Avaliação neurocognitiva em pacientes com sonolência excessiva residual da Síndrome da Apneia Obstrutiva do Sono: um estudo prospectivo controlado

• Ano de defesa: 2016
• Autor(a) principal: Werli, Ksdy Maiara Moura Sousa [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Cpap; Neurocognitiva; Saos
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=3615236; http://repositorio.unifesp.br/handle/11600/46564

Introduction: CPAP is the standard treatment for obstructive sleep apnea (OSA), re-establishing ventilation during sleep, and improving sleepiness and cognitive functions. However, some patients, even with effective CPAP pressure and good adherence to treatment still remain sleepy. Cognitive disorders such as attention, memory and executive functions deficits have been reported in OSA patients. Objective: The objective of this study was to evaluate neurocognitive function in adult patients with Residual Excessive Daytime Sleepiness after appropriate treatment of OSA with CPAP. Methodology: Prospective controlled study. We included patients of both gender, aged 35-60 years with OSA and Apnea Hypopnea Index> 20, effectively treated with CPAP, but with residual Sleepiness Scale Epworth score ?11. The control group comprised OSA patients adequately treated with CPAP and who did not present excessive sleepiness after treatment. Both groups underwent the following evaluations: baseline polysomnography and CPAP titration, blood and cerebrospinal fluid collection, wakefulness maintenance testing, multiple sleep latency test, evaluation of depression (Beck Depression Inventory - BDI) and cognitive assessment including executive functions as main outcome. Results: Regarding the baseline characteristics, the data were matched for age, years of study and body mass index. Age (RES group 51.0 ± 8.4, control group 51.8 ± 8.2 p = 0.52). Sex (men ? RES group 8, control group 11), body mass index (residual sleepiness group 33.5 ± 5.6; control group 33.4 ± 4.4 p = 0.68), hypertension (%) (RES group 71.5; 40 control group p = 0.08), and the index of apnea and hypopnea (RES group 56.1 ± 27.5 control group 52.3 ± 20.4 p = 0, 83). How to neurocognitive long-term data memory assessed by auditory verbal test Rey did not show a significant difference between the two groups when controlled for hypertension (RES group.7 ± 2; control group 6.5 ± 1.9; p = 0.08). With regard to executive functions, Wisconsin test - number of categories (RES group 1.6 ± 1.4; control group 3 ± 1.4; p = 0.01), Wisconsin - perseverative errors (RES group 23.9 ± 9.3 control group 10.5 ± 8.6 p = 0.01), and semantic verbal fluency test (RES group 13,6 ± 3.3 control group 16.9 ± 4.3 p = 0.04) were also different between groups. Finally, the average depression scale score in the group with RES was significantly higher than the control group (RES group 13.6 ± 9; control group 6.4 ± 5.5, p = 0.01). Conclusion: Patients with Excessive Sleepiness Residual confirmed by objective tests showed greater impairment of executive functions, but not in other cognitive domains such as attention, memory and learning.