Sleep Disorders |

Cognitive Impairment and Obstructive Sleep Apnea Syndrome in Early Postmenopausal Women FREE TO VIEW

Chitra Lal, MBBS; Xun Zhu, PhD; Michelle Dibartolo, BS; Jane Joseph, PhD
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Pulmonary, Critical Care, and Sleep Medicine, Medical University of South Carolina, Charleston, SC

Chest. 2014;146(4_MeetingAbstracts):949A. doi:10.1378/chest.1971750
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Cognitive function declines in the early postmenopausal period. Hormone replacement therapy (HRT) is protective, but is associated with substantial risks such as stroke and thromboembolic events. Obstructive sleep apnea syndrome (OSAS) prevalence increases in women after menopause if they are not on HRT. OSAS has been associated with cognitive dysfunction. Thus treatment of OSAS may improve cognition in early postmenopausal women. Our first aim was to compare the prevalence of cognitive problems in early postmenopausal women with OSAS (OSAS+) and without OSAS (OSAS-). The second aim was to perform a pilot and feasibility study of functional MRI (fMRI) in OSAS+ early postmenopausal women.

METHODS: Data on 182 postmenopausal women between 45-60 years of age, within 5 years of natural menopause (defined as no menstrual bleeding for ≥ 1 year) not on HRT was collected. Cognitive function was assessed by Mail-In Cognitive Function Screening Instrument (MCFSI), with higher scores indicating more cognitive problems. Subjects were classified as OSAS+ or OSAS- by the Berlin questionnaire. All data was collected through Redcap surveys.

RESULTS: 120 OSAS+ women and 59 OSAS- women were matched on all variables except depression (44% vs. 28%, t (1, 125) = -2.1, p=0.042) and BMI (34 vs 27, t (1, 157,) = -7.3, p=0.003), as revealed by an independent samples t-tests, assuming unequal variances according to Levene’s test. Analysis of covariance, revealed that the mean MCFSI score after adjusting for depression, was 5.73 in the OSAS+ group and 4.52 in the OSAS- group (F(1, 176) = 5.6, p=0.019)). Preliminary results from 4 OSAS+ women showed that 2 women with MCFSI scores ≥ 5 performed task switching less accurately than the 2 women with MCFSI scores < 5 (60% vs 80%) and showed less activation on fMRI (no statistics were performed as these results are preliminary).

CONCLUSIONS: Early postmenopausal women with OSAS report more cognitive problems than those without OSAS. Cognitive dysfunction and OSAS may modulate brain activation patterns on fMRI.

CLINICAL IMPLICATIONS: Future large studies should fully evaluate the impact of OSAS on cognition in postmenopausal women.Given the higher prevalence of OSAS in postmenopausal women as compared to premenopausal women, the overall higher prevalence of dementia in women as compared to men, and the association of untreated OSAS with cognitive problems and dementia, this is an important area to study further in postmenopausal women.

DISCLOSURE: Chitra Lal: Grant monies (from industry related sources): Invado pharmaceuticals has sponsored a clinical trial on Neutrasal on which I am the PI. Amount $55,000, Consultant fee, speaker bureau, advisory committee, etc.: Ikaria pharmaceuticals, consultant, no compensation received yet., University grant monies: Pilot award from P50 DA106511-11, “Specialized Centers of Research (SCOR) on Sex Differences” (Brady, PI), $15,000 The following authors have nothing to disclose: Xun Zhu, Michelle Dibartolo, Jane Joseph

I will be discussing the use of functional magnetic resonance imaging (fMRI) to study brain changes in patients with obstructive sleep apnea and cognitive decline.




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