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Original Research: Sleep Disorders |

Effect of CPAP on Cognition, Brain Function, and Structure Among Elderly Patients With OSACPAP Effect on Cognition in Elderly Patients: A Randomized Pilot Study

Mireia Dalmases, MD; Cristina Solé-Padullés, PhD; Marta Torres, MSc; Cristina Embid, MD, PhD; Maria Dolores Nuñez, RN; Miguel Ángel Martínez-Garcia, MD; Ramon Farré, PhD; Nuria Bargalló, MD, PhD; David Bartrés-Faz, PhD; Josep M. Montserrat, MD, PhD
Author and Funding Information

From the Sleep Unit (Drs Dalmases, Embid, and Montserrat and Mss Torres and Nuñez), Pneumology Department, Hospital Clínic de Barcelona-Facultat de Medicina, Universitat de Barcelona, Barcelona; CIBERES (Drs Dalmases, Embid, Farré, and Montserrat and Ms Torres), Madrid; Psychiatry and Clinical Psychobiology Department (Drs Solé-Padullés and Bartrés-Faz), Facultat de Medicina, Universitat de Barcelona, Barcelona; Pneumology Department (Dr Martínez-Garcia), Hospital Universitari i Politècnic La Fe, Valencia; Biophysics and Bioengineering Department (Dr Farré), Facultat de Medicina, Universitat de Barcelona - The August Pi Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Image Diagnostic Center (Dr Bargalló), Hospital Clínic de Barcelona, Barcelona; and Magnetic Resonance Image Core Facility (Dr Bargalló), IDIBAPS, Barcelona, Spain.

CORRESPONDENCE TO: Josep M. Montserrat, MD, PhD, Sleep Unit, Pneumology Department, Hospital Clínic de Barcelona, Villarroel, 170, 08036 Barcelona, Spain; e-mail: jcanal@clinic.ub.es


Part of this article has been presented at the 2014 ATS International Conference, May 16-21, 2014, San Diego, CA, and the ERS International Congress 2014, September 6-10, 2014, Munich, Germany.

FUNDING/SUPPORT: This work was supported in part by the Catalan Society of Pneumology (SOCAP) and the Spanish Ministry of Science and Innovation [PI11/01892].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(5):1214-1223. doi:10.1378/chest.15-0171
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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.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01826032; URL: www.clinicaltrials.gov

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