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Impact of obstructive sleep apnea syndrome on cognition in early postmenopausal women

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Obstructive sleep apnea syndrome (OSAS) has a higher prevalence in postmenopausal women who are not on hormone replacement therapy (HRT), as compared to premenopausal women. Cognitive impairment (CI) is associated with OSAS and the early postmenopausal state. We hypothesized that compared to postmenopausal women at low risk for OSAS, postmenopausal women at high risk for OSAS would report worse cognitive function.

Methods

Early postmenopausal women not on HRT between the ages of 45 and 60 years, within 5 years of natural menopause, were enrolled. Participants completed a REDCap survey which collected information on demographics and risk factors, Berlin questionnaire to screen subjects for OSAS risk, and the Mail-In Cognitive Function Screening Instrument (MCFSI) score which was used to assess CI.

Results

Of 381 respondents, 127 were omitted due to missing/duplicate data or not meeting inclusion criteria. One hundred fifty-four women were classified as high risk for OSAS (OSAS+), and 100 were classified as low risk for OSAS (OSAS−). OSAS− women reported lifetime smoking, lifetime drinking, and recreational drug use more often than OSAS+ women, while OSAS+ women reported a depression diagnosis more often. The mean MCFSI score in the OSAS+ group was significantly higher (worse cognition) than in the OSAS− group after controlling for covariates (5.59, 95 % CI 5.08–6.11 vs. 4.29, 95 % CI 3.64–4.93, p < 0.05).

Conclusion

Early postmenopausal women at high risk for OSAS report more CI than those at low risk for OSAS. Future studies should identify biomarkers of this CI and define the degree of reversibility of CI with OSAS treatment.

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Abbreviations

OSAS:

Obstructive sleep apnea syndrome

HRT:

Hormone replacement therapy

CI:

Cognitive impairment

AD:

Alzheimer’s disease

AHI:

Apnea-hypopnea index

MCFSI:

Mail-in Cognitive Function Screening Instrument

MUSC:

Medical University of South Carolina

BQ:

Berlin questionnaire

ANCOVA:

Analysis of covariance

CPAP:

Continuous positive airway pressure

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Funding source

This work was done with funding provided by National Institute on Drug Abuse, P50 DA106511-14, “Specialized Centers of Research (SCOR) on Sex Differences” (K. Brady, PI).

Compliance with ethical standards

This study was conducted in accordance with the amended Declaration of Helsinki. The local institutional review board (IRB) at the Medical University of South Carolina (MUSC) approved the study protocol, PRO # Pro00025410. Waiver of written informed consent was obtained from the IRB for this survey-based study. Data was collected between the dates of 07/2013 to 06/2015.

Conflict of interest

Dr. Lal has received grant funding from Invado Pharmaceuticals and the Specialized Center of Research (SCOR) on Sex and Gender Factors Affecting Women’s Health at the Medical University of South Carolina and is a consultant for Ikaria Pharmaceuticals. Dr. Joseph, Ms. Dibartolo and Dr. Kumbhare and Dr. Strange do not have any conflicts of interest to disclose on the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Pulmonary, Critical Care, and Sleep, Medical University of South Carolina, 96 Jonathan Lucas Street, CSB Suite 812, Msc 630, Charleston, SC, 29425, USA

    Chitra Lal, Suchit Kumbhare & Charlie Strange

  2. Department of Neurosciences, Medical University of South Carolina, Charleston, USA

    Michelle M. DiBartolo & Jane E. Joseph

Authors
  1. Chitra Lal
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  2. Michelle M. DiBartolo
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  3. Suchit Kumbhare
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  4. Charlie Strange
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  5. Jane E. Joseph
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Correspondence to Chitra Lal.

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Lal, C., DiBartolo, M.M., Kumbhare, S. et al. Impact of obstructive sleep apnea syndrome on cognition in early postmenopausal women. Sleep Breath 20, 621–626 (2016). https://doi.org/10.1007/s11325-015-1261-4

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  • DOI: https://doi.org/10.1007/s11325-015-1261-4

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