Efficacy of CPAP duration and adherence for cognitive improvement in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

Jiaxin Li; Wenjie Yan; Minhan Yi; Ruihan Lin; Zini Huang; Yuan Zhang

doi:10.1007/s11325-022-02687-y

Efficacy of CPAP duration and adherence for cognitive improvement in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials

Sleep Breath. 2023 Jun;27(3):973-982. doi: 10.1007/s11325-022-02687-y. Epub 2022 Aug 5.

Authors

Jiaxin Li^#^{1

2

3}, Wenjie Yan^#^{1

2

3}, Minhan Yi^#^{1

4}, Ruihan Lin^{1

2

3}, Zini Huang⁵, Yuan Zhang^{6

7}

Affiliations

¹ Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
³ Xiangya School of Medicine, Central South University, Changsha, China.
⁴ School of Life Sciences, Central South University, Changsha, Hunan, China.
⁵ Bangor College, Central South University of Forestry and Technology, Changsha, Hunan, China.
⁶ Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China. zhangyuan9194@csu.edu.cn.
⁷ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China. zhangyuan9194@csu.edu.cn.

^# Contributed equally.

PMID: 35930191
DOI: 10.1007/s11325-022-02687-y

Abstract

Purpose: Obstructive sleep apnea (OSA) can impair cognition. Continuous positive airway pressure (CPAP) is a recommended treatment for OSA but its effectiveness on cognitive improvement is uncertain, a finding which may be biased by various durations and adherence to treatment with CPAP. In a meta-analysis assessing high-quality randomized controlled trials (RCTs), we estimated whether or not CPAP benefits cognition in patients with OSA.

Methods: PRISMA criteria were followed in the performance of this meta-analysis. The weighted mean difference (WMD) and 95% confidence interval (CI) of six neuropsychological scores covering eight cognitive domains were used to evaluate the benefit between CPAP and non-CPAP interventions. Subgroups of different therapeutic durations and adherence, which were divided into short-term (< 8 weeks) and long-term (≥ 12 weeks) durations, and poor (nighttime < 4 h/night) and good (nighttime ≥ 4 h/night) adherence were also analyzed.

Results: Among 16 RCTs, 1529 participants with OSA were included. Comparing the CPAP group and the control group for all treatment durations and adherence, a mild improvement for digit span forward which reflected short-term memory was observed (WMD[95%CI] = 0.67[0.03,1.31], p = 0.04). Trail making test-part B, which reflected executive function was improved for participants with OSA who had good adherence to CPAP (WMD[95%CI] = - 6.24[- 12.60,0.12], p = 0.05). Patients with OSA who received short-term CPAP treatment (WMD[95%CI] = - 7.20[- 12.57, - 1.82], p = 0.009) had a significant improvement in executive function when compared with controls. There was no statistical difference for all scales between long-term (≥ 12 weeks) CPAP treatment group and control group.

Conclusion: The effectiveness of CPAP on cognitive improvement in patients with OSA is limited, although good adherence to CPAP can mildly benefit executive function with short-term effectiveness.

Keywords: CPAP treatment; Cognitive improvement; Obstructive sleep apnea; Sleepiness.

Publication types

Meta-Analysis

MeSH terms

Cognition
Continuous Positive Airway Pressure*
Executive Function
Humans
Randomized Controlled Trials as Topic
Sleep Apnea, Obstructive* / psychology
Sleep Apnea, Obstructive* / therapy

Abstract

Publication types

MeSH terms

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