Patients with obstructive sleep apnea (OSA) report excessive daytime sleepiness and attention impairment. This study assesses the impact of continuous positive airway pressures (CPAP) treatment of attention deficit.
We studied 41 adult patients who presented at a nationally accredited sleep center for evaluation of OSA. Severity of OSA is evaluated using the Epworth Sleepiness Scale (ESS) a self report questionnaire designed to assess daytime sleepiness on a scale of 0 to 24; and by the respiratory disturbance index (RDI) measured during their sleep study. Attention impairment was evaluated using the adult self-report scale (ASRS) symptom checklist, a validated scale assessing attention impairment on a scale of 0 to 36. A score of 17 or greater indicates possible or probable attention deficit. Patients completed both questionnaires at baseline and following CPAP treatment; the RDI was measured during their baseline sleep study and during a subsequent CPAP titration study.
The average baseline score on ESS was 11.6 (4.2) and 2.7 (3.3) at 3 months post-treatment (t=11.8,p<.0001). The average RDI on the baseline PSG was 29.9 (16.8) and 2.2 (3.6) on the subsequent CPAP study (t=10.5,p<.0001). The ASRS score was 16 (8) at baseline and 11 (8) at 3 months post-treatment (t=6.0,p<.0001). Of 41 patients at baseline, 19 demonstrated an ASRS score of 17 or greater; at 3 months post-treatment, 11 showed an ASRS that had decreased to the normal range, while 8 did not. These patients were subsequently diagnosed with ADD due to a comorbid psychological or neuromuscular diagnosis, hearing or reading deficit, or memory or executive function impairment. Most suffered from concurrent insomnia and non-restorative sleep.
This study demonstrated a high comorbidity between ADD and OSA. Forty-six percent showed significant attention impairment at baseline; with treatments, 58% reported substantial improvement, but 42% reported persistent serious attention deficit, and required further evaluation and treatment.
OSA is a significant factor contributing to ADD. In patients with persisting deficits after CPAP treatment, further evaluation and treatment is required.
Clifford Risk, None.