Arousal Threshold Modifies the Effect of CPAP on Executive Function Among Individuals with Obstructive Sleep Apnea. BACKGROUND Obstructive Sleep Apnea (OSA) is associated with neurocognitive dysfunction. However, randomized trials evaluating the effects of continuous positive airway pressure (CPAP) on neurocognition in those without dementia do not show a benefit. We thus aimed to assess whether arousal threshold (ArTH) modifies the effect of CPAP on neurocognitive function. METHODS We performed a secondary analysis of a randomized, sham-controlled trial, Apnea Positive Pressure Long-term Efficacy Study. ArTH was estimated from polysomnography using a translatable method (Sands et al., SLEEP 2018). Neurocognitive outcomes included the Sustained Working Memory Test-Overall-Mid-Day score (SWMT-OMD, executive function, primary outcome), with the Pathfinder Number Test - total time (attention) and Buschke Selective Reminding Test - sum recall (learning and memory) as secondary outcomes. Generalized linear modeling assessed whether the effect of CPAP was modified by baseline ArTH (treatment-by-ArTH interaction). 833 participants with OSA, [apnea-hypopnea index (AHI) ≥10 events/h], available ArTH, and outcomes were analyzed (CPAP n=437, Sham n=396). RESULTS For executive function, the effect of CPAP treatment was modified by ArTH (p-interaction=0.042). Specifically, for every 1 sd increase in ArTH, the SWMT-OMD score improved by 0.10 95% CI (0.01, 0.18) in active compared to sham CPAP at 6 months; At ArTH 1 sd above the mean SWMT-OMD improvements were nearly three times that in those with average ArTH (0.139 [0.018, 0.261] versus 0.053 [-0.034, 0.140] respectively. No effect modification was observed for attention (p=0.311) or learning and memory (p=0.744). CONCLUSION In OSA, a higher ArTH is associated with greater improvements in executive function following CPAP therapy.

中文翻译：

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觉醒阈值改变了 CPAP 对阻塞性睡眠呼吸暂停个体执行功能的影响。


唤醒阈值改变了 CPAP 对阻塞性睡眠呼吸暂停患者执行功能的影响。背景 阻塞性睡眠呼吸暂停 （OSA） 与神经认知功能障碍有关。然而，评估持续气道正压通气 （CPAP） 对无痴呆患者神经认知影响的随机试验并未显示益处。因此，我们旨在评估觉醒阈值 （ArTH） 是否改变 CPAP 对神经认知功能的影响。方法 我们对一项随机、假对照试验 Apnea Positive Pressure Long-term T疗效研究进行了二次分析。ArTH 是使用可翻译方法从多导睡眠图估计的 （Sands et al.， SLEEP 2018）。神经认知结局包括持续工作记忆测试总体中午评分 （SWMT-OMD，执行功能，主要结局），探路者数字测试 - 总时间（注意力）和 Buschke 选择性提醒测试 - 总回忆（学习和记忆）作为次要结局。广义线性模型评估了基线 ArTH （ArTH 相互作用治疗） 是否改变了 CPAP 的效果。分析了 833 名患有 OSA 、 [呼吸暂停低通气指数 （AHI） ≥10 次事件/小时]、可用 ArTH 和结局的参与者 （CPAP n=437，假手术 n=396）。结果 对于执行功能，ArTH 改变了 CPAP 治疗的效果 （p-interaction=0.042）。具体来说，ArTH 每增加 1 个 sd，与 6 个月假 CPAP 相比，活动 SWMT-OMD 评分提高 0.10 95% CI （0.01， 0.18）;当 ArTH 高于平均值 1 个标准时，SWMT-OMD 改善几乎是平均 ArTH 患者的三倍 （分别为 0.139 [0.018， 0.261] 和 0.053 [-0.034， 0.140]。未观察到注意力 （p=0.311） 或学习和记忆 （p=0.744） 的影响改变。 结论在 OSA 中，较高的 ArTH 与 CPAP 治疗后执行功能的更大改善相关。