Effects of Obstructive Sleep Apnea and Insomnia on Cognitive Function
Main Article Content
Abstract
Purpose of Review. Obstructive sleep apnea and chronic insomnia are the most common sleep disorders in adults. Both sleep disorders can adversely affect physical and mental well-being. Cognitive function has been extensively studied in relation to chronic insomnia and obstructive sleep apnea. This paper reviews the recent studies investigating the cognitive effects of insomnia and obstructive sleep apnea as well as the potential benefits of treatment.
Recent Findings. Recent studies indicate that insomnia is associated with impairments in attention, memory, and executive function. Chronic insomnia may have a moderating role in mild cognitive impairment and Alzheimer’s dementia. Mood and anxiety disorders may moderate the effects of insomnia on cognitive function. Hyperarousal and short sleep time associated with insomnia are risk factors for cognitive impairment. Cognitive behavior therapy for insomnia may improve cognitive function but more studies are needed. Nonbenzodiazepine receptor agonists improve insomnia without causing cognitive impairment. Benzodiazepine use is associated with cognitive impairment.
Obstructive sleep apnea is associated with impairments in attention, concentration, memory, and executive function with apnea severity as measured by the apnea hypopnea index and severity of nocturnal hypoxemia being the largest risk factors. Untreated obstructive sleep apnea may have a significant impact on the progression of mild cognitive impairment and Alzheimer’s dementia. The impact of obstructive sleep apnea treatment, particularly with continuous positive airway pressure, appears to mitigate and slow the rate of cognitive decline but more randomized controlled studies are needed.
Summary. Standardized cognitive assessments and larger, long-term controlled prospective studies with diverse populations are needed to further elucidate the cognitive impairments associated with chronic insomnia and obstructive sleep apnea. More studies are needed on the benefits of various treatments for obstructive sleep apnea and insomnia.
Keywords:
Obstructive sleep apnea, insomnia, cognition, attention, concentration, memory, continuous positive airway pressure (CPAP), continuous positive airway pressure (CPAP), and cognitive behavior therapy-insomnia, cognitive behavior therapy-insomnia, mild cognitive impairment, Alzheimer’s dementia
Article Details
How to Cite
SEDA, Gilbert; SHRIVASTAVA, Sharonya.
Effects of Obstructive Sleep Apnea and Insomnia on Cognitive Function.
Medical Research Archives, [S.l.], v. 11, n. 2, feb. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3578>. Date accessed: 15 may 2025.
doi: https://doi.org/10.18103/mra.v11i2.3578.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Veasey SC, Rosen IM. Obstructive Sleep Apnea in Adults. N Engl J Med. 2019 Apr 11;380(15):1442-1449. doi: 10.1056/NEJMcp1816152. PMID: 30970189.
2. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine 2014.
3. Sutton EL. Insomnia. Ann Intern Med. 2021 Mar;174(3):ITC33-ITC48. doi: 10.7326/AITC202103160. Epub 2021 Mar 9. PMID: 33683929.
4. Zaheed AB, Chervin RD, Spira AP, Zahodne LB. Mental and Physical Health Pathways Linking Insomnia Symptoms to Cognitive Performance 14 Years Later. Sleep. 2022 Oct 30:zsac262. doi: 10.1093/sleep/zsac262. Epub ahead of print. PMID: 36309871.
5. Resciniti NV, Yelverton V, Kase BE, Zhang J, Lohman MC. Time-Varying Insomnia Symptoms and Incidence of Cognitive Impairment and Dementia among Older US Adults. Int J Environ Res Public Health. 2021 Jan 5;18(1):351. doi: 10.3390/ijerph18010351. PMID: 33466468; PMCID: PMC7796486.
6. Beydoun HA, Beydoun MA, Weiss J, Hossain S, Huang S, Alemu BT, Zonderman AB. Insomnia as a predictor of diagnosed memory problems: 2006-2016 Health and Retirement Study. Sleep Med. 2021 Apr;80:158-166. doi: 10.1016/j.sleep.2021.01.038. Epub 2021 Feb 2. PMID: 33601227.
7. Xu W, Tan CC, Zou JJ, Cao XP, Tan L; Alzheimer’s Disease Neuroimaging Initiative. Insomnia Moderates the Relationship Between Amyloid-β and Cognitive Decline in Late-Life Adults without Dementia. J Alzheimers Dis. 2021;81(4):1701-1710. doi: 10.3233/JAD-201582. PMID: 33967043.
