A-41: The Role of Cognitive Reserve in Obstructive Sleep Apnea: A Secondary Analysis of the Apnea Positive Pressure Long-Term Efficacy Study

Abstract

Objective: Cognitive reserve (CR) has been shown to moderate the relationship between cognition and neurological lesion load. However, there is limited research on CR in obstructive sleep apnea (OSA), a condition associated with brain changes and cognitive decline. This study explored the role of years of education and Full-Scale IQ (FSIQ) as CR proxies in individuals with PSG-confirmed OSA. Method/Data Selection: The sample consisted of 1100 participants (mean age=51.55, mean years of education=15.49, mean FSIQ=112.05) from the Apnea Positive Pressure Long-Term Efficacy Study, with diagnoses of mild (n=151), moderate (n=342), or severe (n=607) OSA. Regression was used to examine the relationship between education and FSIQ and scores on measures of attention/psychomotor speed, vigilance, working memory, and verbal memory, controlling for age and OSA severity. Results/Data Synthesis: After accounting for age and OSA severity effects on cognitive scores, a one-year increase in education was associated with better performance in psychomotor speed (β=-0.31, p< 0.001), vigilance reaction time (β=-2.27, p=0.001), auditory working memory (β=4.76, p< 0.001), and learning/recall (β=0.76, p< 0.001; β=1.03, p< 0.001), but not vigilance response accuracy or visual working memory. Associations of smaller magnitude were observed between FSIQ and all cognitive measures. Conclusions: Higher educational level was associated with better cognitive performance in individuals with OSA after accounting for OSA severity; effects of smaller magnitude were observed for FSIQ. Consistent with the CR hypothesis, results suggest a neuroprotective effect of education in OSA. Further research in samples with a broader range of educational attainment and FSIQ, and examining additional CR proxies, is needed.