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Abstract: Poster Presentations |

THE IMPACT OF SLEEP DISORDERS ON THE ATTENTION DEFICIT DISORDER IN THE ADULT PART I: THE PATIENT WITH OBSTRUCTIVE SLEEP APNEA FREE TO VIEW

Clifford G. Risk, MD*
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Clifford Risk, MD, Marlborough, MA


Chest


Chest. 2005;128(4_MeetingAbstracts):231S. doi:10.1378/chest.128.4_MeetingAbstracts.231S
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Abstract

PURPOSE:  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.

METHODS:  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.

RESULTS:  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.

CONCLUSION:  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.

CLINICAL IMPLICATIONS:  OSA is a significant factor contributing to ADD. In patients with persisting deficits after CPAP treatment, further evaluation and treatment is required.

DISCLOSURE:  Clifford Risk, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


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