68| Obstructive Sleep Apnea and Neuropsychology – With Dr. Mark Aloia

Obstructive sleep apnea (OSA) is a disorder of breathing during sleep.  It can lead to both sleep fragmentation and hypoxia, it has a negative impact on cardiovascular functioning, and it is associated with various neurobiological, cognitive, and emotional sequelae.  OSA is underdiagnosed in the general population, and even following successful diagnosis the most popular treatment (positive airway pressure [PAP] devices) is not always well tolerated, leading to low treatment adherence.  Given that OSA impacts the brain and behavior, that it is underdiagnosed, and that successful intervention requires a significant behavior change (e.g., PAP adherence), neuropsychologists have a significant role to play in this public health issue.  In the current episode, John and Ryan speak with Dr. Mark Aloia about various aspects of OSA, including an in-depth discussion of cognitive/emotional effects of the condition, as well as motivational interviewing techniques to improve PAP adherence.

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Topics Covered

  • OSA definition and a brief description of other types of sleep apnea
  • Diagnosis and epidemiology
  • Polysomnography and self-report questionnaires
  • Common cognitive and emotional symptoms
  • Physiological consequences and underlying mechanisms of cognitive/emotional sequelae
  • Overview of positive airway pressure (PAP) devices
  • Motivational interviewing for improving adherence to PAP devices
  • Additional (non-PAP) treatment options
  • Recommendations for clinical neuropsychologists in terms of assessment and treatment

About Mark

Mark Aloia, Ph.D., is a neuropsychologist and an Associate Professor of Medicine at National Jewish Health in Denver, Colorado.  He is also involved in industry research with Philips, Inc.

Note: The International Neuropsychological Society and Navigating Neuropsychology do not have a financial relationship with Philips and do not endorse their products/services.

Selected Resources

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Selected References

Aloia, M. S., Arnedt, J. T., Strand, M., Millman, R. P., & Borrelli, B. (2013). Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial. Sleep, 36(11), 1655-1662.

Bucks, R. S., Olaithe, M., & Eastwood, P. (2013). Neurocognitive function in obstructive sleep apnoea: A meta‐review. Respirology, 18(1), 61-70.

Castronovo, V., Scifo, P., Castellano, A., Aloia, M. S., Iadanza, A., Marelli, S., … & Falini, A. (2014). White matter integrity in obstructive sleep apnea before and after treatment. Sleep, 37(9), 1465-1475.

Daulatzai, M. A. (2015). Evidence of neurodegeneration in obstructive sleep apnea: relationship between obstructive sleep apnea and cognitive dysfunction in the elderly. Journal of neuroscience research, 93(12), 1778-1794.

Gagnon, K., Baril, A. A., Gagnon, J. F., Fortin, M., Decary, A., Lafond, C., … & Gosselin, N. (2014). Cognitive impairment in obstructive sleep apnea. Pathologie Biologie, 62(5), 233-240.

Gosselin, N., Baril, A. A., Osorio, R. S., Kaminska, M., & Carrier, J. (2019). Obstructive sleep apnea and the risk of cognitive decline in older adults. American journal of respiratory and critical care medicine, 199(2), 142-148.

Hilsendager, C. A., Zhang, D., McRae, C., & Aloia, M. (2016). Assessing the influence of obesity on longitudinal executive functioning performance in patients with obstructive sleep apnea syndrome. Obesity research & clinical practice, 10(1), 33-40.

Hoth, K. F., Zimmerman, M. E., Meschede, K. A., Arnedt, J. T., & Aloia, M. S. (2013). Obstructive sleep apnea. Sleep and Breathing, 17(2), 811-817.

Jackson, M. L., McEvoy, R. D., Banks, S., & Barnes, M. (2018). Neurobehavioral impairment and CPAP treatment response in mild-moderate obstructive sleep apnea. Journal of Clinical Sleep Medicine, 14(1), 47-56.

Kerner, N. A., & Roose, S. P. (2016). Obstructive sleep apnea is linked to depression and cognitive impairment: evidence and potential mechanisms. The American Journal of Geriatric Psychiatry, 24(6), 496-508.

Kielb, S. A., Ancoli-Israel, S., Rebok, G. W., & Spira, A. P. (2012). Cognition in obstructive sleep apnea-hypopnea syndrome (OSAS): current clinical knowledge and the impact of treatment. Neuromolecular medicine, 14(3), 180-193.

Lim, D. C., & Pack, A. I. (2014). Obstructive sleep apnea and cognitive impairment: Addressing the blood–brain barrier. Sleep Medicine Reviews, 18(1), 35-48.

Luyster, F. S., Dunbar-Jacob, J., Aloia, M. S., Martire, L. M., Buysse, D. J., & Strollo, P. J. (2016). Patient and partner experiences with obstructive sleep apnea and CPAP treatment: a qualitative analysis. Behavioral sleep medicine, 14(1), 67-84.

Matthews, E. E., Arnedt, J. T., McCarthy, M. S., Cuddihy, L. J., & Aloia, M. S. (2013). Adherence to cognitive behavioral therapy for insomnia: a systematic review. Sleep medicine reviews, 17(6), 453-464.

Olaithe, M., Bucks, R. S., Hillman, D. R., & Eastwood, P. R. (2018). Cognitive deficits in obstructive sleep apnea: insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep medicine reviews, 38, 39-49.

Stranks, E. K., & Crowe, S. F. (2016). The cognitive effects of obstructive sleep apnea: an updated meta-analysis. Archives of clinical neuropsychology, 31(2), 186-193.

Vaessen, T. J., Overeem, S., & Sitskoorn, M. M. (2015). Cognitive complaints in obstructive sleep apnea. Sleep medicine reviews, 19, 51-58.

Zimmerman, M. E., & Aloia, M. S. (2012). Sleep-disordered breathing and cognition in older adults. Current neurology and neuroscience reports, 12(5), 537-546.

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