Sleep Unit, Pneumology Department, Hospital Clínic de Barcelona-Facultat de Medicina, Universitat de Barcelona, Barcelona; CIBERES, Madrid.
Psychiatry and Clinical Psychobiology Department, Facultat de Medicina, Universitat de Barcelona, Barcelona.
Chest. 2015 Nov;148(5):1214-1223. doi: 10.1378/chest.15-0171.
Despite the increasing aging population and the high prevalence of OSA in elderly adults, little is known about cognitive effects of OSA and the effectiveness of CPAP treatment. Therefore, this study investigated whether elderly patients with OSA present cognitive deficits and functional and structural alterations of the brain that could be improved by CPAP treatment.
This randomized, evaluator-blinded, parallel-group, single-center pilot study involved patients aged ≥ 65 years with newly-diagnosed severe OSA syndrome. Thirty-three patients were assigned to receive either conservative care (CC) or CPAP plus CC for 3 months. At baseline and 3 months after treatment, patients underwent a neuropsychologic evaluation and a functional and structural MRI study of connectivity within the default mode network (DMN) and of cortical thickness.
Neuropsychologic evaluation revealed no differences in cognitive performance between OSA groups at baseline. By contrast, after CPAP treatment, patients showed a significant improvement in episodic (between-group difference in change, 7.60; 95% CI, 1.66-13.55; P = .014) and short-term memory (between-group difference in change, 1.06; 95% CI, 0.10-2.01; P = .032) and in executive function (speed of mental processing, 5.74; 95% CI, 1.69-9.79; P = .007; mental flexibility, -47.64; 95% CI, -81.83 to -13.45; P = .008), whereas no changes were observed in the CC group. Neuroimaging revealed an increase in the connectivity in the right middle frontal gyrus after 3 months of CPAP treatment and a higher percentage of cortical thinning in the CC group. No association was seen between cognition and brain functional connectivity changes within the DMN.
Elderly patients with severe OSA who present with cognitive difficulties could benefit from CPAP treatment. Moreover, CPAP treatment increases the connectivity of the DMN and attenuates cortical thinning.
ClinicalTrials.gov; No.: NCT01826032; URL: www.clinicaltrials.gov.
尽管人口老龄化不断加剧，老年人群中阻塞性睡眠呼吸暂停（OSA）的患病率也很高，但人们对 OSA 的认知影响以及 CPAP 治疗的效果知之甚少。因此，本研究旨在探讨老年 OSA 患者是否存在认知缺陷，以及 CPAP 治疗是否可以改善大脑的功能和结构改变。
这是一项随机、评估者设盲、平行组、单中心的初步研究，涉及新诊断为严重 OSA 综合征的年龄≥65 岁的患者。33 名患者被分配接受保守治疗（CC）或 CPAP 加 CC 治疗 3 个月。在基线和治疗 3 个月后，患者接受神经心理学评估和默认模式网络（DMN）内的功能和结构 MRI 连通性以及皮质厚度的研究。
神经心理学评估显示，在基线时 OSA 组之间的认知表现没有差异。相比之下，在 CPAP 治疗后，患者的情景记忆（组间变化差异，7.60；95%置信区间，1.66-13.55；P =.014）和短期记忆（组间变化差异，1.06；95%置信区间，0.10-2.01；P =.032）以及执行功能（心理处理速度，5.74；95%置信区间，1.69-9.79；P =.007；心理灵活性，-47.64；95%置信区间，-81.83 至-13.45；P =.008）有显著改善，而 CC 组没有变化。神经影像学显示，3 个月 CPAP 治疗后右侧额中回的连通性增加，而 CC 组的皮质变薄比例更高。在 DMN 内的大脑功能连通性变化与认知之间没有关联。
患有认知障碍的严重 OSA 老年患者可能会从 CPAP 治疗中受益。此外，CPAP 治疗增加了 DMN 的连通性并减轻了皮质变薄。
ClinicalTrials.gov；编号：NCT01826032；网址：www.clinicaltrials.gov。
