Cognitive Performance and Adherence to Treatment in Patients with Obstructive Sleep Apnea

Cognitive impairment is common in obstructive sleep apnea (OSA), but how cognition relates to positive airway pressure (PAP) adherence among asymptomatic referrals is less clear. We evaluated whether global cognition using the Montreal Cognitive Assessment (MoCA) is associated with continuous PAP (CPAP) adherence.

In total, 29 OSA patients underwent the MoCA test. Data on CPAP adherence was obtained at 3 months. The Pearson correlations quantified associations between MoCA scores and adherence/effectiveness measures.

The mean age of the participants was of 64.3 ± 8.0 years, and 51.7% of them had MoCA scores < 26. Among those with mild OSA, who scored 5 to 15 on the apnea-hypopnea index (AHI), 57.1% were impaired despite being asymptomatic by history. Higher MoCA correlated with higher CPAP use (r = 0.65, p  = 0.023) and showed a positive trend with nights used > 4 hours (r = 0.54, p  = 0.073). The attention domain correlated with both average hours/day and percent nights > 4 hours, while lower language scores correlated with higher residual AHI (r = -0.69, p  = 0.019).

The high prevalence of cognitive impairment despite the absence of self-reported symptoms suggests that cognitive deficits may be underrecognized in patients undergoing evaluation for OSA. The association of global cognition and attention with CPAP use further suggests that cognitive function may influence patients' ability to successfully engage with treatment.

Cognitive impairment was present in 51.7% of this asymptomatic cohort and in 57.1% of participants with mild OSA. Higher global MoCA and attention scores were associated with greater CPAP use, while lower language scores were associated with higher residual AHI.