Daytime Hypercapnia Impairs Working Memory in Young and Middle-Aged Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Abstract

Purpose

Obstructive sleep apnea hypopnea syndrome (OSAHS) can lead to cognitive impairment, though few studies have so far examined hypercapnia as its causal mechanism, due to the invasive nature of conventional arterial CO₂ measurement. The study aims to investigate the effects of daytime hypercapnia on working memory in young and middle-aged patients with OSAHS.

Patients and Methods

This prospective study screened 218 patients and eventually recruited 131 patients (aged 25–60 years) with polysomnography (PSG)-diagnosed OSAHS. Using a cut-off of 45mmHg daytime transcutaneous partial pressure of carbon dioxide (PtcCO₂), 86 patients were assigned into the normocapnic group and 45 patients into the hypercapnic group. Working memory was evaluated using the Digit Span Backward Test (DSB) and the Cambridge Neuropsychological Test Automated Battery.

Results

Compared with the normocapnic group, the hypercapnic group performed worse in verbal, visual, and spatial working memory tasks. PtcCO₂≥45mmHg was an independent predictor for lower DSB scores (OR=4.057), lower accuracy in the immediate Pattern Recognition Memory (OR=2.600), delayed Pattern Recognition Memory (OR=2.766) and Spatial Recognition Memory (OR=2.722) tasks, lower Spatial Span scores (OR=4.795), and more between errors in the Spatial Working Memory task (OR=2.734 and 2.558, respectively). Notably, PSG indicators of hypoxia and sleep fragmentation did not predict task performance.

Conclusion

Hypercapnia may be plays an important role in working memory impairment in patients with OSAHS, perhaps more so than hypoxia and sleep fragmentation. Routine CO₂ monitoring in these patients could prove of utility in clinical practices.

Keywords:

• hypercapnia
• obstructive
• sleep apnea
• working memory

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics Approval

Approved by the Research Ethics Committee of the Second Affiliated Hospital of Soochow University, Suzhou, China (JD-LK-2018-004-02). Our study was conducted in accordance with the Declaration of Helsinki.

Consent for Participation and Publication

Informed consent was sought from all patients involved, with the understanding that anonymized data could be used for research and publications.

Acknowledgments

The authors thank technicians in department of Sleeping Center at the Second Affiliated Hospital of Soochow University for technical assistance throughout the study.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

National Natural Science Foundation of China (Grant/Award Number: 81770085,82070095); Discipline Construction Program of the Second Affiliated Hospital of Soochow University (Grant/Award Number XKTJ-TD202003).