Obstructive Sleep Apnea Risk Is Associated with Cognitive Impairment After Controlling for Mild Traumatic Brain Injury History: A Chronic Effects of Neurotrauma Consortium Study

Overview

Journal J Neurotrauma

Publisher Mary Ann Liebert

Specialties Emergency Medicine
Neurology

Date 2020 Jul 26

PMID 32709212

Citations 5

Authors

Amanda Garcia

Tea Reljic

Terri K Pogoda

Kimbra Kenney

Amma Agyemang

Maya Troyanskaya

Heather G Belanger

Elisabeth A Wilde

William C Walker

Risa Nakase-Richardson

Affiliations

Soon will be listed here.

Abstract

The contribution of sleep disturbance to persistent cognitive symptoms following a mild traumatic brain injury (mTBI) remains unclear. Obstructive sleep apnea (OSA) is very common, yet its relationship between risk factors for developing OSA and cognitive performance in those with history of mTBI has not been investigated. The current study examined OSA risk levels and its association with cognitive performance in 391 combat-exposed, post-911 veterans and service members (median age = 37 years) enrolled in the Chronic Effects of Neurotrauma Consortium (CENC) prospective multi-center study. Participants included those with and without mTBI ( = 326 and 65, respectively). When using clinical cut-offs, those with history of mTBI were more likely to be categorized as high risk for OSA (mTBI positive = 65% vs. mTBI negative = 51%). After adjustment for TBI status and demographic variables, increased OSA risk was significantly associated with worse performance on measures of complex processing speed and executive functioning ( Coding, Trail Making Test, part B) and greater symptom burden (Neurobehavioral Symptom Inventory). Thus, OSA, a modifiable behavioral health factor, likely contributes to cognitive performance following mTBI. Accordingly, OSA serves as a potential point of intervention to improve clinical and cognitive outcomes after injury.

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References

Walker M . The role of sleep in cognition and emotion. Ann N Y Acad Sci. 2009; 1156:168-97. DOI: 10.1111/j.1749-6632.2009.04416.x. View

Rabinowitz A, Li X, McCauley S, Wilde E, Barnes A, Hanten G . Prevalence and Predictors of Poor Recovery from Mild Traumatic Brain Injury. J Neurotrauma. 2015; 32(19):1488-96. PMC: 4702434. DOI: 10.1089/neu.2014.3555. View

Walker J, James N, Campbell H, Wilson S, Churchill S, Weaver L . Sleep assessments for a mild traumatic brain injury trial in a military population. Undersea Hyperb Med. 2017; 43(5):549-566. View

Weintraub S, Dikmen S, Heaton R, Tulsky D, Zelazo P, Bauer P . Cognition assessment using the NIH Toolbox. Neurology. 2013; 80(11 Suppl 3):S54-64. PMC: 3662346. DOI: 10.1212/WNL.0b013e3182872ded. View

McDermott C, Lahoste G, Chen C, Musto A, Bazan N, Magee J . Sleep deprivation causes behavioral, synaptic, and membrane excitability alterations in hippocampal neurons. J Neurosci. 2003; 23(29):9687-95. PMC: 6740462. View

Meterko M, Baker E, Stolzmann K, Hendricks A, Cicerone K, Lew H . Psychometric assessment of the Neurobehavioral Symptom Inventory-22: the structure of persistent postconcussive symptoms following deployment-related mild traumatic brain injury among veterans. J Head Trauma Rehabil. 2011; 27(1):55-62. DOI: 10.1097/HTR.0b013e318230fb17. View

Wallace A, Bucks R . Memory and obstructive sleep apnea: a meta-analysis. Sleep. 2013; 36(2):203-20. PMC: 3543053. DOI: 10.5665/sleep.2374. View

Dash M, Douglas C, Vyazovskiy V, Cirelli C, Tononi G . Long-term homeostasis of extracellular glutamate in the rat cerebral cortex across sleep and waking states. J Neurosci. 2009; 29(3):620-9. PMC: 2770705. DOI: 10.1523/JNEUROSCI.5486-08.2009. View

Miller N, Shattuck L, Matsangas P . Sleep and fatigue issues in continuous operations: a survey of U.S. Army officers. Behav Sleep Med. 2011; 9(1):53-65. DOI: 10.1080/15402002.2011.533994. View

10.

Sjosten N, Vahtera J, Salo P, Oksanen T, Saaresranta T, Virtanen M . Increased risk of lost workdays prior to the diagnosis of sleep apnea. Chest. 2009; 136(1):130-136. DOI: 10.1378/chest.08-2201. View

11.

Carlozzi N, Kirsch N, Kisala P, Tulsky D . An examination of the Wechsler Adult Intelligence Scales, Fourth Edition (WAIS-IV) in individuals with complicated mild, moderate and Severe traumatic brain injury (TBI). Clin Neuropsychol. 2015; 29(1):21-37. DOI: 10.1080/13854046.2015.1005677. View

12.

Jacobs M, Donders J . Criterion validity of the California Verbal Learning Test-Second Edition (CVLT-II) after traumatic brain injury. Arch Clin Neuropsychol. 2007; 22(2):143-9. DOI: 10.1016/j.acn.2006.12.002. View

13.

Lange R, Iverson G, Zakrzewski M, Ethel-King P, Franzen M . Interpreting the trail making test following traumatic brain injury: comparison of traditional time scores and derived indices. J Clin Exp Neuropsychol. 2005; 27(7):897-906. DOI: 10.1080/1380339049091290. View

14.

Gordon W, Haddad L, Brown M, Hibbard M, Sliwinski M . The sensitivity and specificity of self-reported symptoms in individuals with traumatic brain injury. Brain Inj. 2000; 14(1):21-33. View

15.

Gale S, Hopkins R . Effects of hypoxia on the brain: neuroimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea. J Int Neuropsychol Soc. 2004; 10(1):60-71. DOI: 10.1017/S1355617704101082. View

16.

Bliwise D . Alzheimer's disease, sleep apnea, and positive pressure therapy. Curr Treat Options Neurol. 2013; 15(6):669-76. PMC: 3909520. DOI: 10.1007/s11940-013-0262-5. View

17.

Troxel W, Shih R, Pedersen E, Geyer L, Fisher M, Griffin B . Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers. Rand Health Q. 2017; 5(2):19. PMC: 5158299. View

18.

Olaithe M, Bucks R, Hillman D, Eastwood P . Cognitive deficits in obstructive sleep apnea: Insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev. 2017; 38:39-49. DOI: 10.1016/j.smrv.2017.03.005. View

19.

Rohling M, Binder L, Demakis G, Larrabee G, Ploetz D, Langhinrichsen-Rohling J . A meta-analysis of neuropsychological outcome after mild traumatic brain injury: re-analyses and reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab et al. (2009). Clin Neuropsychol. 2011; 25(4):608-23. DOI: 10.1080/13854046.2011.565076. View

20.

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View