Normalization of Memory Performance and Positive Airway Pressure Adherence in Memory-Impaired Patients With Obstructive Sleep Apnea

Molly E. Zimmerman, J. Todd Arnedt, Michael Stanchina, Richard P. Millman, and Mark S. Aloia, Chest December 2006, 130: 1772-1778

Effect Of Obstructive Sleep Apnea (OSA) And Continuous Positive Airway Pressure (CPAP) On Memory

This study demonstrated that the majority of patients with OSA who suffered from verbal memory impairment returned to normal memory function after 3 months of optimal CPAP use. Patients who used CPAP 6 hours or more a night were almost 8 times as likely to show this improvement in memory compared with patients who used CPAP for 2 or fewer hours a night.

In the words of the study, “Logistic regression analyses revealed that the odds of optimal users exhibiting normalization of memory function following 3 months of PAP therapy were 7.9 times (p = 0.01) the odds of poor users exhibiting normalization of memory abilities. Overall, 21% of poor users, 44% of moderate users, and 68% of optimal users exhibited memory performance in the clinically normal range following 3 months of PAP use ({chi}2 = 7.27; p = 0.03).”

According to Dr. Aloia, one of the authors of the study, “Moderate use of CPAP may help, but it might not allow patients to reach their full potential recovery where memory is concerned, especially if memory is impaired at baseline.For patients with OSA, the more regularly and consistently they use CPAP, the better off they will be.”

Dr. Aloia goes on to say, “Our findings also suggest that this optimal level of CPAP adherence is uncommon following 3 months of treatment. We need to find ways of encouraging patients to use their treatment all night, every night in order to optimize treatment response.”

Commentary

I chose this article as the subject for a posting because (1) problems with adherence to CPAP is a good example of noncompliance to treatment other than medication, which seems to be the focus of most of the research in the field and (2) the variation in results between optimal and partial compliance is an important and clinically useful distinction.

A comment made by Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians, is telling:

This statement neatly encapsulates the central issues of noncompliance:

• The essential conundrum, i.e., why do patients fail to adequately execute treatment proven to be beneficial
• The clinician’s intuitive, almost automatic turn to patient education as the answer
• The realization that patient education, while necesssary, is rarely sufficient to overcome noncompliance

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• Adherence Improvement Battle Fought On Many Fronts