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Effect of CPAP on cognition, brain function and structure among elderly patients with obstructive sleep apnea: a randomized pilot study
Dalmases M, Sole-Padulles C, Torres M, Embid C, Nunez MD, Martinez-Garcia MA, Farre R, Bargallo N, Bartres-Faz D, Montserrat JM
Chest 2015 Nov 1;148(5):1214-1223
clinical trial
6/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Despite the increasing aging population and the high prevalence of obstructive sleep apnea (OSA) in elders, little is known about its cognitive effects and the effectiveness of continuous positive airway pressure (CPAP). Therefore, this study was aimed to investigate whether elderly patients with OSA present cognitive deficits and functional and structural alterations of the brain that could be improved by CPAP treatment. METHODS: Randomized, evaluator-blinded, parallel-group single-center pilot study involving 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 three months after treatment patients underwent a neuropsychological evaluation and a functional and structural magnetic resonance imaging study of connectivity within the default mode network (DMN) and cortical thickness (CTh). RESULTS: Neuropsychological evaluation revealed no differences in cognitive performance between the OSA groups at baseline. By contrast, after CPAP treatment, patients showed a significant improvement in episodic and short-term memory (7.60 (95% CI 1.66 to 13.55); p = 0.014 and 1.06 (95% CI 0.10 to 2.01); p = 0.032, respectively) and in executive function (speed of mental processing: 5.74 (95% CI 1.69 to 9.79); p = 0.007 and mental flexibility -47.64 (95% CI -81.83 to -13.45); p = 0.008) whereas no changes were observed in the CC group. Neuroimaging revealed an increase in the connectivity in the right middle frontal gyrus after 3-month 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 increased the connectivity of the DMN and attenuated cortical thinning. TRIAL REGISTRATION: www.ClinicalTrials.gov (identifier NCT01826032).

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