Patients with obstructive sleep apnea (OSA) report excessive daytime sleepiness and attention impairment. This study will assess the impact of continuous positive airway pressure (CPAP) treatment on attention deficits.
This study included 22 adult patients who presented at a nationally accredited sleep center for evaluation of OSA. Severity of OSA was evaluated using the Epworth Sleepiness Scale (ESS), a self-report questionnaire designed to assess daytime sleepiness on a scale of 0 to 24. Attention impairment was evaluated using the Adult Self-Report Scale (ASRS) Symptom Checklist, designed to assess adult attention problems on a scale of 0 to 36. A score of 0 to 16 indicates normal attention, 17 to 23 indicates moderate attention impairment, and 24 or greater indicates severe attention impairment. Patients completed both questionnaires at baseline and following CPAP treatment.
The average baseline score on ESS was 11.6 (4.0) and on ASRS was 17.4 (9.2). The average post-treatment score on ESS was 2.7 (3.6) and on ASRS was 10.4 (8.6), indicating significant change in ESS (F(1,21)=163.1, p<.0001) and ASRS (F(1,21)=24.6, p<.0001). At baseline, 12 patients had ASRS scores in the moderately to severely impaired range. Eight of these 12 patients’ ASRS scores dropped significantly to the normal range after CPAP (F(1,7)=32.3, p<.001). The other 4 patients’ ASRS did not change significantly and remained in the impaired range, despite a significant drop in ESS (F(1,3)=22.6, p=.02).
The results of this study support a high comorbidity between attention deficit and OSA. Fifty-five percent showed significant attention impairment at baseline, but substantially improvement after CPAP treatment. However, 18% continued to report serious attention deficit following treatment. These patients were diagnosed with adult attention deficit disorder (ADD) after neuropsychological testing and required pharmacological intervention and skills training.
Sleep specialists should be aware that even after optimal CPAP treatment of OSA, a residual cohort of patients with an attention deficit may remain who require further evaluation and treatment.
C.G. Risk, None.