Effect of CPAP on Cognition, Brain Function, and Structure Among Elderly Patients With OSA A Randomized Pilot Study
Effect of CPAP on Cognition, Brain Function, and Structure Among Elderly Patients With OSA A Randomized Pilot Study
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DOI：
10.1378/chest.15-0171
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发表时间：
2015-11-01
期刊：
影响因子：
9.6
通讯作者：
Montserrat, Josep M.
中科院分区：
文献类型：
--
作者：
Dalmases, Mireia;Sole-Padulles, Cristina;Montserrat, Josep M.
背景技术背景：尽管人口老龄化的增加和老年人中OSA的高患病率，但对OSA的认知影响和CPAP治疗的有效性知之甚少。因此，本研究探讨老年OSA患者是否存在认知缺陷和功能和结构的改变，可以改善CPAP treatment.METHODS：这个随机，评价者盲法，平行组，单中心试点研究涉及患者年龄= 65岁，新诊断的严重OSA综合征。33例患者被分配接受保守治疗（CC）或CPAP + CC 3个月。在基线和治疗后3个月，患者进行了神经心理学评价和功能和结构的MRI研究内的默认模式网络（DMN）和皮质thickness.RESULTS：神经心理学评价显示，在基线OSA组之间的认知性能没有差异。相比之下，CPAP治疗后，（变化的组间差异，7.60; 95%CI，1.66-13.55; P = .014）和短期记忆（变化的组间差异，1.06; 95% CI，0.10-2.01; P = 0.032）和执行功能（心理处理速度，5.74; 95%CI，1.69-9.79; P = .007;心理灵活性，-47.64; 95%CI，-81.83至-13.45; P = .008），而CC组没有观察到变化。神经影像学检查显示，CPAP治疗3个月后，右侧额中回的连通性增加，CC组皮质变薄的百分比更高。认知和脑功能连接的变化之间没有关联DMN.CONCLUSIONS：老年患者严重OSA谁提出认知困难可以受益于CPAP治疗。此外，CPAP治疗增加了DMN的连通性并减弱了皮质变薄。
BACKGROUND: Despite the increasing aging population and the high prevalence of OSA in elderly adults, little is known about cognitive effects of OSA and the effectiveness of CPAP treatment. Therefore, this study investigated whether elderly patients with OSA present cognitive deficits and functional and structural alterations of the brain that could be improved by CPAP treatment.METHODS: This randomized, evaluator-blinded, parallel-group, single-center pilot study involved patients aged = 65 years with newly-diagnosed severe OSA syndrome. Thirty-three patients were assigned to receive either conservative care (CC) or CPAP plus CC for 3 months. At baseline and 3 months after treatment, patients underwent a neuropsychologic evaluation and a functional and structural MRI study of connectivity within the default mode network (DMN) and of cortical thickness.RESULTS: Neuropsychologic evaluation revealed no differences in cognitive performance between OSA groups at baseline. By contrast, after CPAP treatment, patients showed a significant improvement in episodic (between-group difference in change, 7.60; 95% CI, 1.66-13.55; P = .014) and short-term memory (between-group difference in change, 1.06; 95% CI, 0.10-2.01; P = .032) and in executive function (speed of mental processing, 5.74; 95% CI, 1.69-9.79; P = .007; mental flexibility, -47.64; 95% CI, -81.83 to -13.45; P = .008), whereas no changes were observed in the CC group. Neuroimaging revealed an increase in the connectivity in the right middle frontal gyrus after 3 months of CPAP treatment and a higher percentage of cortical thinning in the CC group. No association was seen between cognition and brain functional connectivity changes within the DMN.CONCLUSIONS: Elderly patients with severe OSA who present with cognitive difficulties could benefit from CPAP treatment. Moreover, CPAP treatment increases the connectivity of the DMN and attenuates cortical thinning.