Review

. 2021 Dec 16;11(12):180.

doi: 10.3390/bs11120180.

Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art

Isabella Pollicina¹, Antonino Maniaci², Jerome R Lechien^{2

3

4}, Giannicola Iannella^{5

6}, Claudio Vicini⁵, Giovanni Cammaroto⁵, Angelo Cannavicci⁵, Giuseppe Magliulo⁵, Annalisa Pace⁶, Salvatore Cocuzza¹, Milena Di Luca¹, Giovanna Stilo¹, Paola Di Mauro¹, Maria Rita Bianco⁷, Paolo Murabito⁸, Vittoria Bannò¹, Ignazio La Mantia¹

Affiliations

¹ Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy.
² Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium.
³ Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFRSimone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 91190 Paris, France.
⁴ Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1050 Brussels, Belgium.
⁵ Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy.
⁶ Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy.
⁷ Otolaryngology, Department of Health Science, University Magna Graecia of Catanzaro, Viale Europa, Germaneto, 88100 Catanzaro, Italy.
⁸ Department of Surgery and Medical and Surgical Specialties-Section of Anaesthesiology and Intensive Care, University of Catania (Italy), 95123 Catania, Italy.

PMID: 34940115
PMCID: PMC8698492
DOI: 10.3390/bs11120180

Review

Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art

Isabella Pollicina et al. Behav Sci (Basel). 2021.

. 2021 Dec 16;11(12):180.

doi: 10.3390/bs11120180.

Authors

Affiliations

¹ Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", ENT Section, University of Catania, 95123 Catania, Italy.
² Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), 7000 Mons, Belgium.
³ Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, School of Medicine, UFRSimone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 91190 Paris, France.
⁴ Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, 1050 Brussels, Belgium.
⁵ Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Head-Neck, Morgagni Pierantoni Hospital, 47121 Forli, Italy.
⁶ Department of "Organi di Senso", University "Sapienza", 00185 Rome, Italy.
⁷ Otolaryngology, Department of Health Science, University Magna Graecia of Catanzaro, Viale Europa, Germaneto, 88100 Catanzaro, Italy.
⁸ Department of Surgery and Medical and Surgical Specialties-Section of Anaesthesiology and Intensive Care, University of Catania (Italy), 95123 Catania, Italy.

PMID: 34940115
PMCID: PMC8698492
DOI: 10.3390/bs11120180

Abstract

Background: Obstructive Sleep Apnea (OSA) syndrome is a respiratory sleep disorder characterized by partial or complete episodes of upper airway collapse with reduction or complete cessation of airflow. Although the connection remains debated, several mechanisms such as intermittent hypoxemia, sleep deprivation, hypercapnia disruption of the hypothalamic-pituitary-adrenal axis have been associated with poor neurocognitive performance. Different treatments have been proposed to treat OSAS patients as continuous positive airway pressure (CPAP), mandibular advancement devices (MAD), surgery; however, the effect on neurocognitive functions is still debated. This article presents the effect of OSAS treatments on neurocognitive performance by reviewing the literature.

Methods: We performed a comprehensive review of the English language over the past 20 years using the following keywords: neurocognitive performance and sleep apnea, neurocognitive improvement and CPAP, OSAS, and cognitive dysfunction. We included in the analysis papers that correlated OSA treatment with neurocognitive performance improvement. All validated tests used to measure different neurocognitive performance improvements were considered.

Results: Seventy papers reported neurocognitive Performance improvement in OSA patients after CPAP therapy. Eighty percent of studies found improved executive functions such as verbal fluency or working memory, with partial neural recovery at long-term follow-up. One article compared the effect of MAD, CPAP treatment on cognitive disorders, reporting better improvement of CPAP and MAD than placebo in cognitive function.

Conclusions: CPAP treatment seems to improve cognitive defects associated with OSA. Limited studies have evaluated the effects of the other therapies on cognitive function.

Keywords: CPAP; MAD; OSAS; cognitive impairment; positional OSA.

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Conflict of interest statement

The authors declare no conflict of interesting of the manuscript.

Figures

**Figure 1**
Flow-diagram. OSAS pathways and neurocognitive dysfunction.

See this image and copyright information in PMC

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Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art

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Neurocognitive Performance Improvement after Obstructive Sleep Apnea Treatment: State of the Art

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