Obstructive Sleep Apnea Risk Level Affect Executive Function Rather than Attention

Herpan Syafii Harahap, Yanna Indrayana


Obstructive sleep apnea (OSA) is a kind of sleep disorders which is associated with cognitive impairment, either independently or by its strong association with metabolic syndrome. OSA affected attention and executive functions. Since the diagnosis of OSA had limitation, the assessment of OSA risk level by using STOP-BANG Questionnaire instrument in common population is important. This was a cross-sectional study aimed to investigate the effect of OSA risk level determined based on STOP-BANG Questionnaire score to attention and executive functions in 82 subjects. The demographic and clinical characteristics data obtained were age, gender, level of education, hypertension, body mass index (BMI), neck circumference, OSA risk level, and attention and executive functions.  Attention function was assessed by using Forward Digit Span and Trailmaking Test A (TMT-A) instruments, while executive function was assessed by using Backward Digit Span and Verbal Fluency Test instruments. The demographic and clinical characteristics data showed significant higher proportion of male gender, large neck circumference, and hypertension in high risk OSA group. The OSA risk level significantly impaired the executive function but did not impaired attention function.


Obstructive sleep apnea risk level, metabolic syndrome, attention, executive function

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Adamis, D., Meagher, D., Murray, O., O’Neill, D., O’Mahony, E., Mulligan, O., et al., 2016. Evaluating Attention in Delirium: A Comparison of Bedside Tests of Attention. Geriatrics Gerontology International, 16, pp. 1028-1035.

Adedayo, A. M., Olafiranye, O., Smith, D., Hill, A., Zizi, F., Brown, C., et al., 2014. Obstructive Sleep Apnea and Dyslipidemia: Evidence and Underlying Mechanism. Sleep and Breathing, 18 (1), pp. 13-18.

Ahbab, S., Ataoglu, H. E., Tuna, M., Karasulu, L., Cetin, F., Temiz, L. U., et al., 2013. Neck Circumference, Metabolic Syndrome and Obstructive Sleep Apnea Syndrome; Evaluation of Possible Linkage. Medical Science Monitor, 19, pp. 111-117.

Alfie, J., Diaz, M., Paez, O., Cufaro, P., Rodriguez, P., Fabregues, G., et al., 2012. Relationship Between Neck Circumference and Hypertension in the National Hypertension Registry (the RENATA study). Revista Argentina de Cardiologia, 80, pp. 275-279.

Aurora, R. N., Zak, R. S., Karippot, A., Lamm, C. I., Morgenthaler, T. I., Auerbach, S. H., et al., 2011. Practice Parameters for the Respiratory Indications for Polysomnography in Children. SLEEP, 34 (3), pp. 379-388.

Bucks, R. S., Olaithe, M., & Eastwood, P., 2013. Neurocognitive Function in Obstructive Sleep Apnoea: A Meta-review. Respirology, 18, pp. 61-70.

Canessa, N., Castronovo, V., Cappa, S. F., Aloia, F. S., Marelli, S., Falini, A., et al., 2011. Obstructive Sleep Apnea: Brain Structural Changes and Neurocognitive Function before and after Treatment. American Journal of Respiratory and Critical Care Medicine, 183, pp. 1419-1426.

Cavalieri, M., Ropele, S., Petrovic, K., Pluta-Fuerst, A., Homayoon, N., Enzinger, C., et al., 2010. Metabolic Syndrome, Brain Magnetic, Resonance Imaging, and Cognition. Diabetes Care, 33, pp. 2489-2495.

Chen, J., Li, Q., Jiang, G., Zeng, S., Shen, J., Sun, J., et al., 2018. Association of Neck Circumference and Cognitive Impairment among Chinese Elderly. Brain and Behavior, 8, pp. e00937.

Choraghe, R. P., & Pillai, C., 2016. Assessment of Cognitive Deficits in Obstructive Sleep Apnea with Paper-based Tests and Choice Reaction. Current Science, 111 (11), pp. 1825-1831.

