Download PDF
CC BY-NC-ND 4.0 · Sleep Sci 2021; 14(04): 319-329
DOI: 10.5935/1984-0063.20200099
ORIGINAL ARTICLE

The role of education in cognitive functions among middle-age and older patients with untreated obstructive sleep apnea

Ei E Hlaing
1   University of Lynchburg, Psychological Science - Lynchburg - VA - United States.
,
Stephanie M Clancy Dollinger
2   Southern Illinois University Carbondale, Psychology - Carbondale - IL - United States.
,
Terry M Brown
3   Sleep Medicine Associates, LLC, Sleep Medicine - Marion - IL - United States.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Objective The goal of the current study was to examine the interaction between educational level and obstructive sleep apnea (OSA), one of the most under diagnosed sleep disorders, on cognitive functions such as verbal fluency, psychomotor vigilance, executive functions, visuospatial ability, and attention span.

Material and Methods One hundred and nine participants (47 controls and 62 untreated OSA patients) participated in the study and completed the Wisconsin Card Sorting Test, WAIS-III digit span and block design, semantic and phonemic fluency tests, and a psychomotor vigilance task. Subjective sleep and health measures were assessed.

Results In semantic fluency and visuospatial ability tasks, patients with higher education performed better than patients with lower education and controls with lower education. This difference in moderation effects was not observed for vigilance, phonemic fluency, attention span, or executive functions although education was a significant predictor for all cognitive tasks.

Conclusion Higher education may have contributed to cognitive reserve in OSA patients (but not for controls) as reflected in better semantic fluency and visuospatial ability. This benefit of higher education contributing to larger cognitive reserve in patients with OSA helped buffer the deficits for some cognitive functions but not for others. This may indicate that this buffer is not limitless because when the cognitive demand gets higher the educational buffer no longer works.

