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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(11): 1104-1111
DOI: 10.1055/s-0042-1758399
Original Article

Interaction between apolipoprotein E genotypes, excessive daytime sleepiness, and cognitive function in obstructive sleep apnea patients

Interação entre genótipos da apolipoproteína E, sonolência excessiva diurna e função cognitiva em pacientes com apneia obstrutiva do sono
Fernanda Maurer Balthazar 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor Neuro-Sono, Disciplina de Neurologia, São Paulo SP, Brazil.
,
Walter André dos Santos Moraes 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor Neuro-Sono, Disciplina de Neurologia, São Paulo SP, Brazil.
,
James Richard Hunter 
2   Universidade Federal de São Paulo, Departamento de Medicina, Disciplina de Infectologia, São Paulo SP, Brazil.
,
Gilmar Fernandes do Prado 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor Neuro-Sono, Disciplina de Neurologia, São Paulo SP, Brazil.
,
Luciane Bizari Coin de Carvalho 
1   Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Setor Neuro-Sono, Disciplina de Neurologia, São Paulo SP, Brazil.
› Author Affiliations Support The present study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).
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Abstract

Background Some studies show an association between the apolipoprotein E ε4 allele (ApoEε4) and obstructive sleep apnea syndrome (OSAS), and other studies, an association between ApoEε4 and excessive daytime sleepiness (EDS), but there are no data in the literature on the interaction between EDS, cognitive function, and ApoEε4 in patients with OSA.

Objective To examine the cognitive function of adults with and without EDS and with and without ApoEε4.

Methods A total of 21 male and female patients aged between 33 and 79 years, underwent a clinical interview, ApoE genotyping, neuropsychological evaluation, polysomnography, and the application of the Epworth Sleepiness Scale.

Results Excessive daytime sleepiness was associated with lower intelligence quotient (IQ; total performance) and worse immediate visual memory, regardless of the ApoE genotype. Patients carrying the ApoEε3/ε4 genotype had a worse performance in divided attention, constructional praxis, perceptual organization, and cognitive flexibility. A combination of the ε4 allele and EDS potentiates the negative effect on cognition, except for immediate visual memory. In this case, patients had a worse performance in terms of processing speed, selective attention, and visuomotor coordination.

Conclusions Excessive daytime sleepiness and the ApoEε3/ε4 genotype are associated with worse cognitive performance in OSA patients. The combination of EDS and ε4 allele potentiates cognitive impairment.

Resumo

Antecedentes Alguns estudos mostram uma associação entre o alelo ε4 da apolipoproteina E (ApoEε4) e a síndrome da apneia obstrutiva do sono (SAOS), e outros, entre ApoEε4 e a sonolência excessiva diurna (SED), mas não há dados na literatura sobre a interação entre SED, função cognitiva e ApoEε4 em pacientes com SAOS.

Objetivo Avaliar a função cognitiva em adultos com SAOS com e sem SED e com e sem ApoEε4.

Métodos Ao todo, 21 pacientes, de 33 a 79 anos, homens e mulheres, foram avaliados clinicamente, e submetidos a genotipagem ApoE, avaliação neuropsicológica, polissonografia, e aplicação da Escala de Sonolência de Epworth.

Resultados A SED esteve associada com menor quociente de inteligência (QI; desempenho geral) e pior memória visual imediata, independentemente do genótipo ApoE. Pacientes com genótipo ApoEε3/ε4 apresentaram pior desempenho na atenção dividida, praxe construcional, organização perceptiva e flexibilidade cognitiva. A combinação do alelo ε4 com a SED potencializa esse efeito deletério na cognição, exceto na memória visual imediata. Nesse caso, os pacientes tiveram uma menor velocidade de processamento cognitivo, e piores atenção seletiva e coordenação visiomotora.

Conclusões A SED e o genótipo ApoEε3/ε4 estão associados a um pior desempenho cognitivo em pacientes com SAOS. A combinação de SED e do alelo ε4 potencializa esse efeito.

Keywords

Apolipoproteins E - Sleep Apnea, Obstructive - Disorders of Excessive Somnolence - Cognitive Dysfunction

Palavras-chave

Apolipoproteínas E - Apneia Obstrutiva do Sono - Distúrbios do Sono por Sonolência Excessiva - Disfunção Cognitiva

Authors' Contributions

FMB: hypothesis conception, data collection, analysis; WASM: hypothesis conception, data collection, article writing, analysis; JRH: hypothesis conception, statistics, analysis; GFP, LBCC: hypothesis conception, analysis, review.




Publication History

Received: 14 September 2021

Accepted: 20 January 2022

Article published online:
28 December 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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