Chung, F., Abdullah, H. R., & Liao, P., 2016. STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. CHEST, 149 (3), pp. 631-638.

Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., et al., 2008. STOP Questionnaire: A Tool to Screen Patients for Obstructive Sleep Apnea. Anesthesiology, 108, pp. 812-821.

Daulatzai, M. A., 2012. Pathogenesis of Cognitive Dysfunction in Patients with Obstructive Sleep Apnea: A Hypothesis with Emphasis on the Nucleus Tractus Solitarius. Sleep Disorders, 2012

Deng, X., Gu, W., Li, Y., Liu, M., Li, Y., & Gao, X., 2014. Age-Group-Specific Associations between the Severity of Obstructive Sleep Apnea and Relevant Risk Factors in Male and Female Patients. PLoS ONE, 9 (9), pp. e107387.

Dewan, N. A., Nieto, F. J., & Somers, V. K., 2015. Intermittent Hypoxemia and OSA. Implications for Comorbidities. CHEST, 147 (1), pp. 266-274.

Doshi, V., Walia, R., Jones, K., Aston, C. E., & Awab, A., 2015. STOP-BANG Questionnaire as a Screening Tool for Diagnosis of Obstructive Sleep Apnea by Unattended Portable Monitoring Sleep Study. SpringerPlus, 4, pp. 795.

Drager, L. F., Genta, P. R., Pedrosa, R. P., Nerbas, F. B., Gonzaga, C. C., Krieger, E. M., et al., 2010. Characteristics and Predictors of Obstructive Sleep Apnea in Patients With Systemic Hypertension. American Journal of Cardiology, 105, pp. 1135-1139.

Drager, L. F., Togeiro, S. M., Polotsky, V. Y., & Lorenzi-Filho, G., 2013. Obstructive Sleep Apnea. A Cardiometabolic Risk in Obesity and the Metabolic Syndrome. Journal of the American College of Cardiology, 62 (7), pp. 569-576.

Faria, C. A., Alves, H. V., & Charchat-Fichman, H., 2015. The Most Frequently Used Tests for Assessing Executive Functions in Aging. Dementia & Neuropsychologia, 9(2), pp. 149-155.

Franklin, K. A., & Lindberg, E., 2015. Obstructive Sleep Apnea is A Common Disorder in The Population—A Review on the Epidemiology of Sleep Apnea. Journal of Thoracic Disease, 7 (8), pp. 1311-1322.

Geer, E. B., & Shen, W., 2009. Gender Differences in Insulin Resistance, Body Composition, and Energy Balance. Gender Medicine, 6 (Suppl 1), pp. 60-75.

Gunawan, P. Y., Harris, S., Octaviana, F., & Herqutanto, H., 2013. Prevalensi Obstructive Sleep Apnea dengan Kuesioner STOP-BANG dan Risiko Stroke pada Populasi Normal. Neurona, 30(4), pp. 1-8.

Iadecola, C., Yaffe, K., Biller, J., Bratzke, L. C., Faraci, F. M., Gorelick, P. B., et al., 2016. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association. Hypertension, 68(6), pp. e67-e94.

Joo, E. Y., Tae, W. S., Lee, M. J., Kang, J. W., Park, H. S., Lee, J. Y., et al., 2010. Reduced Brain Gray Matter Concentration in Patients With Obstructive Sleep Apnea Syndrome. SLEEP, 33(2), pp. 235-241.

Kelompok Studi Neurobehavior PERDOSSI., 2016. Pemeriksaan Neurologi dan Neurobehavior untuk Fit and Proper Test. Jakarta: PERDOSSI.

Kim, S. E., Park, B. S., Park, S. H., Shin, K. J., Ha, S. Y., Park, J., et al., 2015. Predictors for Presence and Severity of Obstructive Sleep Apnea in Snoring Patients: Signifcance of Neck Circumference. Journal of Sleep Medicine, 12(2), pp. 34-38.

