Effect of CPAP Compliance on a Cognitive Screening Test in a Memory Clinic Population with Sleep Apnea
Vallejo Luces, Tatiana Marie
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Objectives: To determine whether the Montreal Cognitive Assessment (MoCA) was a sensitive indicator of cognitive improvement following introduction of continuous positive airway pressure (CPAP) in community memory clinic (CMC) patients who had been diagnosed with sleep apnea (SA). Method: Twenty-six CPAP compliant CMC patients (61.5% male; 96.2% Caucasian/Non-Hispanic) with a diagnosis of SA (66-87 years (M=76.27(4.90)) completed a MoCA before initiation of treatment and again 4-9 months later. CPAP compliance was documented through CPAP machine compliance reports and/or clinical interview with patient and family member during subsequent medical visits. Twenty CPAP non-compliant CMC patients (85% male, 100% Caucasian/Non-Hispanic; 66-90 years (M=77.45 (6.88)) similarly diagnosed with SA completed MoCAs before initiation of treatment and again 4-8 months later. CMC diagnoses of the patients included: no cognitive impairment, Alzheimer’s disease, mild cognitive impairment, cognitive disorder NOS, or other dementia. Results: Post-treatment MoCA scores for the CPAP compliant group (M= 22.27) were significantly higher than pre-treatment scores (M= 20.38; t(25)= -4.992; p<0.001). Nineteen of the 26 compliant individuals evidenced increases in MoCA, three remained the same, and four declined. The non-compliant group showed no change over time (MoCA pre- M= 19.90, MoCA post- M= 20.50; t(19)= -.798; p= .435), with seven scores decreasing, eleven increasing, and two remaining the same. There was no significant interaction between CPAP compliance groups and MoCA change scores, Wilks’ Lambda= .94, F (1, 44) = 2.67, partial eta squared= .057. Conclusions: More patients with SA who complied with CPAP recommendation demonstrated improved MoCA performance than did those who did not comply with the recommendation. Within-subject comparison of pre- and post-CPAP usage via paired t-test was significant only for the compliant group. Finding no effect on change score or interaction between MoCA test time and compliance using the mixed-model ANOVA was likely due to the relative small sample size, which did not supply sufficient power to the study. This interpretation is supported by the t-test outcome as well as the numerical difference in numbers of patients whose MoCA scores increased from the pre-test to the post-test measurement (19 versus 7).