Sleep Apnea - Obstructive - Cognition - Education


Publication History

Received: 26 August 2020

Accepted: 25 January 2021

Article published online:
30 November 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Nebes RD, Buysse DJ, Halligan EM, Houck PR, Monk TH. Selfreported sleep quality predicts poor cognitive performance in healthy older adults. J Geron Psychol Sci. 2009 Mar;64(2):180-7. DOI: https:// doi.org/10.1093/geronb/gbn037
  • 2 Sforza E, Roche F. Sleep apnea syndrome and cognition. Front Neurol. 2012;3:87.
  • 3 Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep- disordered breathing among middle-aged adults. N Engl J Med. 1993 Apr;328(17):1230-5.
  • 4 Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O. Sleep disordered breathing in community dwelling elderly. Sleep. 1991 Dec;14(6):486-95.
  • 5 Ferini-Strambi L, Baietto C, Di Gioia MR, Castaldi P, Castonovo C, Zucconi M, et al. Cognitive dysfunction in patients with obstructive sleep apnea (OSA): Partial reversibility after continuous positive airway pressure (CPAP). Brain Res Bull. 2003 Jun;61(1):87-92. DOI: https:// doi.org/10.1016/s0361-9230(03)00068-6
  • 6 Ross CE, Mirowsky J. Sex differences in the effect of education on depression: resource multiplication or resource substitution?. Soc Sci Med. 2006 Sep;63(5):1400-13. DOI: https://doi.org/10.1016/j. socscimed.2006.03.013
  • 7 Bauldry S. Conditional health-related benefits of higher education: An assessment of compensatory versus accumulative mechanism. Soc Sci Med. 2014 Jun;111:94-100. DOI: https://doi.org/10.1016/j. socscimed.2014.04.005
  • 8 Altindag D, Cannonier C, Mocan N. The impact of education on health knowledge. Econ Edu Rev. 2011;30(5):792-812.
  • 9 Alachantis M, Zias N, Deligiorgis N, Amfilochiou A, Dionellis G, Orphanidou D. Sleep apnea-related cognitive deficits and intelligence: an implication of cognitive reserve theory. J Sleep Res. 2005 Mar;14(1):69-75.
  • 10 Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc. 2002 Mar;8(3):448-60.
  • 11 Scarmeas N, Stern Y. Cognitive reserve and lifestyle. J Clin Exp Neuropsychol. 2003 Aug;25(5):625-33.
  • 12 Sumowski JF, Rocca MA, Leavitt VM, Riccitelli G, Giancarlo G, Comi G, et al. Brain reserve and cognitive reserve in multiple sclerosis: what you’ve got and how you use it. Neurology. 2013 Jun;80(24):2186-93.
  • 13 Ahles TA, Saykin AJ, McDonald BC, Li Y, Furstenberg CT, Hanscom BS, et al. Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. J Clin Onc. 2010 Oct;28(29):4434-40.
  • 14 Stern Y. Cognitive reserve in ageing and Alzheimer’s disease. Lancet Neurol. 2012 Nov;11(11):1006-12.
  • 15 Reuter-Lorenz PA, Park DC. How does it STAC up? Revisiting the scaffolding theory of aging and cognition. Neuropsychol Rev. 2014 Aug;24:355-70. DOI: https://doi.org/10.1007/s11065-014-9270-9
  • 16 Barulli D, Stern Y. Efficiency, capacity, compensation, maintenance, plasticity: emerging concepts in cognitive reserve. Trends Cogn Sci. 2013 Oct;17(10):502-9. DOI: https://doi.org/10.1016/j.tics.2013.08.012
  • 17 Schneider W, Eschman A, Zuccolotto A. E-Prime user’s guide. Pittsburgh: Psychological Software Tools Inc.; 2002.
  • 18 Grant DA, Berg EA, Heaton RK, Chelune GJ, Talley JL, Kay GG, et al. Wisconsin Card Sorting Test® (WCST). [Internet]. Lutz: Psychological Assessment Resources (PAR®); 2003. Available from: http://www4. parinc.com/Products/Product.aspx?ProductID=WCST
  • 19 Straus E, Sherman EMS, Spreen OA. A compendium of neuropsychological tests: administration, norms, and commentary. 3rd ed. New York: Oxford University Press; 2006.
  • 20 Wechsler D. WAIS-III: administration and scoring manual. San Antonio: The Psychological Association; 1997.
  • 21 Berry RB, Brooks R, Garnaldo CE, Harding SM, Lloyd RM, Marcus CL, et al. The AASM for the scoring of sleep and associated events: rules, terminology, and technical specifications (version 2.2). Darien: American Academy of Sleep Medicine (AASM); 2015.
  • 22 Chen H, Lowe AA, Bai Y, Hamilton P, Fleethan JA, Almeida FR. Evaluation of a portable recording device (ApneaLink) for case selection of obstructive sleep apnea. Sleep Breath. 2009 Aug;13(3):213-9.
  • 23 Beck AT, Steer RA, Ball R, Ranieri W. Comparison of Beck depression inventories – IA and II in psychiatric outpatients. J Pers Assess. 1996 Dec;67(3):588-97.
  • 24 Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56(6):893-7. DOI: https://doi.org/10.1037/0022-006x.56.6.893
  • 25 Curran SL, Andrykowski MA, Studt JL. Short form of the Profile of Mood States (POMS-SF): psychometric information. Psychol Assess. 1995;7(1):80-3.
  • 26 Johns MW. Reliability and factor analysis of the Epworth sleepiness scale. Sleep. 1992 Aug;15(4):376-81.
  • 27 Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh quality of sleep index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989 May;28(2):193-213.
  • 28 Horne JA, Ostberg O. A self-assessment questionnaire to determine morningnesseveningness in human circadian rhythms. Int J Chronobiol. 1976;4(2):97-110.
  • 29 Kapur VK, Auckley DH, Chowdhuri S, Kuhlmann DC, Mehra R, Ramar K, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med. 2017 Mar;13(3):479-503.
  • 30 Tariq SH, Tumosa N, Chibnall JT, Perry HM, Morley JE. Comparison of the Saint Louis University mental status examination and the minimental state examination for detecting dementia and mild neurocognitive disorder--a pilot study. Am J Geriatr Psychiatry. 2006 Nov;14(11):900-10.
  • 31 Allison P. Multiple regression: a primer. California: Pine Forge Press Inc.; 1999.
  • 32 Kahneman D. Attention and effort. Englewood Cliffs: Prentice-Hall; 1973.
  • 33 Hockey GRJ, Wastell DG, Sauer J. Effects of sleep deprivation and user interface on complex performance: a multilevel analysis of compensatory control. Human Factors. 1998 Jun;40(2):233-53. DOI: https://doi.org/10.1518/001872098779480479
  • 34 Biesbroek JM, Van Zandvoort MJ, Kappelle LJ, Velthuis BK, Biessels GJ, Postma A. Shared and distinct anatomical correlates of semantic and phonemic fluency revealed by lesion-symptom mapping in patients with ischemic stroke. Brain Struct Funct. 2016 May;221(4):2123-34. DOI: https://doi.org/10.1007/s00429-015-1033-8
  • 35 Cavaco S, Gonçalves A, Pinto C, Almeida E, Gomes F, Moreira I, et al. Semantic fluency and phonemic fluency: regression-based norms for the Portuguese population. Arch Clin Neuropsych. 2013 May;28(3):262-71. DOI: https://doi.org/10.1093/arclin/act001
  • 36 Baldo JV, Schwartz S, Wilkins D, Dronkers NF. Role of frontal versus temporal cortex in verbal fluency as revealed by voxel-based lesion symptom mapping. J Int Neuropsychol Soc. 2006 Nov;12(6):896-900.
  • 37 Risser MR, Ware JC, Freeman FG. Driving simulation with EEG monitoring in normal and obstructive sleep apnea patients. Sleep. 2000 May;23(3):393-8.
  • 38 Engleman HM, Wild MR. Improving CPAP use by patients with the sleep apnoea/hypopnea syndrome (SAHS). Sleep Med Rev. 2003 Feb;7(1):81-99.
  • 39 Ito K, Ikeda T. Accuracy of type III portable monitors for diagnosing obstructive sleep apnea. Biomed Hub. 2018 Jun;3(2):1-10. DOI: https://doi.org/10.1159/000489158
  • 40 El Shayeb M, Topfer LA, Stafinski T, Pawluk L, Menon D. Diagnostic accuracy of level 3 porTable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ. 2014 Jan;186(1):E25-51. DOI: https://doi.org/10.1503/ cmaj.130952
  • 41 Olaithe M, Bucks RS. Executive dysfunction in OSA before and after treatment: a meta-analysis. Sleep. 2013 Sep;36(9):1297-305. DOI: https://doi.org/10.5665/sleep.2950
  • 42 Cabeza R. Hemispheric asymmetry reduction in older adults: the HAROLD model. Psychol Aging. 2002 Mar;17(1):85-100.
  • 43 León J, García-García J, Roldán-Tapia L. Estimating cognitive reserve in healthy adults using the cognitive reserve scale. PLOS One. 2014 Jul;9(7):e102632. DOI: https://doi.org/10.1371/journal.pone.102632