Comparison of Neurocognitive Functions between Positional Obstructive Sleep Apnea Patients and Non-Positional Obstructive Sleep Apnea Patients in the Korean Elderly Population

Hyung Chan Kim; Suk-Hoon Kang; Jin Hee Choi; Hae Gyung Chung; Tae Yong Kim; Hyung Seok So

doi:10.4306/jknpa.2015.54.4.564

Journal List > J Korean Neuropsychiatr Assoc > v.54(4) > 1017775

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Kim, Kang, Choi, Chung, Kim, and So: Comparison of Neurocognitive Functions between Positional Obstructive Sleep Apnea Patients and Non-Positional Obstructive Sleep Apnea Patients in the Korean Elderly Population

Original Article

Journal of Korean Neuropsychiatric Association 2015; 54(4): 564-569.

Published online: 30 November 2015

DOI: https://doi.org/10.4306/jknpa.2015.54.4.564

Comparison of Neurocognitive Functions between Positional Obstructive Sleep Apnea Patients and Non-Positional Obstructive Sleep Apnea Patients in the Korean Elderly Population

Hyung Chan Kim, MD¹, Suk-Hoon Kang, MD^1,², Jin Hee Choi, MD¹, Hae Gyung Chung, MD¹, Tae Yong Kim, MD, PhD¹, Hyung Seok So, MD^1,³

¹Department of Psychiatry, Veterans Health Service Medical Center, Seoul, Korea.

²Center for Sleep Medicine, Veterans Health Service Medical Center, Seoul, Korea.

³Posttraumatic Stress Disorder Clinic, Veterans Health Service Medical Center, Seoul, Korea.

Address for correspondence: Suk-Hoon Kang, MD. Department of Psychiatry, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-gil, Gangdong-gu, Seoul 05368, Korea. Tel +82-2-2225-1330, Fax +82-2-477-6190, sleepkang@bohun.or.kr

Received 13 August 2015 Revised 15 September 2015 Accepted 17 September 2015

Abstract

Objectives

Obstructive sleep apnea (OSA) is classified as positional sleep apnea (POSA) and non-positional sleep apnea (NPOSA) according to apnea-hypopnea index (AHI) changed by sleep position. The aim of this study was to compare neurocognitive functions between two groups in the elderly Korean population.

Methods

Forty-four subjects in OSA patients with total AHI≥5 participated as criteria for POSA (n=25) with 1) supine position AHI/non-supine position AHI≥2 and 2) total AHI≥5 or not (NPOSA, n=19). All participants completed clinical interview by physician and neurocognitive function assessments. Mann-Whitney U and chi-square test were performed for comparison of neurocognitive functions and sleep characteristics with polysomnography between two groups.

Results

No significant difference in demographic and clinical characteristics was observed between the two groups. However the NPOSA group showed more decline than the POSA group on the Boston naming test (p=0.034), digit span test (p=0.001), go-no-go test (p=0.042), and fist-edge-palm test (p=0.007).

Conclusion

In this study NPOSA patients were found to have lower cognitive functions compared to POSA patients. A larger sample and long term follow-up study might be needed.

Keywords: Obstructive sleep apnea, Sleep position, Non-positional sleep apnea, Polysomnography, Neurocognitive function

Figures and Tables

Table 1

Demographic and clinical characteristics

Data are presented as mean (standard deviation) for continuous variables and number (%) for categorical variables. p<0.05, chi square test for comorbidities variables and Mann-Whitney test for other variables. POSA : Positional obstructive sleep apnea, NPOSA : Non-positional obstructive sleep apnea, BMI : Body mass index, PSQI : Pittsburgh Sleep Quality Index, ESS : Epworth Sleepiness Scale, ISI : Insomnia Severity Index, BDI : Beck Depression Inventory

Table 2

Comparison of sleep characteristics between POSA and NPOSA

Data are presented as mean (standard deviation) for continuous variables. ^* : p<0.05, Mann-Whitney test. POSA : Positional obstructive sleep apnea, NPOSA : Non-positional obstructive sleep apnea, TST : Total sleep time, WASO : Wake after sleep onset, NSD : Non-supine time duration, SD : Supine time duration, SE : Sleep efficiency, S1 : Total stage N1 percent, S2 : Total stage N2 percent, S3 : Total stage N3 percent, R : Total stage R percent, AHI : Apnea-hypopnea index, NSAHI : Non-supine apnea-hypopnea index, SAHI : Supine apnea-hypopnea index, ODI : O₂ desaturation index, CSA : Central sleep apnea index, MSA : Mixed sleep apnea index, SaO₂<90 : Percentage of total sleep time of SaO₂<90%, MinSaO₂ : Minimum O₂ saturation, Snoring : Percentage of snoring in total sleep

Table 3

Comparison of neurocognitive function test between POSA and NPOSA

Data are presented as mean (standard deviation) for continuous variables. ^* : p<0.05, Mann-Whitney test. POSA : Positional obstructive sleep apnea, NPOSA : Non-positional obstructive sleep apnea, MMSE-KC : The Mini-Mental State Exam-Korean version of MMSE in the Korean version of CERAD Assessment Packet, VF : Verbal fluency test, BNT : Boston naming test, WLM : Word list memory, WLR : Word list recall, WLRc : Word list recognition, CP : Construction praxis, CR : Construction recall, DSF : Digit span test forward, DSB : Digit span test backward, CDT : Clock drawing test, ConPro : Contrasting program, GNG : Go-no-go test, FEP : Fist-edge-palm test, CERAD : The consortium to establish a registry for Alzheimer disease

Notes

^{Conflicts of Interest} The authors have no financial conflicts of interest.

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