ORIGINAL RESEARCH article
Front. Neurosci.
Sec. Sleep and Circadian Rhythms
Volume 19 - 2025 | doi: 10.3389/fnins.2025.1619467
This article is part of the Research TopicThe Promise of Sleep TechnologyView all 9 articles
Pathological respiratory chemoreflex activation predicts improvement of neurocognitive function in response to comtinuous positive airway pressure (CPAP) therapy
Provisionally accepted
- 1Department of Respiratory, Critical Care and Sleep Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
- 2Department of Respiratory Care, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
- 3MyCardio-LLC, Denver, United States
- 4Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, United States
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RATIONALE There is a need for biomarkers predicting neurocognitive improvement following treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP). The role of sleep apnea endotypes as predictors are promising. OBJECTIVE To assess the relationship between a high loop gain biomarker, elevated low frequency narrow band (e-LFCNB), and improvements in neurocognitive function in the Apnea Positive Pressure Long-term Efficacy Study (APPLES). METHODS The e-LFCNB % metric was estimated on baseline polysomnography. Logistic regression analysis was performed to identify the potential association between e-LFCNB% of total sleep time and the observed improvement in neurocognitive function following the specified treatment. RESULTS A total of 362 subjects received CPAP and had e-LFCNB % measurements. For Sustained Working Memory Test-Overall Mid-Day (SWMT-OMD), e-LFCNB% > 2.35% correlates positively with the proportion of participants who showed an increase in test scores > 0.65 after 2 months CPAP treatment (OR: 2.617, 95% CI: 1.095-6.252, p: 0.030); e-LFCNB% > 9.45% correlates positively with improvement in test scores > 0.8 after 6 months CPAP treatment (OR: 2.553, 95% CI: 1.017-6.409, p: 0.046). For Buschke Selective Reminding Test sum recall (BSRT-SR), e-LFCNB% > 3.65% correlates positively with an increase in test scores > 12 after 2 months CPAP treatment (OR: 2.696, 95% CI: 1.041-6.982, p: 0.041). Results of the Pathfinder Number Test-Total Time (PFN-TOTL) were not significant. CONCLUSION e-LFCNB% (probable high loop gain) may be a clinically useful predictor of cognitive improvement following CPAP.
Keywords: Sleep Apnea, Positive airway pressure, Cardiopulmonary coupling, neurocognitive function, high loop gain
Received: 28 Apr 2025; Accepted: 11 Sep 2025.
Copyright: © 2025 Hu, Ni, Hilmisson and Thomas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yuenan Ni, Department of Respiratory Care, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
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