Consistent Treatment of Sleep Apnea Necessary to Correct Cognitive Problems.

July 31, 2011 - PRLog -- A recent article in the American Journal of Respiratory and Critical Care Medicine (PubMed abstract below) concluded that "The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive nocturnal intermittent hypoxemia. These negative effects may be recovered by consistent and thorough treatment. Our findings highlight the importance of early diagnosis and successful treatment of this disorder."

The findings that consistent and thorough treatment is necessary means that up to 75% of patients are not receiving effective treatment with CPAP.  Studies have shown that up to 60% of patients abandon CPAP treatment.  Even patients who use CPAP average only 4-5 hours/night 4-5 times a week.  This is neither the consistent or thorough treatment  required leaving these patients at risk for permanent neurocognitive disabilities in spite of CPAP (inadequate)  use.  Oral appliances ( WWW.I HATE CPAP.COM) are preferred over CPAP  by the majority of patients offered a choice of therapy.  They are considered a first line therapy for mild to moderate obstructive sleep apnea and an alternative to CPAP for severe sleep apnea when patients do not tolerate CPAP.

Unfortunately, many patients are never offered oral appliance therapy.  This may be due to ignorance of the effectiveness of oral appliances but is often due to sleep physicians financial interest in patients utilizing CPAP.  Many physicians and or family members own DME companies that supply CPAP machines and masks and other supplies to patients.  This is a legitimate enterprise as long as patients are offered an oral appliance alternative as prescribed by the American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine.  

Medicare may frown on relationships that violate "Stark" laws but patients are not harmed unless physicians refuse to offer legitimate alternatives to CPAP when patients do not tolerate CPAP or use it only part time.

Am J Respir Crit Care Med. 2011 May 15;183(10):1419-26. Epub 2010 Oct 29.
Obstructive sleep apnea: brain structural changes and neurocognitive function before and after treatment.
Canessa N, Castronovo V, Cappa SF, Aloia MS, Marelli S, Falini A, Alemanno F, Ferini-Strambi L.
Source

Center for Cognitive Neuroscience, Vita-Salute San Raffaele University, Milan, Italy.
Abstract
RATIONALE:

Obstructive sleep apnea (OSA) is commonly associated with neurocognitive impairments that have not been consistently related to specific brain structure abnormalities. Knowledge of the brain structures involved in OSA and the corresponding functional implications could provide clues to the pathogenesis of cognitive impairment and its reversibility in this disorder.
OBJECTIVES:

To investigate the cognitive deficits and the corresponding brain morphology changes in OSA, and the modifications after treatment, using combined neuropsychologic testing and voxel-based morphometry.
METHODS:

A total of 17 patients treatment-naive to sleep apnea and 15 age-matched healthy control subjects underwent a sleep study, cognitive tests, and magnetic resonance imaging. After 3 months of treatment, cognitive and imaging data were collected to assess therapy efficacy.
MEASUREMENTS AND MAIN RESULTS:

Neuropsychologic results in pretreatment OSA showed impairments in most cognitive areas, and in mood and sleepiness. These impairments were associated with focal reductions of gray-matter volume in the left hippocampus (entorhinal cortex), left posterior parietal cortex, and right superior frontal gyrus. After treatment, we observed significant improvements involving memory, attention, and executive-functioning that paralleled gray-matter volume increases in hippocampal and frontal structures.
CONCLUSIONS:

The cognitive and structural deficits in OSA may be secondary to sleep deprivation and repetitive nocturnal intermittent hypoxemia. These negative effects may be recovered by consistent and thorough treatment. Our findings highlight the importance of early diagnosis and successful treatment of this disorder.

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I HATE CPAP! LLC provides information on Sleep Apnea, Dental Sleep Medicine and alternative to CPAP for patients who are CPAP intolerant. The website http://www.ihatecpap.com has valuable information on treating sleep apnea utilizing oral appliances.