Effects of continuous positive airway pressure on neurocognitive architecture and function in patients with obstructive sleep apnoea: study protocol for a multicentre randomised controlled trial

Huajun Xu, Hui Wang, Jian Guan, Hongliang Yi, Yingjun Qian, Jianyin Zou, Yunyan Xia, Yiqun Fu, Xinyi Li, Xiao Jiao, Hengye Huang, Pin Dong, Ziwei Yu, Jun Yang, Mingliang Xiang, Jiping Li, Yanqing Chen, Peihua Wang, Yizhou Sun, Yuehua Li, Xiaojian Zheng, Wei Jia, Shankai Yin, Huajun Xu, Hui Wang, Jian Guan, Hongliang Yi, Yingjun Qian, Jianyin Zou, Yunyan Xia, Yiqun Fu, Xinyi Li, Xiao Jiao, Hengye Huang, Pin Dong, Ziwei Yu, Jun Yang, Mingliang Xiang, Jiping Li, Yanqing Chen, Peihua Wang, Yizhou Sun, Yuehua Li, Xiaojian Zheng, Wei Jia, Shankai Yin

Abstract

Objectives: Many clinical studies have indicated that obstructive sleep apnoea (OSA), the most common chronic sleep disorder, may affect neurocognitive function, and that treatment for continuous positive airway pressure (CPAP) has some neurocognitive protective effects against the adverse effects of OSA. However, the effects of CPAP treatment on neurocognitive architecture and function remain unclear. Therefore, this multicentre trial was designed to investigate whether and when neurocognitive architecture and function in patients with OSA can be improved by CPAP treatment and to explore the role of gut microbiota in improving neurocognitive function during treatment.

Methods/design: This study will be a multicentre, randomised, controlled trial with allocation concealment and assessor blinding. A total of 148 eligible patients with moderate to severe OSA will be enrolled from five sleep centres and randomised to receive CPAP with best supportive care (BSC) intervention or BSC intervention alone. Cognitive function, structure and function of brain regions, gut microbiota, metabolites, biochemical variables, electrocardiography, echocardiography, pulmonary function and arterial stiffness will be assessed at baseline before randomisation and at 3, 6 and 12 months.

Ethics and dissemination: This study has been approved by the Medical Ethics Committee of Shanghai Jiao Tong University Affiliated Sixth People's Hospital (approval number 2015-79). The results from this study will be published in peer-reviewed journals and at relevant conferences.

Trial registration number: NCT02886156; pre-results.

Keywords: cognitive function; continuous positive airway pressure; gut microbiota; metabolomics; obstructive sleep apnoea.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
The flow diagram of this randomised controlled trial. BSC, best supportive care; CPAP, continuous positive airway pressure; fMRI, functional MRI; PSG, polysomnography.

