Werli Ksdy S, Otuyama Leonardo J, Bertolucci Paulo H, Rizzi Camila F, Guilleminault Christian, Tufik Sergio, Poyares Dalva
Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil.
Sleep Med. 2016 Oct;26:6-11. doi: 10.1016/j.sleep.2016.06.028. Epub 2016 Oct 6.
This study aimed to evaluate neurocognitive function in adult patients with residual excessive sleepiness (RES) after appropriate treatment of obstructive sleep apnea (OSA) with CPAP and good adherence to treatment.
This was a prospective controlled study. We included patients of both sexes, aged 35-60 years with OSA and an apnea-hypopnea index >20 ev/h, effectively treated with CPAP, but with a residual Epworth Sleepiness Scale score ≥11. The control group consisted of OSA patients adequately treated with CPAP who did not present with excessive sleepiness after treatment. Both groups underwent the following evaluations: polysomnography, multiple sleep latency testing, depression symptoms, and cognitive assessment.
Regarding baseline characteristics, the data were matched for age, years of study, and body mass index. Long-term memory result did not show a significant difference between the two groups (RES group 4.7 ± 2.0; control group 6.5 ± 1.9; p = 0.08). The executive functions were the most affected, with alterations in Wisconsin test, number of categories (RES group: 1.6 ± 1.4; control group: 3.0 ± 1.4; p = 0.01), and semantic verbal fluency test (RES group: 13.6 ± 3.3; control group: 16.9 ± 4.3; p = 0.04).
In summary, the mean depression scale score in the group with residual excessive sleepiness was significantly higher than that in the control group. Patients with residual excessive sleepiness showed impairment of executive functions but no impairments in other cognitive domains.
本研究旨在评估阻塞性睡眠呼吸暂停（OSA）患者经持续气道正压通气（CPAP）适当治疗且治疗依从性良好后仍存在残余过度嗜睡（RES）的成年患者的神经认知功能。
这是一项前瞻性对照研究。我们纳入了年龄在35 - 60岁、患有OSA且呼吸暂停低通气指数>20次/小时的成年男女患者，这些患者经CPAP有效治疗，但Epworth嗜睡量表评分仍≥11分。对照组由经CPAP充分治疗且治疗后无过度嗜睡症状的OSA患者组成。两组均接受以下评估：多导睡眠图、多次睡眠潜伏期测试、抑郁症状评估和认知评估。
关于基线特征，两组在年龄、受教育年限和体重指数方面的数据相匹配。两组的长期记忆结果无显著差异（RES组4.7±2.0；对照组6.5±1.9；p = 0.08）。执行功能受影响最大，威斯康星测试、分类数量（RES组：1.6±1.4；对照组：3.0±1.4；p = 0.01）以及语义言语流畅性测试（RES组：13.6±3.3；对照组：16.9±4.3；p = 0.04）均有改变。
总之，残余过度嗜睡组的平均抑郁量表评分显著高于对照组。残余过度嗜睡患者存在执行功能受损，但其他认知领域未受损。
