Cognition and psychomotor vigilance in treated sleep apnea patients with and without daytime sleepiness: the MAGNETO study

STUDY OBJECTIVES: Residual excessive daytime sleepiness (EDS) persists in some patients with obstructive sleep apnea (OSA) despite adequate positive airway pressure (PAP) therapy and is linked to cognitive deficits. This study examined whether residual EDS in PAP-adherent OSA is associated with poorer cognition. METHODS: A cross-sectional single site study (N = 65), examining PAP-adherent (mean use ≥ 6 h/night; device reported normalized AHI < 5 per hour) patients with OSA (mean age (SD) = 61 (9.2); 34% female; 72% Hispanic; 6% Black; mean diagnostic AHI = 38.05 (28.4). Objective sleepiness was measured via the Psychomotor Vigilance Task (PVT); > 5 lapses ≥ 500 ms defined PVT derived EDS (N = 30). Cognitive function assessed via NeuroTrax® battery accounting for age and education. General linear models adjusted for sex, time since diagnosis and self-reported sleep duration were used to test associations in this exploratory, hypothesis generating analysis. RESULTS: Greater residual EDS was associated with worse performance in global cognition (β = -4.09, p < .001), memory (β = -3.97, p = .001), executive functioning (β = -3.91, p = .004), attention (β = -2.68, p = .036), and processing speed (β = -4.89, p = .012). In categorical analyses, those with EDS performed approximately .43-.58 of a NeuroTrax® SD worse in global cognition and memory, a magnitude roughly comparable to 1-2 points on the MoCA or MMSE. CONCLUSIONS: Residual EDS was associated with poorer cognitive performance. These findings suggest residual EDS represents a cognitive risk phenotype in OSA, independent of PAP adherence. PVT provides a brief, objective tool to detect cognitive deficits and may serve as a valuable measure in OSA related brain health research. Current Knowledge/Study Rationale In obstructive sleep apnea (OSA), residual excessive daytime sleepiness (EDS) can persist despite regular adherence to positive airway pressure (PAP) therapy. EDS is associated with cognitive decline and dementia risk, yet few studies have evaluated objective sleepiness and cognitive outcomes in this population. Study Impact This study shows that residual EDS, objectively measured by the Psychomotor Vigilance Task (PVT), is associated with worse cognition in PAP-adherent people with OSA. These findings highlight a distinct cognitive risk phenotype in treated OSA and support the PVT as a practical tool for detecting cognitive deficits in clinical and research settings.