Association Between Fractional Exhaled Nitric Oxide (FeNO) and Cognitive Function in Patients with Obstructive Sleep Apnea
Qilin Zhu,1,* Lili Huang,1,* Licheng Zhu,1 Xiaobai Zhang,1 Honghua Ji,1 Donghua Niu,1 Wangfei Ji,1 Qingqing Ma,1 Rong Chen,1 Haiyan Shi,1 Yihua Wang,2– 4 Lina Xu1 1Department of Respiratory and Critical Care Medicine, Affiliated Nantong Hospital 3 of Nantong University &a...
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| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2025-07-01
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| Series: | Nature and Science of Sleep |
| Subjects: | |
| Online Access: | https://www.dovepress.com/association-between-fractional-exhaled-nitric-oxide-feno-and-cognitive-peer-reviewed-fulltext-article-NSS |
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| Summary: | Qilin Zhu,1,&ast; Lili Huang,1,&ast; Licheng Zhu,1 Xiaobai Zhang,1 Honghua Ji,1 Donghua Niu,1 Wangfei Ji,1 Qingqing Ma,1 Rong Chen,1 Haiyan Shi,1 Yihua Wang,2– 4 Lina Xu1 1Department of Respiratory and Critical Care Medicine, Affiliated Nantong Hospital 3 of Nantong University & Nantong Third People’s Hospital, Nantong, Jiangsu, 226000, People’s Republic of China; 2Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK; 3Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, UK; 4NIHR Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, SO16 6YD, UK&ast;These authors contributed equally to this workCorrespondence: Lina Xu, Email xuvictor8@163.com Yihua Wang, Email yihua.wang@soton.ac.ukPurpose: Obstructive sleep apnea (OSA) is characterised by intermittent hypoxia and sleep fragmentation, both of which can impair cognition. This study aimed to investigate the association between fractional exhaled nitric oxide (FeNO), a non-invasive marker of airway inflammation, and memory performance in patients with OSA.Methods: A total of 102 participants were enrolled: 62 with moderate or severe OSA (apnea-hypopnea index, AHI≥ 15) and 40 with snoring or mild OSA (AHI < 15). Memory was assessed with the Rey-Osterrieth Complex Figure Test (RCFT), Digit Ordering Test (DOT), and Logical Memory Test (LMT). FeNO was measured at 50mL/s (FeNO50) and 200mL/s (FeNO200); alveolar NO (CaNO) was calculated. Group comparisions used t-tests and chi-square tests, cognitive scores employed mixed-design ANOVA, and associations were examined with Spearman correlation plus hierarchical regression.Results: Compared with the snoring or mild OSA group, participants with moderate or severe OSA had larger neck circumference, higher body-mass index, greater daytime sleepiness, and elevated FeNO50 and FeNO200 (P < 0.05). They also showed poorer immediate and delayed visual memory (both P< 0.05), which correlated negatively with AHI (r = − 0.088/-0.103, P < 0.05) and FeNO50 (r = − 0.286/-0.302, P < 0.05). RCFT scores fell over time (F = 271.171, P < 0.05), with a significant group × time interaction (F = 3.065, P < 0.05). FeNO50 independently predicted poorer immediate recall (β = − 0.28, P = 0.018), whereas FeNO200 was not significant.Conclusion: Moderate or severe OSA is associated with impaired immediate and delayed visual memory. Higher FeNO50 correlates with memory decline, supporting a link between airway inflammation and cognitive dysfunction in OSA.Plain language summary: OSA is a common sleep disorder in which breathing repeatedly stops and restarts during the night. This disrupted sleep can lead to persistent tiredness, poor concentration, and memory problems. In our study, we explored whether a quick, non-invasive breath test called FeNO could flag early memory decline in people with OSA. We found that individuals with more severe OSA had higher FeNO readings and poorer memory scores. These findings suggest that FeNO reflects airway inflammation that may also affect the brain. Our study provides early evidence that this simple breath test could help clinicians identify memory issues in OSA patients sooner and more effectively.Keywords: obstructive sleep apnea, polysomnography, fractional exhaled nitric oxide, cognitive function |
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| ISSN: | 1179-1608 |