Sleep Apnea: Neuropsychological Effects, Research, and Treatment. By: Brooke Schauder, PhD Erie Psychological Consortium Pacific Graduate School of Psychology
What is Apnea?
Sleep Apnea: Absence of breathing for 10 seconds during sleep, either due to obstruction, central, or mixed. Obstructive is by far the most common form.
Obstructive Sleep Apnea: 1 st described in 1965, characterized by recurrent interruptions of breathing during sleep due to temporary obstruction of the airway by tissues (soft palate, uvula, or tonsils) with resultant hypoxemia and chronic lethargy.
Hypoxia: Decrease below normal levels of oxygen in inspired gases, arterial blood, or tissue.
Normal oxygen hemoglobin saturation is approximately 95%. Decreases up to 50% during apneic episodes
Anoxia: Absence or almost complete absence of oxygen in inspired gases, arterial blood, or tissue.
Sleep Stages and Apnea
During REM motor tone is at lowest level.
Collapse of upper airway.
Accessory muscles of respiration are effectively paralyzed in REM. Diaphragm is solely responsible for breathing.
Typically worse at the end of the night, during longer stages of REM sleep & stages 3-4.
Sleep Apnea Symptoms
Gasping for air with complete or partial waking
Nightmares or night-terrors
Enuresis (in children)
Apneic episodes typically last 10-120 seconds.
Episodes may be recurrent – 1 to 100 times throughout the night.
Affects 4% of men and 2% of women between ages 30 and 60.
Mainly affects middle-aged adults.
“ Typical” patient is overweight adult male.
Up to 88% of adults patients estimated to be overweight.
Incidence increases with advancing age.
1% to 3% of children are affected
Hypnotics use (benzodiazepines)
Recognizing Sleep Apnea
Consider diagnosis if patient snores AND any of the following are present:
Gastro esophageal Reflux Disease
Congestive Heart Failure
Diagnosis is confirmed with by polysomnography, measuring:
Arterial oxygen saturation during sleep
At least 30 episodes over 7 hours of REM and NREM sleep.
At least 5 apneic episodes per hour.
Sustained Attention and Concentration
Immediate and Delayed Recall of Visual and Verbal Information
Selective attention, mental flexibility, impulse control, behavioral and emotional regulation, and metacognition in children (Beebe, 2004).
Deficits on visual memory, concentration, and auditory reaction time (Laakso, Herrala, & Rikka (1999).
Neuropsychological Deficits (continued)
Motor disturbances: posture, gait, involuntary movements, Parkinsonian symptoms, limb appraxia.
Psychological: Depression, personality changes, and emotional lability.
May look similar to TBI or Carbon Monoxide poisoning on testing: however, less depression and more anxiety.
Impairment on Stroop: Errors as well as RT (Van Diest, 2000).
Mean processing speed is 93 when compared to age matched sample (100). Apnea index >30 mean processing speed is 87.4. (Cassel, 1989).