title: Factors affecting executive functions in obstructive sleep apnea syndrome and volumetric changes in the prefrontal cortex.
abstract: OBJECTIVE
  Obstructive sleep apnea syndrome (OSAS) is associated with cognitive changes and executive functions are among the cognitive domains most affected. However, it is not completely understood which of the factor(s) among hypoxemia, repeated arousal, and sleepiness affect the executive functions. This study aims to evaluate the possible relationship between the executive functions and nocturnal parameters, Epworth Sleepiness Scale (ESS) scores, and prefrontal cortex (PFC) volumes.
  
  
  METHODS
  A total of 28 patients aged between 18 and 60 years who were newly diagnosed with OSAS were included in this study. The Wisconsin Card Sorting Test (WCST) and Stroop test which were used in the evaluation of executive functions were applied to all patients. Cranial magnetic resonance imaging (MRI) and volumetric measurements of the PFC were performed. Polysomnography (PSG), WCST, Stroop test, and cranial MRI were also applied to the control group which consisted of age- and education status-matched 15 healthy subjects. The correlation of WCST and Stroop tests and PFC volume, PSG parameters, and ESS scale was examined.
  
  
  RESULTS
  The WCST-6 test scores were statistically significantly higher in the patient group (p = 0.022; p < 0.05). Additionally, the Stroop test 5 (p = 0.043) and Stroop test-5 correction (p = 0.005) measurements were statistically significantly higher in the patient group (p < 0.05). A negative and statistically significant correlation was found between the WCST-4 and WCST-10 and ESS measurements in the patient group (r -0.452; p 0.016; p < 0.05; r -0.437; p 0.020; p < 0.05). However, there was no correlation between the PSG parameters and WCST and Stroop test scores. No statistically significant differences in the MRI volumetric measurements of the PFC were found between the patient and control groups.
  
  
  CONCLUSIONS
  Impairment in the attentive and executive functions in OSAS is evident. The most influential factor is excessive daytime sleepiness, rather than hypoxemia and severity of the disease.
authors.affiliation: Clinic of Neurology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
authors.forename: Zahide
authors.initials: Z
authors.lastname: Yılmaz
authors.affiliation: Clinic of Radiology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
authors.forename: Nuray
authors.initials: N
authors.lastname: Voyvoda
authors.affiliation: Clinic of Psychiatry, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
authors.forename: Eda
authors.initials: E
authors.lastname: İnan
authors.affiliation: Clinic of Neurology, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
authors.forename: Pınar Bekdik
authors.initials: PB
authors.lastname: Şirinocak
authors.affiliation: Clinical of Physical Medicine and Rehabilitation, Kocaeli Derince Education and Research Hospital, Kocaeli, Turkey.
authors.forename: Rabia
authors.initials: R
authors.lastname: Terzi
keywords: Excessive daytime sleepiness; Executive function; Hypoxemia; Obstructive sleep apnea; Prefrontal cortex