The Relationship between Psychomotor Vigilance Performance and Quality of Life in Obstructive Sleep Apnea

Abstract

Objective: Patients with obstructive sleep apnea (OSA) commonly have cognitive complaints, particularly in attention, and report decreased quality of life. We examined how vigilance and sustained attention, as assessed by the Psychomotor Vigilance Task (PVT), were related to quality of life after controlling for apnea severity and depression in subjects with OSA. Subjects and Methods: Fifty-seven patients with newly diagnosed and untreated OSA had their sleep monitored with polysomnography. Quality of life was assessed by the Short Form-36 health survey questionnaire (SF-36). Mood was assessed by the Center for Epidemiologic Studies-Depression (CES-D) Scale. After sleep monitoring and psychological assessments were performed, the 10-minute PVT was administered. The main outcome variables were PVT lapse count and average response time (RT). Simple correlations and multiple linear regression were used to examine the association between PVT performance and age, body mass index, sleep variables, apnea hypopnea index, oxygen desaturation index, and CES-D. Results and Conclusion: Both the PVT lapse count and RT were significantly associated with the SF-36 physical component summary score (PCS). In multiple linear regression, PVT RT was an independent predictor of the SF-36 PCS (full model R 2 = 0.331, p = 0.003). PVT lapse was also an independent predictor of the SF-36 PCS (full model R 2 = 0.320, p = 0.004). However, neither PVT RT nor lapse was a significant independent predictor of the SF-36 mental component summary score (MCS). Only CES-D was an individual predictor of the SF-36 MCS (β = -0.676, p < 0.001). Impairments in sustained attention and vigilance may underlie the limitations in physical health-related quality of life reported by people with OSA, even after controlling for demographic variables, apnea severity, and depression. S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is a chronic condition characterized by repetitive upper airway obstruction during sleep, leading to apneic episodes, hypoxemia, and recurrent arousals from sleep.1 It has been estimated that 2% to 4% of middle-aged men and 1% to 2% of middle-aged women suffer from OSA, 2 and the rate is even higher in older adults. 3 OSA is associated with considerable morbidity and mortality, particularly from hypertension, cardiovascular disease, and insulin resistance.4,5 Furthermore, the excessive daytime sleepiness associated with OSA can result in an increased risk for motor vehicle crashes 6 or serious industrial accidents. 7People with OSA commonly report having a decreased quality of life (QoL). 8,9 Previous studies have reported that these patients have a significant impairments in virtually every domain of health-related QoL, with the most consistent impairments found in the domains of sleep and vitality/energy. 10 Interestingly, studies have not consistently demonstrated a linear relationship between physiologic measures of OSA severity (i.e., apnea hypopnea index [AHI] or degree of nocturnal oxygen desaturat...

CPAP Adherence is Associated With Attentional Improvements in a Group of Primarily Male Patients With Moderate to Severe OSA

“…The PVT is an objective measure of vigilance performance 43 and has been demonstrated to be sensitive to sleep loss and recovery regardless of cause. 44,45 For OSA, there is not good evidence of a clear dose-response relationship between the primary measure of sleep apnea severity (ie, AHI) and PVT as one might expect, 24,28,29 with the likely reason being that AHI is not highly correlated with daytime symptoms and functioning. However, measures of daytime sleepiness are related to the PVT in patients with OSA.…”

“…The Psychomotor Vigilance Task (PVT) is a sustained attention and reaction time test that has seen widespread use in the study of sleep and circadian rhythms. [25][26][27][28] It has been demonstrated to be sensitive to deficits in alertness and sustained attention, both of which are commonly observed in patients with OSA, 24 as well as improvements in these domains resulting from treatment. [29][30][31][32] A number of studies have provided evidence that attentionrelated impairments resulting from OSA can significantly improve following treatment with CPAP.…”

Fatigue and sleepiness determine respiratory quality of life among veterans evaluated for sleep apnea

“…In another series of 135 consecutive patients with suspected OSA, ESS was associated with generic physical HRQL, but not the AHI or EEG arousal index [10]. Other referral series also fail to show a relationship between AHI and physical HRQL [5, 7, 11]. Given these findings and our own, there appears to be no clear association between OSA severity (as measured by AHI) and generic physical HRQL, even though subjective sleepiness (measured by the ESS) indeed is correlated consistently with HRQL.…”

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“…The following sympathetic activation, with increased levels of catecholamines, leads to atherosclerosis and increased risk for cardiovascular morbidity and mortality . Psychosocial issues, such as depressive symptoms and poor self‐rated health, are also associated with OSA and affect both the patient and partner . A recent Swedish study found that 59% of middle‐aged primary care patients with diagnosed and treated hypertension had undiagnosed and untreated OSA .…”