The Carlat Psychiatry Podcast
Does Cognition Improve When You Treat Sleep Apnea? [60 Sec Psych]
Before you tell your patient how good they're going to feel once they get that sleep apnea treated, check out this review of Wang ML, Wang C, Tuo M, et al. Cognitive Effects of Treating Obstructive Sleep Apnea: A Meta-Analysis of Randomized Controlled Trials. J Alzheimers Dis. 2020;10.3233/JAD-200088. [Link]
Date Published: 5/9/20
How much do CPAPs improve cognition?
14 studies and 1,926 participants
Sleep apnea is bad for cognition. It deprives the brain of oxygen at night, fragments sleep, and lays down amyloid plaques and tau proteins that set the stage for dementia. But does treatment with a CPAP do much to reverse those changes?
A new meta-analysis by Mei-Ling Wang and colleagues looked into that question through 14 studies involving nearly 2000 patients. The results were surprising.
CPAP did not improve daytime sleepiness, attention, executive function, processing speed, or memory. There was however a difference in those with severe sleep apnea, where CPAP use lead to mild gains in attention and processing speed.
Although these results are disappointing, The authors point out that most of these were short term studies, and from what we know about the biology it probably takes 6-12 months to see cognitive changes after starting a CPAP. Patients often want to stop their CPAP and may not feel better in the first few months of treatment. Their experience is real, but we need to encourage them to hold out for longer term gains.
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