Cognitive Functions in Patients with Moderate-to-Severe Obstructive Sleep Apnea Syndrome with Emphasis on Executive Functions and Decision-Making

Lei Zhao; Yanyan Zhao; Dongmei Su; Zhi Lv; Fei Xie; Panpan Hu; Kierstin L A Porter; Isabella Mazzei; Jaeson D Chin; Yongsheng Wang; Yujiang Fang

doi:10.3390/brainsci13101436

Cognitive Functions in Patients with Moderate-to-Severe Obstructive Sleep Apnea Syndrome with Emphasis on Executive Functions and Decision-Making

Brain Sci. 2023 Oct 10;13(10):1436. doi: 10.3390/brainsci13101436.

Authors

Lei Zhao¹, Yanyan Zhao¹, Dongmei Su¹, Zhi Lv¹, Fei Xie², Panpan Hu³, Kierstin L A Porter⁴, Isabella Mazzei⁴, Jaeson D Chin⁴, Yongsheng Wang¹, Yujiang Fang^{4

5}

Affiliations

¹ Department of Respiratory Medicine, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Heifei 230011, China.
² Neurology Department of Neurology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Heifei 230011, China.
³ Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Heifei 230022, China.
⁴ Department of Microbiology, Immunology & Pathology, Des Moines University, Des Moines, IA 50312, USA.
⁵ Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA.

Abstract

Background: Patients with obstructive sleep apnea syndrome (OSAS) have cognitive dysfunction in many aspects, however, these patients' decision-making function remains unclear. In this study, the Game of Dice Task (GDT) was used to investigate the function of decision making in patients with OSAS.

Methods: 30 participants with moderate to severe OSAS and 27 participants with no or mild OSAS diagnosed by sleep breathing monitor were selected from June 2021 to March 2022. Risky decision making was tested through the GDT with known risk probability. General demographic information and background cognitive functions, such as the overall cognitive functioning and executive functioning, were tested to establish baseline data.

Results: There were no significant differences in gender, age, and years of education between the two groups. During the GDT, the moderate to severe OSAS group opted for the safety option at a statistically significant lower rate when compared to the no or mild OSAS group (7.53 ± 4.43 vs. 10.26 ± 4.26, p = 0.022). The moderate to severe OSAS group utilized the higher risk option than the group with no or mild OSAS (10.47 ± 4.43 vs. 7.74 ± 4.26, p = 0.022). The utilization rate of negative feedback in the moderate and severe OSAS group was lower than that in the no or mild OSAS group (7.50, 52.50 vs. 28.57, 100.00, p = 0.001). At the end of the GDT, the moderate and severe OSAS group was more likely to have negative total assets than the patients with no or mild OSAS (-1846.67 ± 2587.20 vs. 300.00 ± 1509.97, p < 0.001). Multiple linear regression analysis shows that there is a negative correlation between the selection of risk options and negative feedback utilization in the GDT.

Conclusion: Patients with moderate and severe OSAS displayed impaired decision-making throughout the study. Impaired decision-making is related to executive processes and may be caused by diminished prefrontal cortex functioning. However, the functions of memory, attention, language, abstraction, and orientation are relatively retained.

Keywords: Game of Dice Task; cognitive function; obstructive sleep apnea syndrome; verbal fluency test.

Grants and funding

This research received no external funding.