References

    1. Strollo PJ, Rogers RM. Obstructive sleep apnea. N Engl J Med 1996;334:99–104. 10.1056/NEJM199601113340207
    1. Young T, Palta M, Dempsey J, et al. . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5. 10.1056/NEJM199304293281704
    1. Peppard PE, Young T, Barnet JH, et al. . Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 2013;177:1006–14. 10.1093/aje/kws342
    1. Heinzer R, Vat S, Marques-Vidal P, et al. . Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med 2015;3:310–8. 10.1016/S2213-2600(15)00043-0
    1. Sánchez-de-la-Torre M, Campos-Rodriguez F, Barbé F. Obstructive sleep apnoea and cardiovascular disease. Lancet Respir Med 2013;1:61–72. 10.1016/S2213-2600(12)70051-6
    1. Aurora RN, Punjabi NM. Obstructive sleep apnoea and type 2 diabetes mellitus: a bidirectional association. Lancet Respir Med 2013;1:329–38. 10.1016/S2213-2600(13)70039-0
    1. Rosenzweig I, Glasser M, Polsek D, et al. . Sleep apnoea and the brain: a complex relationship. Lancet Respir Med 2015;3:404–14. 10.1016/S2213-2600(15)00090-9
    1. Sales LV, Bruin VM, D'Almeida V, et al. . Cognition and biomarkers of oxidative stress in obstructive sleep apnea. Clinics 2013;68:449–55. 10.6061/clinics/2013(04)03
    1. Quera Salva MA, Barbot F, Hartley S, et al. . Sleep disorders, sleepiness, and near-miss accidents among long-distance highway drivers in the summertime. Sleep Med 2014;15:23–6. 10.1016/j.sleep.2013.06.018
    1. Stevenson MR, Elkington J, Sharwood L, et al. . The role of sleepiness, sleep disorders, and the work environment on heavy-vehicle crashes in 2 Australian states. Am J Epidemiol 2014;179:594–601. 10.1093/aje/kwt305
    1. Zhou J, Camacho M, Tang X, et al. . A review of neurocognitive function and obstructive sleep apnea with or without daytime sleepiness. Sleep Med 2016;23:99–108. 10.1016/j.sleep.2016.02.008
    1. Crawford-Achour E, Dauphinot V, Martin MS, et al. . Protective effect of long-term CPAP therapy on cognitive performance in elderly patients with severe OSA: the PROOF study. J Clin Sleep Med 2015;11:519–24. 10.5664/jcsm.4694
    1. Tahmasian M, Rosenzweig I, Eickhoff SB, et al. . Structural and functional neural adaptations in obstructive sleep apnea: an activation likelihood estimation meta-analysis. Neurosci Biobehav Rev 2016;65:142–56. 10.1016/j.neubiorev.2016.03.026
    1. Henderson LA, Fatouleh RH, Lundblad LC, et al. . Effects of 12 months continuous positive airway pressure on sympathetic activity related brainstem function and structure in obstructive sleep apnea. Front Neurosci 2016;10:90 10.3389/fnins.2016.00090
    1. Dalmases M, Solé-Padullés C, Torres M, et al. . Effect of CPAP on cognition, brain function, and structure among elderly patients with OSA: a randomized pilot study. Chest 2015;148:1214–23. 10.1378/chest.15-0171
    1. Rosenzweig I, Glasser M, Crum WR, et al. . Changes in neurocognitive architecture in patients with obstructive sleep apnea treated with continuous positive airway pressure. EBioMedicine 2016;7:221–9. 10.1016/j.ebiom.2016.03.020
    1. Rogers GB, Keating DJ, Young RL, et al. . From gut dysbiosis to altered brain function and mental illness: mechanisms and pathways. Mol Psychiatry 2016;21:738–48. 10.1038/mp.2016.50
    1. Forsythe P, Sudo N, Dinan T, et al. . Mood and gut feelings. Brain Behav Immun 2010;24:9–16. 10.1016/j.bbi.2009.05.058
    1. Moreno-Indias I, Torres M, Montserrat JM, et al. . Intermittent hypoxia alters gut microbiota diversity in a mouse model of sleep apnoea. Eur Respir J 2015;45:1055–65. 10.1183/09031936.00184314
    1. Durgan DJ, Ganesh BP, Cope JL, et al. . Role of the gut microbiome in obstructive sleep apnea-induced hypertension. Hypertension 2016;67:469–74. 10.1161/HYPERTENSIONAHA.115.06672
    1. Chan AW, Tetzlaff JM, Altman DG, et al. . SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158:200–7. 10.7326/0003-4819-158-3-201302050-00583
    1. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010;152:726–32. 10.7326/0003-4819-152-11-201006010-00232
    1. Iber C A-IS, Chesson AL, Quan SF; for the American Academy of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1 edn Westchester, IL: American Academy of Sleep Medicine, 2007.
    1. Guan J, Yi H, Zou J, et al. . Distinct severity stages of obstructive sleep apnoea are correlated with unique dyslipidaemia: large-scale observational study. Thorax 2016;71:347–55. 10.1136/thoraxjnl-2015-207403
    1. Zhang C, Yin A, Li H, et al. . Dietary modulation of gut microbiota contributes to alleviation of both genetic and simple obesity in children. EBioMedicine 2015;2:968–84. 10.1016/j.ebiom.2015.07.007
    1. Xu H, Zheng X, Qian Y, et al. . Metabolomics profiling for obstructive sleep apnea and simple snorers. Sci Rep 2016;6:30958 10.1038/srep30958
    1. Wu SQ, Liao QC, Xu XX, et al. . Effect of CPAP therapy on C-reactive protein and cognitive impairment in patients with obstructive sleep apnea hypopnea syndrome. Sleep Breath 2016;20 10.1007/s11325-016-1331-2
    1. Poroyko VA, Carreras A, Khalyfa A, et al. . Chronic sleep disruption alters gut microbiota, induces systemic and adipose tissue inflammation and insulin resistance in mice. Sci Rep 2016;6:35405 10.1038/srep35405

Source: PubMed

3
Tilaa