For snorers, CPAP is a no-brainer

4 minute read

It’s not sexy, but nor is cognitive decline.

This Back Page correspondent is a snorer. I know, it’s an attractive thought, isn’t it?

Snorers don’t like to talk about it, to be honest. Most of the time we deny it. We’ll go to any lengths to attribute our nasal noises to a temporary cause. I’ve got a cold at the moment. I’m allergic to my cat/partner/pillow. My cat/partner/pillow is imagining things.

But the truth is we serious snorers are our own worst enemies. We’re doing damage to ourselves if we don’t go get assessed for obstructive sleep apnoea (OSA) and then get treatment if the answer is yes.

I finally gave in in my early 30s when I suddenly sat up in bed in a cold sweat and gasping for breath. It scared the ever-loving poop out of me. And I booked in for a sleep assessment the next day. Hearing that I was waking myself up to breathe literally 300 times a night was a sobering moment.

Here’s the thing, though. Treatment for OSA is honestly one of the easiest things I’ve ever had to do, when it comes to chronic disease. Wear a mask and breathe with a machine. Problem solved.

Is it sexy? No.

Is it sexier than trumpeting, increased risk of stroke, heart attack, and cognitive decline? Why yes, yes it is.

I had a recent conversation with a male acquaintance who admitted to being a snorer with a recent OSA diagnosis. He was not enjoying the CPAP experience and was questioning its worth.

Dude, here’s yet another reason to get with the CPAP program. International research in Frontiers in Sleep, including from the University of WA and Monash University, found “poorer executive-functioning, visuospatial memory, and deficits in vigilance sustained attention, psychomotor and impulse control” in middle-aged men with OSA.

And, to cap it off: “Remarkably, we also report, for the first time, effects on social cognition in this group.”

The researchers took 27 middle-aged male patients with untreated OSA, who had no concomitant comorbidities, and compared them with seven matched controls. Of the 27 patients, 16 had mild OSA and 11 had severe OSA.

The 27 OSA patients are a bit specific, because most men and women with OSA have co-morbidities such as cardiovascular and metabolic disease, stroke, diabetes, chronic systemic inflammation, or depression. They were also not smokers or alcohol abusers and were not obese. The researchers also tested the subjects’ cognitive function with the Cambridge Neuropsychological Test Automated Battery of tests.

“The most significant deficits … were demonstrated in the tests that assess both simultaneous visual matching ability and short-term visual recognition memory for non-verbalisable patterns, tests of executive functioning and cued attentional set shifting, in vigilance and psychomotor functioning, and lastly, in social cognition and emotion recognition,” wrote the authors.

The authors concluded that OSA is sufficient to cause these cognitive deficits, which previous studies had attributed to the most common co-morbidities of OSA such as systemic hypertension, cardiovascular and metabolic diseases, and type 2 diabetes.

The mechanism in play is cause for speculation, but Rosenzweig et al. have a theory that “the cognitive deficits are due to intermittent low oxygen and high carbon dioxide in the blood, changes in blood flow to the brain, sleep fragmentation, and neuroinflammation in OSA patients”.

“It’s likely that these lead to widespread neuroanatomical and structural changes in the brain and associated functional cognitive and emotional deficits.

“Our findings suggest that co-morbidities likely worsen and perpetuate any cognitive deficits caused directly by OSA itself. What remains to be clarified in future studies is whether co-morbidities have an additive or synergistic effect on the latter deficits, and whether there is a difference in brain circuitry in OSA patients with or without co-morbidities.”

The bottom line is that putting up with a little initial discomfort and looking vaguely ridiculous is totally worth it.

Just choose your model carefully.

Send story tips to to heal your cognitive deficits.

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