title: Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES).
abstract: OBJECTIVE
  To determine the neurocognitive effects of continuous positive airway pressure (CPAP) therapy on patients with obstructive sleep apnea (OSA).
  
  
  METHODS
  The Apnea Positive Pressure Long-term Efficacy Study (APPLES) was a 6-month, randomized, double-blind, 2-arm, sham-controlled, multicenter trial conducted at 5 U.S. university, hospital, or private practices. Of 1,516 participants enrolled, 1,105 were randomized, and 1,098 participants diagnosed with OSA contributed to the analysis of the primary outcome measures.
  
  
  METHODS
  Active or sham CPAP  MEASUREMENTS: THREE NEUROCOGNITIVE VARIABLES, EACH REPRESENTING A NEUROCOGNITIVE DOMAIN: Pathfinder Number Test-Total Time (attention and psychomotor function [A/P]), Buschke Selective Reminding Test-Sum Recall (learning and memory [L/M]), and Sustained Working Memory Test-Overall Mid-Day Score (executive and frontal-lobe function [E/F])
  
  
  RESULTS
  The primary neurocognitive analyses showed a difference between groups for only the E/F variable at the 2 month CPAP visit, but no difference at the 6 month CPAP visit or for the A/P or L/M variables at either the 2 or 6 month visits. When stratified by measures of OSA severity (AHI or oxygen saturation parameters), the primary E/F variable and one secondary E/F neurocognitive variable revealed transient differences between study arms for those with the most severe OSA. Participants in the active CPAP group had a significantly greater ability to remain awake whether measured subjectively by the Epworth Sleepiness Scale or objectively by the maintenance of wakefulness test.
  
  
  CONCLUSIONS
  CPAP treatment improved both subjectively and objectively measured sleepiness, especially in individuals with severe OSA (AHI > 30). CPAP use resulted in mild, transient improvement in the most sensitive measures of executive and frontal-lobe function for those with severe disease, which suggests the existence of a complex OSA-neurocognitive relationship.
  
  
  BACKGROUND
  Registered at clinicaltrials.gov. Identifier: NCT00051363.
  
  
  BACKGROUND
  Kushida CA; Nichols DA; Holmes TH; Quan SF; Walsh JK; Gottlieb DJ; Simon RD; Guilleminault C; White DP; Goodwin JL; Schweitzer PK; Leary EB; Hyde PR; Hirshkowitz M; Green S; McEvoy LK; Chan C; Gevins A; Kay GG; Bloch DA; Crabtree T; Demen WC. Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). SLEEP 2012;35(12):1593-1602.
authors.affiliation: Stanford University, Stanford, CA, USA. clete@stanford.edu
authors.forename: Clete A
authors.initials: CA
authors.lastname: Kushida
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Nichols
authors.forename: Tyson H
authors.initials: TH
authors.lastname: Holmes
authors.forename: Stuart F
authors.initials: SF
authors.lastname: Quan
authors.forename: James K
authors.initials: JK
authors.lastname: Walsh
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gottlieb
authors.forename: Richard D
authors.initials: RD
authors.lastname: Simon
authors.forename: Christian
authors.initials: C
authors.lastname: Guilleminault
authors.forename: David P
authors.initials: DP
authors.lastname: White
authors.forename: James L
authors.initials: JL
authors.lastname: Goodwin
authors.forename: Paula K
authors.initials: PK
authors.lastname: Schweitzer
authors.forename: Eileen B
authors.initials: EB
authors.lastname: Leary
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Hyde
authors.forename: Max
authors.initials: M
authors.lastname: Hirshkowitz
authors.forename: Sylvan
authors.initials: S
authors.lastname: Green
authors.forename: Linda K
authors.initials: LK
authors.lastname: McEvoy
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chan
authors.forename: Alan
authors.initials: A
authors.lastname: Gevins
authors.forename: Gary G
authors.initials: GG
authors.lastname: Kay
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Bloch
authors.forename: Tami
authors.initials: T
authors.lastname: Crabtree
authors.forename: William C
authors.initials: WC
authors.lastname: Dement
mesh_terms: D000328:Adult; D003071:Cognition / Q000502:physiology*; D045422:Continuous Positive Airway Pressure; D004311:Double-Blind Method; D056344:Executive Function / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000523:psychology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome