chronic pain in SOF personnel relative to CF personnel, as fragmented sleep and hypoxemia in OSA may increase sensitivity to pain while also aggravating systemic inflammation. 36 Finally, rates of hyperlipidemia in SOF are likely associated with higher age in SOF personnel than in CF personnel in this sample.…”

Advanced brain age in deployment-related traumatic brain injury: A LIMBIC-CENC neuroimaging study

“…Participants were included from a secondary analysis of data collected as part of the ongoing LIMBIC-CENC Prospective Longitudinal Study, which is described at length in prior publications (31)(32)(33). Briefly, the parent study collects longitudinal physical, cognitive, mental health, everyday functioning, demographic, fluid biomarker, and neuroimaging data on post-9/11 era SMVs with a history of deployment and either positive or negative mTBI histories at eleven sites throughout the United States.…”