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Contribution of hypercapnia to cognitive impairment in severe sleep-disordered breathing
- Source :
- J Clin Sleep Med
- Publication Year :
- 2022
- Publisher :
- American Academy of Sleep Medicine (AASM), 2022.
-
Abstract
- STUDY OBJECTIVES: Although cognitive impairment in obstructive sleep apnea (OSA) is primarily attributed to intermittent hypoxemia and sleep fragmentation, hypercapnia may also play a role in patients whose OSA is complicated by hypoventilation. This study investigated the impact of hypercapnia on cognitive function in severe sleep-disordered breathing (OSA accompanied by hypoventilation). METHODS: Patients with severe OSA (apnea-hypopnea index >30 events/h; n = 246) underwent evaluation for accompanying hypoventilation with polysomnography that included continuous transcutaneous carbon dioxide (TcCO(2)) monitoring and awake arterial blood gas analysis. Patients were categorized as having no hypoventilation (n = 84), isolated sleep hypoventilation (n = 40), or awake hypoventilation (n = 122). Global cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA), memory with the Rey Auditory Verbal Learning Test (RAVLT), and processing speed with the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), Digit Symbol Coding subtest (DSC). RESULTS: Apnea-hypopnea index was similar across groups (P = .15), but the sleep and awake hypoventilation groups had greater nocturnal hypoxemia compared with the no-hypoventilation group (P < .01). Within all groups, mean MoCA scores were < 26, which is the validated threshold to indicate mild cognitive impairment; RAVLT scores were lower than age-matched norms only in the awake-hypoventilation group (P ≤ .01); and DSC scores were lower than age-matched norms within all groups (P < .01). In multivariable regression analyses, higher arterial partial pressure of carbon dioxide (PaCO(2)) and TcCO(2) during wakefulness were associated with lower MoCA and DSC scores (P ≤ .03), independent of confounders including overlap syndrome (OSA + chronic obstructive pulmonary disease). CONCLUSIONS: Awake hypoventilation is associated with greater deficits in cognitive function in patients with severe sleep-disordered breathing. CITATION: Beaudin AE, Raneri JK, Ayas NT, Skomro RP, Smith EE, Hanly PJ; on behalf of Canadian Sleep and Circadian Network. Contribution of hypercapnia to cognitive impairment in severe sleep-disordered breathing. J Clin Sleep Med. 2022;18(1):245–254.
- Subjects :
- Adult
Pulmonary and Respiratory Medicine
Canada
medicine.medical_specialty
Polysomnography
Hypoxemia
Hypercapnia
Sleep Apnea Syndromes
Internal medicine
medicine
Humans
Cognitive Dysfunction
medicine.diagnostic_test
business.industry
Montreal Cognitive Assessment
medicine.disease
Scientific Investigations
respiratory tract diseases
Hypoventilation
Obstructive sleep apnea
Neurology
Cardiology
Breathing
Wakefulness
Neurology (clinical)
medicine.symptom
business
Subjects
Details
- ISSN :
- 15509397 and 15509389
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Journal of Clinical Sleep Medicine
- Accession number :
- edsair.doi.dedup.....e534be377d5d2fff00d34ab8172c9b6f