Am. J. Respir. Crit. Care Med., Volume 163, Number 7, June 2001, 1626-1631

Relation of Measures of Sleep-Disordered Breathing to Neuropsychological Functioning

NANCY ADAMS, MILTON STRAUSS, MARK SCHLUCHTER, and SUSAN REDLINE

Departments of Psychology and Neurology, Case Western Reserve University, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; and Department of Pediatrics, Case Western Reserve University, Rainbow Babies and Children's Hospital, Cleveland, Ohio

Sleep-disordered breathing (SDB) has been associated with neuropsychological (NP) deficits. The extent to which such effects are attributable to unmeasured confounders or selection biases, or are manifest across a range of SDB is unclear. The relationship of SDB with a broad range of NP functions was examined in 100 volunteers with a spectrum of SDB and without underlying comorbidity. Factor analysis suggested that the NP tests could be summarized as four constructs: declarative memory, signal discrimination, working memory, and set shifting. These factors plus vigilance were dependent variables. Independent variables were age, the respiratory disturbance index (RDI), a sleepiness score, the arousal index, and sleep-associated hypoxemia. Factors "declarative memory" (measuring 25% of the common variance,  = 0.95), "signal discrimination" (10% variance,  = 0.70), and "working memory" (9% variance,  = 0.52) were each significantly, linearly predicted by hypoxemia and/or the RDI, with no evidence for significant threshold effects. SDB measures accounted for 4-6% of the variance in NP constructs. In contrast, sleepiness best predicted vigilance. Thus, adverse exposures (hypoxemia or RDI) during sleep may negatively influence NP functions in a dose-response relationship, and, other than vigilance, these effects may not be directly attributable to sleepiness.

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