Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea
Abstract 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 a...
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BMC
2025-01-01
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| Series: | Sleep Science and Practice |
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| Online Access: | https://doi.org/10.1186/s41606-024-00120-9 |
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| author | Thomas Georgeson Lacey Atkins Alex Zahnleiter Philip I Terrill Eamonn Eeles Elizabeth J Coulson Irene Szollosi |
| author_facet | Thomas Georgeson Lacey Atkins Alex Zahnleiter Philip I Terrill Eamonn Eeles Elizabeth J Coulson Irene Szollosi |
| author_sort | Thomas Georgeson |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-b00222422fb44c8dac03be2c832a9301 |
| institution | DOAJ |
| issn | 2398-2683 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | Sleep Science and Practice |
| spelling | doaj-art-b00222422fb44c8dac03be2c832a93012025-08-20T02:40:36ZengBMCSleep Science and Practice2398-26832025-01-019111110.1186/s41606-024-00120-9Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoeaThomas Georgeson0Lacey Atkins1Alex Zahnleiter2Philip I Terrill3Eamonn Eeles4Elizabeth J Coulson5Irene Szollosi6Sleep Disorders Centre, The Prince Charles HospitalClem Jones Centre for Ageing Dementia Research, Queensland Brain InstituteSchool of Biomedical Sciences, The University of QueenslandSchool of Information Technology and Electrical Engineering, The University of QueenslandInternal Medicine, The Prince Charles HospitalSchool of Biomedical Sciences, The University of QueenslandSleep Disorders Centre, The Prince Charles HospitalAbstract 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.https://doi.org/10.1186/s41606-024-00120-9OSACognitive impairmentCognitive complaintACE-RPSGESS |
| spellingShingle | Thomas Georgeson Lacey Atkins Alex Zahnleiter Philip I Terrill Eamonn Eeles Elizabeth J Coulson Irene Szollosi Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea Sleep Science and Practice OSA Cognitive impairment Cognitive complaint ACE-R PSG ESS |
| title | Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea |
| title_full | Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea |
| title_fullStr | Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea |
| title_full_unstemmed | Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea |
| title_short | Sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea |
| title_sort | sleep fragmentation and hypoxaemia as key indicators of cognitive impairment in patients with obstructive sleep apnoea |
| topic | OSA Cognitive impairment Cognitive complaint ACE-R PSG ESS |
| url | https://doi.org/10.1186/s41606-024-00120-9 |
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