Arousal threshold modifies the effect of CPAP on executive function among individuals with obstructive sleep apnoea.

However, randomised trials evaluating the effects of continuous positive airway pressure (CPAP) on neurocognition in those without dementia do not show a benefit.

然而，评估持续气道正压通气（CPAP）对无痴呆患者神经认知影响的随机试验并未显示出益处。

We thus aimed to assess whether arousal threshold (ArTH) modifies the effect of CPAP on neurocognitive function.

我们因此旨在评估觉醒阈值（ArTH）是否改变了持续气道正压通气（CPAP）对神经认知功能的影响。

Methods

We performed a secondary analysis of a randomised, sham-controlled trial (Apnea Positive Pressure Long-term Efficacy Study (APPLES); ClinicalTrials.gov: NCT00051363).

我们对一项随机、安慰剂对照试验进行了二次分析（阻塞性睡眠呼吸暂停正压通气长期疗效研究（APPLES）；ClinicalTrials.gov: NCT00051363）。

ArTH was estimated from polysomnography using a translatable method.

ArTH 通过多导睡眠图使用一种可翻译的方法进行估计。

Neurocognitive outcomes included the Sustained Working Memory Test-Overall Mid-Day (SWMT-OMD) score (executive function, primary outcome), with the Pathfinder Number Test total time (attention) and Buschke Selective Reminding Test sum recall (learning and memory) as secondary outcomes.

神经认知结果包括持续工作记忆测试-总体中午（SWMT-OMD）得分（执行功能，主要结果），以及 Pathfinder 数字测试总时间（注意力）和 Buschke 选择性提醒测试总回忆（学习和记忆）作为次要结果。

Generalised linear modelling assessed whether the effect of CPAP was modified by baseline ArTH (treatment×ArTH interaction). 833 participants with OSA (apnoea-hypopnoea index ≥10 events·h-1), available ArTH and outcomes were analysed (active CPAP n=437 and sham CPAP n=396).

广义线性模型评估了基线ArTH是否改变了CPAP的效应（治疗×ArTH交互作用）。分析了833名OSA患者（呼吸暂停低通气指数≥10次/小时），这些患者有可用的ArTH和结果数据（活性CPAP n=437和安慰剂CPAP n=396）。

Results

For executive function, the effect of CPAP treatment was modified by ArTH (pinteraction=0.042).

对于执行功能，CPAP治疗的效果被ArTH所改变（pinteraction=0.042）。

Specifically, for every 1sd increase in ArTH, the SWMT-OMD score improved by 0.091 (95% CI 0.003-0.178) in active compared to sham CPAP at 6 months; at ArTH 1sd above the mean, SWMT-OMD improvements were nearly three times that in those with average ArTH (0.139 (95% CI 0.018-0.261) versus 0.053 (95% CI -0.034-0.140), respectively).

具体来说，对于每增加1个标准差的ArTH，活跃与假性CPAP相比，SWMT-OMD评分在6个月时提高了0.091（95%置信区间0.003-0.178）；在ArTH高于平均值1个标准差的情况下，SWMT-OMD的改善几乎是平均ArTH患者的三倍（0.139（95%置信区间0.018-0.261）对比0.053（95%置信区间-0.034-0.140））

No effect modification was observed for attention (p=0.311) or learning and memory (p=0.744).

注意力（p=0.311）或学习和记忆（p=0.744）方面未观察到效应修饰。

Conclusions

In OSA, a higher ArTH is associated with greater improvements in executive function following CPAP therapy.

在阻塞性睡眠呼吸暂停(OSA)患者中，较高的平均呼吸暂停低通气指数(ArTH)与持续气道正压(CPAP)治疗后执行功能的显著改善相关。