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Obstructive Sleep Apnea–Hypopnea and Neurocognitive Functioning in
The Sleep Heart
Health Study.
ABSTRACT
Background and purpose: Obstructive sleep apnea–hypopnea (OSAH) is associated
with sleep fragmentation and nocturnal hypoxemia. In clinical samples, patients with OSAH frequently are
found to have deficits in neuropsychological function. However, the nature and severity of these abnormalities
in non-clinical populations is less well defined.
Patients and methods: One hundred and forty-one participants from the Tucson, AZ and New York, NY
field centers of the Sleep Heart Health Study completed a battery of neuropsychological tests for 9–40 months
(mean=24 months, SD=7 months) after an unattended home polysomnogram. Sixty-seven participants had OSAH
(AHI>10) and 74 did not have OSAH (control (CTL), apnea–hypopnea index (AHI)<5). In addition to the individual
tests, composite variables representing attention, executive function, MotorSpeed and processing speed were
constructed from the neuropsychological test battery.
Results: There were no significant differences in any individual neuropsychological test or composite
variable between the OSAH and CTL groups. However, when time spent with O2 saturations less than 85% was
dichotomized into those participants in the top quartile of the distribution and those in the lower three
quartiles, motor speed was significantly impaired in those who were more hypoxemic. In addition, poorer motor
speed (model adjusted R2=0.242, P<0.001) and processing speed performance (model adjusted R2=0.122, P<0.001)
were associated with more severe oxygen desaturation even after controlling for degree of daytime sleepiness,
age, gender and educational level.
Conclusions: Mild to moderate OSAH has little impact on the selected measures of attention, executive
function, motor speed and processing speed. However, hypoxemia adversely affects both motor and processing
speed. These results suggest that in middle-aged to elderly adults the neuropsychological effects of
clinically unrecognized mild to moderate OSAH are neither global nor large.
Keywords: Sleep disordered breathing, Obstructive sleep apnea, Neuropsychologic function, Hypoxemia,
Neurocognitive function, epidomiology
