Daytime Hypercapnia Impairs Working Memory in Young and Middle-Aged Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Hua-Man Wu; Zhi-Jun Wang; Chao-Hong Cheng; Tong Su; Jing Wang; Ye-Zhou Li; Qiao-Jun Wang; Fei Han; Rui Chen

doi:10.2147/NSS.S398440

Daytime Hypercapnia Impairs Working Memory in Young and Middle-Aged Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Nat Sci Sleep. 2023 May 17:15:363-373. doi: 10.2147/NSS.S398440. eCollection 2023.

Authors

Hua-Man Wu^#^{1

2}, Zhi-Jun Wang^#¹, Chao-Hong Cheng¹, Tong Su¹, Jing Wang¹, Ye-Zhou Li³, Qiao-Jun Wang⁴, Fei Han⁴, Rui Chen^{1

4}

Affiliations

¹ Department of Respiratory, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.
² Department of Respiratory and Critical Care Medicine, Zigong First People's Hospital, Zigong, Sichuan, People's Republic of China.
³ School of Medicine, the University of Manchester, Manchester, UK.
⁴ Department of Sleeping Center, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Obstructive sleep apnea hypopnea syndrome (OSAHS) can lead to cognitive impairment, though few studies have so far examined hypercapnia as its causal mechanism, due to the invasive nature of conventional arterial CO₂ measurement. The study aims to investigate the effects of daytime hypercapnia on working memory in young and middle-aged patients with OSAHS.

Patients and methods: This prospective study screened 218 patients and eventually recruited 131 patients (aged 25-60 years) with polysomnography (PSG)-diagnosed OSAHS. Using a cut-off of 45mmHg daytime transcutaneous partial pressure of carbon dioxide (PtcCO₂), 86 patients were assigned into the normocapnic group and 45 patients into the hypercapnic group. Working memory was evaluated using the Digit Span Backward Test (DSB) and the Cambridge Neuropsychological Test Automated Battery.

Results: Compared with the normocapnic group, the hypercapnic group performed worse in verbal, visual, and spatial working memory tasks. PtcCO₂≥45mmHg was an independent predictor for lower DSB scores (OR=4.057), lower accuracy in the immediate Pattern Recognition Memory (OR=2.600), delayed Pattern Recognition Memory (OR=2.766) and Spatial Recognition Memory (OR=2.722) tasks, lower Spatial Span scores (OR=4.795), and more between errors in the Spatial Working Memory task (OR=2.734 and 2.558, respectively). Notably, PSG indicators of hypoxia and sleep fragmentation did not predict task performance.

Conclusion: Hypercapnia may be plays an important role in working memory impairment in patients with OSAHS, perhaps more so than hypoxia and sleep fragmentation. Routine CO₂ monitoring in these patients could prove of utility in clinical practices.

Keywords: hypercapnia; obstructive; sleep apnea; working memory.

Grants and funding

National Natural Science Foundation of China (Grant/Award Number: 81770085,82070095); Discipline Construction Program of the Second Affiliated Hospital of Soochow University (Grant/Award Number XKTJ-TD202003).