Cognitive Functions, Depressive and Anxiety Symptoms After One Year of CPAP Treatment in Obstructive Sleep Apnea

Figures & data

Table 1 Inclusion and Exclusion Criteria

Inclusion criteria

Moderate to severe obstructive sleep apnoea (apnoea-hypopnoea index >15) according to Czech guidelines for diagnostic and treatment of OSA.^Citation72

Both sexes

Age between 18 and 70 years

Written consent with the study

Exclusion criteria

Severe mental disorder lifetime

Present psychiatric disorder

Present usage of psychofarmacs

Neurological disorders

Intellectual disability

Acute suicidal syndrome

Surgically treatable cause of OSA

Hypoxemia requires an oxygen supply

The initial refusal of the CPAP therapy

Indication to the other positive pressure therapy modes (bi-level airway pressure, etc.)

Table 2 Initial Measures of Patients at the Beginning of the CPAP Treatment

Variable	All Patients Included in the Study (n=81)	CPAP Adherent Group (n=59)	CPAP Non-Adherent (n=8)
AHI	49.8 ± 23.6	51.7 ± 24.3	39.3 ± 12.1
ODI	62.4 ± 56.2	65.3 ± 64.2	41.3 ± 9.9
t90	27.5 ± 28.1	26.7 ± 27.1	11.9 ± 12.9
Average saturation of 02	90.5 ± 4.1	90.5 ± 4.0	92.7 ± 1.5
CRP	4.6 ± 6.1	4.2 ± 3.1	1.1 ± 0.3
BMI	37.3 ± 7.2	37.1 ± 7.0	34.4 ± 6.8
BDI-II	8.4 ± 6.7	7.7 ± 5.2	7.5 ± 5.1
BAI	9.1 ± 7.4	8.8 ± 7.5	6.7 ± 6.3
ESS	8.6 ± 4.1	8.7 ± 3.9	6.1 ± 4.3

Abbreviations: AHI, apnoe/hypopnoe index; ODI, oxygen desaturation index; t90, time spent under 90% saturation; CRP, C-reactive protein; BMI, body mass index; BDI-II, Beck depression inventory; BAI, Beck anxiety inventory; ESS, Epworth Sleepiness Scale.

Table 3 Summary of OSA Treatment Results in Adherent and Non-Adherent Group

	CPAP adherent group (n=59)	CPAP adherent group (n=59)	p-value	CPAP adherent group (n=59)	p-value
	Beginning	2-month follow-up		1-year follow-up
ESS	8.7 ± 3.9	4.2 ± 2.3	<0.001	3.2 ± 2.4	<0.001
AHI	51.7 ± 24.3	4.3 ± 5.7	<0.0001	3.3 ± 3.5	<0.001
	CPAP non-adherent group (n=8)	CPAP non-adherent group (n=8)	p-value	CPAP non-adherent group (n=8)	p-value
	Beginning	2-month follow-up		1-year follow-up
ESS	6.1 ± 4.3	3.8 ± 3.2	n.s.	4.6 ± 2.9	n.s.
AHI	39.3 ± 12.1	Not used CPAP	x	Not used CPAP	x

Abbreviations: ESS, Epworth sleepiness scale; AHI, Apnoe/hypopnoe index; n.s., non-significant; x, p-value cannot be calculated.

Table 4 Comparison of Results in BDI-II and BAI in the Adherent Group

	CPAP adherent group (n=59)	CPAP adherent group (n=59)	p-value	Effect size (Cohen’s d)	CPAP adherent group (n=59)	p-value	Effect size (Cohen’s d)
	Beginning	2-month follow-up			1-year follow-up
BDI-II	7.7 + 5.2	4.2 ± 4.4	<0.001	0.63	4.4 ± 4.5	<0.001	0.61
BAI	8.8 + 7.5	5.4 ± 5.5	<0.001	0.71	5.3 ± 5.4	<0.001	0.59
	CPAP non-adherent group (n=8)		p-value	Effect size (Cohen’s d)	CPAP non-adherent group (n=8)	p-value	Effect size (Cohen’s d)
	Beginning				1-year follow-up
BDI-II	7.5 + 5.1	3.6 + 5.5	0.053	0.67	3.1 + 4.9	<0.01	0.96
BAI	6.7 + 6.3	8.2 + 6.2	n.s.	0.21	5.0 + 2.9	n.s.	0.27

Abbreviations: BDI-II, Beck depression inventory; BAI, Beck anxiety inventory.

Table 5 Comparison of Results in Cognitive Tests in the Adherent Group

	CPAP adherent group (n=59)	CPAP adherent group (n=59)	p-value	Effect size (Cohen’s d)
	Beginning	1-year follow-up
TMT-A (s)	34.8 ± 9.8	34.6 ± 9.6	n.s.	0.02
TMT-B (s)	81.3 ± 29.5	70.7 ± 19.1	p<0.01	0.39
VFT	44.7 ± 13.2	49.4 ± 15.3	p<0.01	0.41
d2 – performance	308.7 ± 96.2	350.5 ± 102.9	p<0.001	0.50
d2 - % mistakes	18.67 ± 14.2	16.5 ± 12.3	n.s. (p=0.16)	0.19
	CPAP non-adherent group (n=8)	CPAP non-adherent group (n=8)	p-value	Effect size (Cohen’s d)
	Beginning	1-year follow-up
TMT-A (s)	27.3 ± 6.3	32.7 ± 6.7	n.s.	0.83
TMT-B (s)	77.1 ± 19.5	70.8 ± 16.4	n.s.	0.31
VFT	47.1 ± 20.8	49.5 ± 19.3	n.s.	0.25
d2 – performance	338.4 ± 124.2	354.5 ± 82.2	n.s.	0.18
d2 - % mistakes	15.5 ± 10.3	25.6 ± 15.4	p<0.01	1.11

Abbreviations: TMT-A, trial-making test part A; TMT-B, trial-making test part B; VFT, verbal fluency test.

Pretl M, Hobzová M, Honnerová M, et al. Indikační kritéria pro léčbu poruch dýchání ve spánku pomocí přetlaku v dýchacích cestách u dospělých Dokument České společnosti pro výzkum spánku a spánkovou medicínu. [Indication criteria for the treatment of sleep-disordered breathing using excess pressure in the airways in adults Document of the Czech Society for Sleep Research and Sleep Medicine]. Neurologie pro praxis. 2013;14(1):38–41.

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