Sleep Apnea and Visual Perceptual Skill Learning

The Effect of Sleep Apnea on Sleep Dependent Learning Using the Visual Discrimination Task.

The purpose of this study is to determine whether obstructive sleep apnea affects sleep dependent memory and learning. Subjects with apnea will be given a test of perceptual skill learning (the Visual Discrimination Task (VDT)) that has previously been shown to depend on sleep. Subjects will be tested on this task before and after sleep. The difference in performance after sleep compared to before sleep provides a measure of sleep dependent learning. Participants will be tested on one night when they have less apnea because they are using continuous positive airway pressure (CPAP) as prescribed by their physician, which is well known to reduce apnea; and on another night when they are in their native state and have a greater degree of apnea. Memory performance will be compared between the two nights to determine how apnea affects sleep dependent memory.

Study Overview

• Status: Completed
• Conditions: Apnea
• Intervention / Treatment: Other: Subject using usual positive airway pressure therapy while sleeping for one night

• Study Type: Interventional
• Enrollment (Actual): 14
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27514
      • UNC Hospitals Sleep Disorders Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Clinical diagnosis of sleep apnea
• Use PAP therapy as prescribed by his/her physician for 3-4 weeks prior to enrollment
• Right-handed

Exclusion Criteria:

• Major neurological or psychiatric condition
• Chronic pain condition
• Learning disabilities
• Serious brain or head injury (e.g. seizure, stroke, head trauma)
• Major surgery or general anesthesia in the past year
• Pregnant or nursing
• Problems with eyes or vision (besides corrected-to-normal with glasses or contacts)
• Past diagnosis of infection that can affect the brain (e.g. meningitis, HIV/AIDS)
• Medications that affect sleep (antidepressants, muscle relaxants, sleep aids, beta-blockers, stimulants, or corticosteroids)
• Recreational drug use, including marijuana
• Night-shift work
• Cancer or cancer treatment in the last 2 years
• Smoke more than 10 cigarettes per day
• Consume more than 3 caffeinated foods or beverages per day

Study Plan

How is the study designed?

Design Details

• Allocation: Non-Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Apnea patients on and off PAP in order A; Subject using usual positive airway pressure therapy while sleeping for one night, then crossing over to not using usual apnea therapy while sleeping for another night.	Other: Subject using usual positive airway pressure therapy while sleeping for one night; Participants use their usual positive airway pressure therapy while sleeping overnight
Other: Apnea patients on and off PAP in order B; Subject not using apnea therapy while sleeping for one night, then crossing over and subject using usual positive airway pressure therapy while sleeping for one night.	Other: Subject using usual positive airway pressure therapy while sleeping for one night; Participants use their usual positive airway pressure therapy while sleeping overnight

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
VDT learning Change Score	Learning on the visual discrimination task (VDT) is measured by comparing performance on the perceptual task at a baseline session prior to sleep to that in a second session after sleep. Subjects are standardly tested in the hour prior to their typical bedtime, and re-tested after spontaneously awakening after a night of sleep. Sleep is known to consolidate learning on this task, such that more robust learning occurs after an interval of sleep compared to when the patient is awake over the same interval (Stickgold et al, J Cog Neurosci,2000; Stickgold et al., Nat Neurosci, 2000). Our aim is to determine if sleep dependent learning is disrupted by apnea, and preserved when apnea is eliminated.	Change from baseline after 6-9 hours sleep

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Apnea Hypopnea Index (AHI)	The AHI is a measure of the average number of respiratory events recorded per hour of sleep based on a record which includes a minimum of 6-hours of recorded sleep. Standard clinical categories for the severity of apnea are as follows: Mild = 5-10/ hour; Moderate = 10-15/ hour; Severe = >15/ hour. We will measure the Apnea Hypopnea Index on the night when participants are using their standard recommended PAP therapy and on the night when they are not using that therapy in order to be able to determine how the degree of apnea (AHI) correlates with the primary outcome measure.	During minimum 6 hour sleep recording

Collaborators and Investigators

• Sponsor: Heidi Roth, MD
• Investigators: Principal Investigator: Heidi Roth, MD, University of North Carolina, Chapel Hill

Publications and helpful links

General Publications

• Stickgold R, Whidbee D, Schirmer B, Patel V, Hobson JA. Visual discrimination task improvement: A multi-step process occurring during sleep. J Cogn Neurosci. 2000 Mar;12(2):246-54. doi: 10.1162/089892900562075.
• Karni A, Sagi D. Where practice makes perfect in texture discrimination: evidence for primary visual cortex plasticity. Proc Natl Acad Sci U S A. 1991 Jun 1;88(11):4966-70. doi: 10.1073/pnas.88.11.4966.
• Karni A, Tanne D, Rubenstein BS, Askenasy JJ, Sagi D. Dependence on REM sleep of overnight improvement of a perceptual skill. Science. 1994 Jul 29;265(5172):679-82. doi: 10.1126/science.8036518.
• Stickgold R, James L, Hobson JA. Visual discrimination learning requires sleep after training. Nat Neurosci. 2000 Dec;3(12):1237-8. doi: 10.1038/81756. No abstract available.

Study record dates

Study Major Dates

• Study Start: November 1, 2009
• Primary Completion (Actual): April 1, 2012
• Study Completion (Actual): May 1, 2012

Study Registration Dates

• First Submitted: April 25, 2013
• First Submitted That Met QC Criteria: May 13, 2013
• First Posted (Estimate): May 14, 2013

Study Record Updates

• Last Update Posted (Estimate): May 14, 2013
• Last Update Submitted That Met QC Criteria: May 13, 2013
• Last Verified: May 1, 2013

More Information

Terms related to this study

• Keywords: Memory
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Respiration Disorders; Signs and Symptoms, Respiratory; Apnea
• Other Study ID Numbers: 09-1944