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Background <p>This study aimed to identify characteristics associated with cognitive impairment in older individuals with obstructive sleep apnoea (OSA) using the Addenbrooke’s Cognitive Examination-Revised (ACE-R) that could aid in stratifying those at higher risk for impairment.</p> Methods <p>We analysed existing cross-sectional datasets that measured the performance of 89 adult patients (aged 50–85 years) with OSA on the ACE-R cognitive test. Receiver operating characteristic curves and logistic regression analysis were utilised to identify associations between impairment status and various factors, including demographic characteristics, self-reported sleepiness, cognitive complaints, and OSA severity.</p> Results <p>According to established thresholds (ACE-R <i>≤</i> 88), 36% of participants were cognitively impaired. When adjusted for age and education, the strongest factors associated with impairment status were prior measures of arousal index (cut-off: <i>≥</i>28events/hr, OR: 5.67, <i>p</i> &lt; 0.01), sleep mean SpO<sub>2</sub> (cut-off: <i>≤</i>92%, OR: 3.52, <i>p</i> &lt; 0.05), 3% oxygen desaturation index (cut-off: <i>≥</i>27events/hr, OR: 3.75, <i>p</i> &lt; 0.05), and sleep time spent under 90% SpO<sub>2</sub> (cut-off: <i>≥</i>9%, OR: 3.16, <i>p</i> &lt; 0.05). Combining these factors achieved a high sensitivity (<i>≥</i> 93%) of detecting impairment within this cohort. Conversely, the apnoea-hypopnoea index, daytime sleepiness, and cognitive complaints were not associated with impairment status.</p> Conclusions <p>The ACE-R identified a significant proportion of patients with OSA as having cognitive impairment. Traditional indices of sleep fragmentation and hypoxaemia may allow clinicians to identify at-risk patients for cognitive evaluation, however further studies are needed to validate these findings and explore whether poor cognitive performance can be remediated via OSA treatment.</p>

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Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月10日

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  • Thomas Georgeson,
  • Lacey Atkins,
  • Alex Zahnleiter,
  • Philip I Terrill,
  • Eamonn Eeles,
  • Elizabeth J Coulson,
  • Irene Szollosi

摘要

Background

This study aimed to identify characteristics associated with cognitive impairment in older individuals with obstructive sleep apnoea (OSA) using the Addenbrooke’s Cognitive Examination-Revised (ACE-R) that could aid in stratifying those at higher risk for impairment.

Methods

We analysed existing cross-sectional datasets that measured the performance of 89 adult patients (aged 50–85 years) with OSA on the ACE-R cognitive test. Receiver operating characteristic curves and logistic regression analysis were utilised to identify associations between impairment status and various factors, including demographic characteristics, self-reported sleepiness, cognitive complaints, and OSA severity.

Results

According to established thresholds (ACE-R ≤ 88), 36% of participants were cognitively impaired. When adjusted for age and education, the strongest factors associated with impairment status were prior measures of arousal index (cut-off: ≥28events/hr, OR: 5.67, p < 0.01), sleep mean SpO2 (cut-off: ≤92%, OR: 3.52, p < 0.05), 3% oxygen desaturation index (cut-off: ≥27events/hr, OR: 3.75, p < 0.05), and sleep time spent under 90% SpO2 (cut-off: ≥9%, OR: 3.16, p < 0.05). Combining these factors achieved a high sensitivity (≥ 93%) of detecting impairment within this cohort. Conversely, the apnoea-hypopnoea index, daytime sleepiness, and cognitive complaints were not associated with impairment status.

Conclusions

The ACE-R identified a significant proportion of patients with OSA as having cognitive impairment. Traditional indices of sleep fragmentation and hypoxaemia may allow clinicians to identify at-risk patients for cognitive evaluation, however further studies are needed to validate these findings and explore whether poor cognitive performance can be remediated via OSA treatment.