Konecny, T., Kara, T., & Somers, V. K., 2014. Obstructive Sleep Apnea and Hypertension – an Update. Hypertension, 63(2), pp. 203-209.

Korneliani, K., & Meida, D., 2012. Obesitas dan Stress dengan Kejadian Hipertensi. KEMAS, 7(2), pp. 117-121.

Krysta, K., Bratek, A., Zawada, K., & Stepanczak, R., 2017. Cognitive Deficits in Adults with Obstructive Sleep Apnea Compared to Children and Adolescents. Journal of Neural Transmission, 124 (Suppl 1), pp. S187-S201.

Lam, J. C., Sharma, S. K., & Lam, B., 2010. Obstructive Sleep Apnoea: Defnitions, Epidemiology & Natural History. Indian Journal of Medical Research, 131, pp. 165-170.

Li, H., Zhang, F., Zhao, D., Xin, Z., Guo, S., Wang, S., et al., 2014. Neck Circumference As A Measure of Neck Fat and Abdominal Visceral Fat in Chinese Adults. BMC Public Health, 14, pp. 311.

Nagappa, M., Liao, P., Wong, J., Auckley, D., Ramachandran, S. K., Memtsoudis, S., et al., 2015. Validation of the STOP-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea among Different Populations: A Systematic Review and Meta-Analysis. PLoS ONE, 10(12), pp. e0143697.

Nannapaneni, S., Ramar, K., & Surani, S., 2013. Effect of Obstructive Sleep Apnea on Type 2 Diabetes Mellitus: A Comprehensive Literature Review. World Journal of Diabetes, 4(6), pp. 238-244.

Romero-Corral, A., Caples, S. M., Lopez-Jimenez, F., & Somers, V. K., 2010. Interactions Between Obesity and Obstructive Sleep Apnea. Implications for Treatment. CHEST, 137(3), pp. 711-719.

Rosjidi, C. H., Isro’in, L., & Wahyuni, N. S., 2017. Differences in Risk Factor of Cardiovascular Disease Risk on Rural and Urban Population. KEMAS, 13 (1), pp. 69-76.

Salthouse, T. A., 2011. What Cognitive Abilities are Involved in Trail-making Performance? Intelligence, 39(4), pp. 222-232.

Torralva, T., Roca, M., Gleichgerrcht, E., Bekinschtein, T., & Manes, F., 2009. A Neuropsychological Battery to Detect Specific Executive and Social Cognitive Impairments in Early Frontotemporal Dementia. Brain, 132, pp. 1299-1309.

Valadares, R. J., Sousa, K. G., Espindola, M. N., dos Santos, C. E., & Viegas, C. A., 2015. Gender Differences in Comorbidities and Sleep Patterns of Obese Patients with Obstructive Sleep Apnea. World Journal of Neuroscience, 5, pp. 49-57.

Xu, S., Wan, Y., Xu, M., Ming, J., Xing, Y., An, F., et al., 2015. The Association Between Obstructive Sleep Apnea and Metabolic Syndrome: A Systematic Review and Meta-Analysis. BMC Pulmonary Medicine, 15, pp. 105.

Yang, Q., Wang, Y., Feng, J., Cao, J., & Chen, B. (2013). Intermittent Hypoxia from Obstructive Sleep Apnea May Cause Neuronal Impairment and Dysfunction in Central Nervous System: The Potential Roles Played by Microglia. Neuropsychiatric Disease and Treatment, 9, pp. 1077-1086.

Yates, K. F., Sweat, V., Yau, P. L., Turchiano, M. M., & Convit, A., 2012. Impact of Metabolic Syndrome on Cognition and Brain: A Selected Review of the Literature. Arteriosclerosis, Thrombosis, and Vascular Biology, 32 (9), pp. 2060-2067.

Zhang, W., & Si, L., 2012. Obstructive sleep apnea syndrome (OSAS) and hypertension: Pathogenic mechanisms and possible therapeutic approaches. Upsala Journal of Medical Sciences, 117, pp. 370-382.


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