Treatment of obstructive sleep apnea using CPAP and cognitive impairment

Study objectiveTo evaluate the association between obstructive sleep apnea (OSA) and cognitive impairment by comparing individuals with continuous positive airway pressure (CPAP)-treated OSA, untreated OSA, and those without OSA. MethodsIn this cross-sectional study, participants were divided into 3 groups based on overnight sleep study and CPAP use: (1) OSA-CPAP group, (2) OSA-no treatment group, and (3)non-OSA group. The primary outcome was the prevalence of cognitive impairment among 3 groups measured by Montreal Cognitive Assessment (MoCA) and the secondary outcome was ambulatory blood pressure monitoring (ABPM). ResultsA total of 113 participants (male 69.9%, median age: 57.0 years) are enrolled, comprising 50 participants in the OSA-CPAP group, 50 participants in the OSA-no treatment group, and 13 participants in the non-OSA group. The cognitive impairment prevalence was 46.0% in the OSA-CPAP group, 70.0% in the OSA-no treatment group, and 46.0% in the non-OSA groups (p=0.038). Subdomain analysis showed significantly higher scores in memory and visuospatial abilities in the OSA-CPAP and the non-OSA group (p=0.039 and p=0.005). Post-hoc analysis revealed significantly higher MoCA scores and lower prevalence of cognitive impairment in the OSA-CPAP group compared to OSA-no treatment group (p=0.002 and p=0.015). No significant differences in ABPM parameters were observed. ConclusionCPAP therapy in patients with OSA is associated with better cognitive performance and lower prevalence of cognitive impairment. These findings suggest a potential role for OSA treatment preserving cognitive function, however further longitudinal studies are needed. BRIEF SUMMARYThe relationship between obstructive sleep apnea (OSA) and cognitive impairment remains controversial. Most prior studies relied on retrospective analyses or selected participants using strict inclusion and exclusion criteria, limiting their real-world applicability. In this study, we analyzed data from unselected patients attending a sleep clinic. We found that patients with treated OSA had a similar prevalence of cognitive impairment as those without OSA, and both groups had a lower prevalence than patients with untreated OSA.