Ağır Derecede Obstrüktif Uyku Apne Sendromu Hastalarında Bilişsel İşlevlerin Değerlendirilmesi

Yıl 2023, Cilt: 7 Sayı: 2, 219 - 224, 31.08.2023

Firdevs Ezgi Uçan Tokuç , Fatma Genç , Ömer Tarık Selçuk , Ruhsen Ocal , Aylin Yaman

https://doi.org/10.29058/mjwbs.1225470

Öz

Amaç: Üst solunum yolu obstrüksiyonuna bağlı apne ve oksijen satürasyonunda düşme ile karakterize
obstrüktif uyku apne sendromunun (OUAS) bazı nörokognitif bozukluklara sebep olabileceği daha önceki
çalışmalarda ileri sürülmüştür. Bu çalışmada sağlıklı kontrol grubuna kıyasla, ağır OUAS hastalarında
gelişebilecek ileri kognitif fonksiyonları değerlendirmeyi amaçladık.
Gereç ve Yöntemler: Polisomnografik (PSG) inceleme yapılmış olan hastalardan ağır OUAS tanısı
alan 18-70 yaş arasındaki 25 hastaya ileri kognitif testler uygulandı. Olgular yaş ve cinsiyet uyumlu
25 sağlıklı kontrol grubu ile kıyaslandı. Hasta ve kontrol gruplarına; epizodik bellek ve öğrenmeyi
değerlendirilmek için Rey İşitsel Sözel Öğrenme Testi (Rey ‘Auditory Verbal Learning Test’, AVLT) ile
yürütücü fonksiyonlar ve dikkati değerlendirmek için Stroop Testi uygulandı.
Bulgular: Gruplar arasında Stroop-1, Stroop-2, Stroop-3, Stroop-4 ve Stroop-Toplam sürelerinde (sırası
ile ortalama ± standart sapma: 13,3±5,3 saniye, 13,2±4 saniye, 18,1±7,1 saniye, 24,2±7,4 saniye,
100,8±29,7 saniye ve p değerleri: p=0.031, p=0.044, p=0.013, p=0.027 ve p=0.032) uzama, AVLT
testinde ise AVLT B, AVLT Tanıma puanlarında düşüş izlendi (sırası ile ortalama ± standart sapma:
12,7±2,3 puan, 38±10,2 puan ve p değerleri: p=0.042, p<0.001). OUAS grubunda yaş, cinsiyet ve komorbit
hastalıklar ile Stroop Testi ve AVLT sonuçları karşılaştırıldığında istatistiksel olarak anlamlı bir
farklılık saptanmadı (p>0.05).
Sonuç: Çalışmamızda ağır derecede OUAS hastalarında Stroop Testi ve AVLT sonucuna göre dikkat ve
epizodik belleğin belirgin şekilde bozulduğunu gösterdik.

Anahtar Kelimeler

Kognitif disfonksiyon, obstrüktif uyku apne sendromu, rey işitsel sözel öğrenme testi, stroop testi

Evaluation of Cognitive Functions in Patients with Severely Obstructive Sleep Apnea Syndrome

Öz

Aim: Obstructive sleep apnea syndrome (OSAS), which is characterized by apnea due to recurrent
upper respiratory tract obstruction and a decrease in oxygen saturation, is known to cause many
neurocognitive disorders. In this study, we aimed to show the effect on cognitive functions that may
develop in severe OSAS patients compared to the healthy control group.
Material and Methods: We compared the cognitive status of 25 patients diagnosed with severe OSAS
between 18 - 70 years with an all-night Polysomnographic (PSG) examination with 25 healthy voluntary
control groups of similar age and gender. In both groups, patients who were previously diagnosed with cognitive dysfunction, who used drugs that would impair cognitive functions and who were diagnosed with a psychiatric disease were
exclueded from the study. Rey Auditory Verbal Learning Test (AVLT) and Stroop Test were applied to the patient and control groups.
Results: There was slowed responce time in Stroop-1, Stroop-2, Stroop-3, Stroop-4 and Stroop-Total tests (mean ± standard deviation:
13.3±5.3 second, 13.2±4 second, 18.1±7.1 second, 24.2±7.4 second, 100.8±29.7 second and p values: p=0.031, p=0.044, p=0.013,
p=0.027, p=0.032, respectively) and also there was worsening in in AVLT B1, AVLT-Recognition tests ( mean ± standard deviation: 12.7±2.3
point, 38±10.2 point and p values: p=0.042, p<0.001 respectively). As compared age, gender, comorbid disease with Stroop Test and AVLT
there wasn’t statistically significant in the OSAS group (p>0.05).
Conclusion: Our findings confirm that attention and episodic memory can be significantly impaired using the Stroop and AVLT in patients
with severe OSAS.

