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From the University of California, San Diego, Departments of Psychiatry (W.A.B., S.A.-I., J.E.D.) and Family and Preventive Medicine (C.C.B.); and Veterans Affairs San Diego Healthcare System (W.A.B., S.A.-I.), San Diego, California.
Address reprint requests to: Wayne A. Bardwell, PhD, University of California, San Diego, Department of Psychiatry-0804, 9500 Gilman Drive, La Jolla, CA 92093-0804. Email: wabardwell{at}ucsd.edu
OBJECTIVE: To determine whether 1-week continuous positive airway pressure (CPAP) treatment, compared with placebo CPAP, improves cognitive functioning in patients with obstructive sleep apnea (OSA).
METHODS: 36 OSA patients (aged 32–60 years, respiratory disturbance index [RDI] > 15) were monitored 2 nights with polysomnography, then randomized for 1-week treatment to CPAP or placebo (CPAP at 2 cm H2O with holes in mask). Participants completed Wechsler Adult Intelligence Scale—Revised Digit Symbol and Digit Span, Trailmaking A/B, Digit Vigilance, Stroop Color-Word, Digit Ordering, and Word Fluency tests pre- and posttreatment. These produced 22 scores per participant, which were analyzed by use of repeated-measures analysis of variance (ANOVA) and a rank-sum test.
RESULTS: In ANOVA, only 1 of the 22 scores showed significant changes specific to CPAP treatment, a number that could be expected by chance alone: Digit Vigilance-Time (p = .035). The CPAP group improved their time (from 7.5 to 6.9 minutes, p = .013). The rank-sum test revealed that the CPAP group had significantly better overall cognitive functioning posttreatment than the placebo group (mean ranks of 17.8 vs. 20.2, respectively; p = .022).
CONCLUSIONS: Although results suggest overall cognitive improvement due to CPAP, no beneficial effects in any specific cognitive domain were found. Future studies of neuropsychological effects of CPAP treatment should include a placebo CPAP control group. Placebo studies that use longer-term treatment might demonstrate additional effects. It is also possible that, even at 2 cm H2O, CPAP conveys some beneficial neuropsychological effects.
Key Words: apnea • CPAP • neuropsychological functioning • cognitive deficits
Abbreviations: AHI = apnea/hypopnea index; ANOVA = analysis of variance; BMI = body mass index; BP = blood pressure; CABG = coronary artery bypass graft; COPD = chronic obstructive pulmonary disease; CPAP = continuous positive airway pressure; O2 = oxygen; PSG = polysomnography; RDI = respiratory disturbance index; REM = rapid eye movement; SD = standard deviation; WAIS = Wechsler Adult Intelligence Scale.
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