Simões Eunice N, Padilla Catarina S, Bezerra Marcio S, Schmidt Sergio L
Department of Neurology, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil.
Front Psychiatry. 2018 Oct 4;9:435. doi: 10.3389/fpsyt.2018.00435. eCollection 2018.
Obstructive sleep apnea (OSA) is characterized by apnea-hypopnea during sleep. Overnight polysomnography (PSG) is usually used to detect the frequency of apneic and hypopneic events. Attention and executive deficits are commonly reported in OSA patients. Previous investigations suggested that cognitive impairments were dependent on attention deficits. However, attention is not a unitary domain and consists of different subdomains such as alertness, sustained attention, focused attention, and executive attention (impulsivity/hyperactivity). Little is known about the attention subdomains affected in OSA. Attention is commonly assessed using continuous performance tests, such as the continuous visual attention test (CVAT). Distinct variables can be derived from the CVAT. Each CVAT variable is associated with a specific attention subdomain. This study aimed to examine the variables of the CVAT that are affected by OSA and to identify the most reliable CVAT variable that distinguishes OSA from controls via discriminant analysis. Patients scheduled to perform a PSG were invited to participate in this study. Immediately before the PSG, they performed the CVAT. Based on the PSG results, 27 treatment-naïve OSA patients were sampled. The same number of healthy controls were selected to match the two groups by age and gender. Five CVAT variables were examined: commission errors, omission errors, reaction time (RT), variability of reaction time (VRT), and coefficient of variability (VRT/RT). ANCOVAs indicated that RT and VRT were affected by OSA. No difference in accuracy (omission and commission errors) was observed between healthy controls and OSA patients. When the VRT measurements were corrected for their respective RT values (VRT/RT), the mean difference on this coefficient did not reach significance. The discriminant analysis indicated that the two groups could be best differentiated by the RT variable. Attention problems, commonly observed in OSA patients, may reflect a primary problem on the alertness subdomain. The CVAT was able to detect the primary (alertness-RT parameter) and the secondary deficits (sustained attention-VRT parameter) associated with OSA. As there is no learning effect in the condition of retests, the CVAT can be used to assess the cognitive recovery in OSA patients during treatment.
阻塞性睡眠呼吸暂停（OSA）的特征是睡眠期间出现呼吸暂停和呼吸不足。夜间多导睡眠图（PSG）通常用于检测呼吸暂停和呼吸不足事件的频率。OSA患者常出现注意力和执行功能缺陷。先前的研究表明，认知障碍取决于注意力缺陷。然而，注意力并非单一领域，它由不同的子领域组成，如警觉性、持续注意力、集中注意力和执行注意力（冲动/多动）。关于OSA中受影响的注意力子领域知之甚少。注意力通常使用连续操作测试进行评估，如连续视觉注意力测试（CVAT）。可以从CVAT得出不同的变量。每个CVAT变量都与一个特定的注意力子领域相关。本研究旨在检查受OSA影响的CVAT变量，并通过判别分析确定区分OSA与对照组的最可靠的CVAT变量。计划进行PSG检查的患者被邀请参加本研究。在PSG检查前，他们进行了CVAT测试。根据PSG结果，选取了27例未经治疗的OSA患者。选择相同数量的健康对照，按年龄和性别匹配两组。检查了五个CVAT变量：错误肯定、错误否定、反应时间（RT）、反应时间变异性（VRT）和变异系数（VRT/RT）。协方差分析表明，RT和VRT受OSA影响。健康对照组和OSA患者在准确性（错误否定和错误肯定）方面未观察到差异。当对VRT测量值进行各自RT值的校正（VRT/RT）时，该系数的平均差异未达到显著水平。判别分析表明，RT变量能够最好地区分两组。OSA患者中常见的注意力问题可能反映了警觉性子领域的原发性问题。CVAT能够检测与OSA相关的原发性（警觉性-RT参数）和继发性缺陷（持续注意力-VRT参数）。由于在复测情况下不存在学习效应，CVAT可用于评估OSA患者治疗期间的认知恢复情况。