Anahtar Kelimeler

Cognitive dysfunction, obstructive sleep apnea syndrome, Rey auditory verbal learning test, stroop test

Kaynakça

• 1. Jordan AS, McSharry DG, Malhotra A. Adult obstructive sleep apnoea. Lancet 2014;383(9918):736-747.
• 2. Wang F, Xiong X, Xu H, Huang H, Shi Y, Li X, Qian Y, Zou J, Yi H, Guan J, Yin S. The association between obstructive sleep apnea syndrome and metabolic syndrome: A confirmatory factor analysis. Sleep Breath 2019;23(3):1011-1019.
• 3. Arnold J, Sunilkumar M, Krishna V, Yoganand SP, Kumar MS, Shanmugapriyan D. Obstructive sleep apnea. J Pharm Bioallied Sci 2017;9(Suppl 1):S26-S28.
• 4. Sateia MJ. International classification of sleep disorders-third edition: Highlights and modifications. Chest 2014;146(5):1387- 1394.
• 5. Devita M, Zangrossi A, Marvisi M, Merlo P, Rusconi ML, Mondini S. Global cognitive profile and different components of reaction times in obstructive sleep apnea syndrome: Effects of continuous positive airway pressure over time. Int J Psychophysiol 2018;123:121-126.
• 6. Kulkas A, Tiihonen P, Julkunen P, Mervaala E, Töyräs J. Novel parameters indicate significant differences in severity of obstructive sleep apnea with patients having similar apneahypopnea index. Med Biol Eng Comput 2013;51(6):697-708.
• 7. Morrell MJ, McRobbie DW, Quest RA, Cummin AR, Ghiassi R, Corfield DR. Changes in brain morphology associated with obstructive sleep apnea. Sleep Med 2003;4(5):451-454.
• 8. Guzel A, Gunbey E, Koksal N. The performance of critical flicker frequency on determining of neurocognitive function loss in severe obstructive sleep apnea syndrome. J Sleep Res 2017;26(5):651-656.
• 9. Comallı Pe, Wapner S, Werner H. Interference effects of Stroop color-word test in childhood, adulthood, and aging. J Genet Psychol 1962;100:47-53.
• 10. Arli B, Bilen S, Titiz AP, Ulusoy EK, Mungan S, Gurkas E, Oztekin ZN, Ozcan M, Ak F. Comparison of cognitive functions between obstructive sleep apnea syndrome and simple snoring patients: OSAS may be a modifiable risk factor for cognitive decline. Appl Neuropsychol Adult 2015;22(4):282-286.
• 11. Mathieu A, Mazza S, Décary A, Massicotte-Marquez J, Petit D, Gosselin N, Malo J, Montplaisir J. Effects of obstructive sleep apnea on cognitive function: A comparison between younger and older OSAS patients. Sleep Med 2008;9(2):112-120.
• 12. Deveci E, Öztürk A, Kırpınar İ, Engin Rİ, Melikoğlu M, Sakat SC, Demir M, Canpolat S. Akneli hastalarda izotretinoin kullanımı sırasında dikkat ve yürütücü işlevlerde düzelme. Turkderm [Internet] 2013;47(2):109-113.
• 13. Yılmaz Z, Voyvoda N, İnan E, Şirinocak PB, Terzi R. Factors affecting executive functions in obstructive sleep apnea syndrome and volumetric changes in the prefrontal cortex. Springerplus 2016;5(1):1934.
• 14. Hrubos-Strøm H, Nordhus IH, Einvik G, Randby A, Omland T, Sundet K, Moum T, Dammen T. Obstructive sleep apnea, verbal memory, and executive function in a community-based highrisk population identified by the Berlin Questionnaire Akershus Sleep Apnea Project. Sleep Breath 2012;16(1):223-231.
• 15. Torelli F, Moscufo N, Garreffa G, Placidi F, Romigi A, Zannino S, Bozzali M, Fasano F, Giulietti G, Djonlagic I, Malhotra A, Marciani MG, Guttmann CR. Cognitive profile and brain morphological changes in obstructive sleep apnea. Neuroimage 2011;54(2):7877-7893.
• 16. Verstraeten E, Cluydts R, Pevernagie D, Hoffmann G. Executive function in sleep apnea: Controlling for attentional capacity in assessing executive attention. Sleep 2004;27(4):6856-6893.
• 17. Verstraeten E. Neurocognitive effects of obstructive sleep apnea syndrome. Curr Neurol Neurosci Rep 2007;7(2):161- 166.
• 18. Hamamcı M, İntepe YS, Çiftçi B. Evaluation of cognitive functions in obstructive sleep apnea syndrome. Düzce Med J 2020;22(1):29-35.
• 19. Kanbay A, Demir NC, Tutar N, Köstek O, Özer Şimşek Z, Buyukoglan H, Demir R, Parrino L. The effect of CPAP therapy on insulin-like growth factor and cognitive functions in obstructive sleep apnea patients. Clin Respir J 2017;11(4):506- 513.
• 20. Lau EY, Eskes GA, Morrison DL, Rajda M, Spurr KF. Executive function in patients with obstructive sleep apnea treated with continuous positive airway pressure. J Int Neuropsychol Soc 2010;16(6):1077-1088.
• 21. Alomri RM, Kennedy GA, Wali SO, Ahejaili F, Robinson SR. Differential associations of hypoxia, sleep fragmentation, and depressive symptoms with cognitive dysfunction in obstructive sleep apnea. Sleep 2021;44(4):zsaa213.
• 22. Vanek J, Prasko J, Genzor S, Ociskova M, Kantor K, Holubova M, Slepecky M, Nesnidal V, Kolek A, Sova M. Obstructive sleep apnea, depression and cognitive impairment. Sleep Med 2020;72:50-58.
• 23. Thompson C, Legault J, Moullec G, Martineau-Dussault MÈ, Baltzan M, Cross N, Dang-Vu TT, Gervais N, Einstein G, Hanly P, Ayas N, Lorrain D, Kaminska M, Gagnon JF, Lim A, Carrier J, Gosselin N. Association between risk of obstructive sleep apnea, inflammation and cognition after 45 years old in the Canadian Longitudinal Study on Aging. Sleep Med 2022;91:21- 30.
• 24. Saunamäki T, Jehkonen M. A review of executive functions in obstructive sleep apnea syndrome. Acta Neurol Scand 2007;115(1):1-11.