8. Baril AA, Beiser AS, Sanchez E, Mysliwiec V, Redline S, Gottlieb DJ, O'Connor GT, Gonzales MM, Himali D, Seshadri S, Himali JJ, Pase MP. Insomnia symptom severity and cognitive performance: Moderating role of APOE genotype. Alzheimers Dement. 2022 Mar;18(3):408-421. doi: 10.1002/alz.12405. Epub 2021 Jul 26. PMID: 34310026; PMCID: PMC8802306.
9. Olaithe M, Ree M, McArdle N, Donaldson S, Pushpanathan M, Eastwood PR, Bucks RS. Cognitive Dysfunction in Insomnia Phenotypes: Further Evidence for Different Disorders. Front Psychiatry. 2021 Jul 19;12:688672. doi: 10.3389/fpsyt.2021.688672. PMID: 34349682; PMCID: PMC8326515.
10. Khassawneh BY, Bathgate CJ, Tsai SC, Edinger JD. Neurocognitive performance in insomnia disorder: The impact of hyperarousal and short sleep duration. J Sleep Res. 2018 Dec;27(6):e12747. doi: 10.1111/jsr.12747. Epub 2018 Aug 1. PMID: 30069961.
11. Etholén A, Pietiläinen O, Kouvonen A, Hänninen M, Rahkonen O, Lallukka T. Trajectories of Insomnia Symptoms Among Aging Employees and Their Associations With Memory, Learning Ability, and Concentration After Retirement - A Prospective Cohort Study (2000-2017). J Aging Health. 2022 Oct;34(6-8):916-928. doi: 10.1177/08982643221078740. Epub 2022 Apr 28. PMID: 35482013; PMCID: PMC9483690.
12. Chunhua X, Jiacui D, Xue L, Kai W. Impaired emotional memory and decision-making following primary insomnia. Medicine (Baltimore). 2019 Jul;98(29):e16512. doi: 10.1097/MD.0000000000016512. PMID: 31335727; PMCID: PMC6709269.
13. Brownlow JA, Klingaman EA, Boland EM, Brewster GS, Gehrman PR. Psychiatric disorders moderate the relationship between insomnia and cognitive problems in military soldiers. J Affect Disord. 2017 Oct 15;221:25-30. doi: 10.1016/j.jad.2017.06.023. Epub 2017 Jun 13. PMID: 28628764.
14. Dagher M, Farchakh Y, Barbar S, Haddad C, Akel M, Hallit S, Obeid S. Association between problematic social media use and memory performance in a sample of Lebanese adults: the mediating effect of anxiety, depression, stress and insomnia. Head Face Med. 2021 Feb 23;17(1):6. doi: 10.1186/s13005-021-00260-8. PMID: 33622360; PMCID: PMC7901207.
15. Borchgrevink P, Inge Landrø N. The Effect of Insomnia on Neuropsychological Functioning in Patients with Comorbid Symptoms of Pain, Fatigue, and Mood Disorders. Arch Clin Neuropsychol. 2018 Feb 1;33(1):14-23. doi: 10.1093/arclin/acx040. PMID: 28453603; PMCID: PMC5860517.
16. Cross NE, Carrier J, Postuma RB, Gosselin N, Kakinami L, Thompson C, Chouchou F, Dang-Vu TT. Association between insomnia disorder and cognitive function in middle-aged and older adults: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Sleep. 2019 Aug 1;42(8):zsz114. doi: 10.1093/sleep/zsz114. PMID: 31089710; PMCID: PMC6685318.
17. Zhao JL, Cross N, Yao CW, Carrier J, Postuma RB, Gosselin N, Kakinami L, Dang-Vu TT. Insomnia disorder increases the risk of subjective memory decline in middle-aged and older adults: a longitudinal analysis of the Canadian Longitudinal Study on Aging. Sleep. 2022 Nov 9;45(11):zsac176. doi: 10.1093/sleep/zsac176. PMID: 35877203; PMCID: PMC9644124.
18. Unsal P, Sengul Aycicek G, Deniz O, Esme M, Dikmeer A, Balcı C, Koca M, Ucar Y, Boga I, Burkuk S, Halil MG, Cankurtaran M, Dogu BB. Insomnia and falls in older adults: are they linked to executive dysfunction? Psychogeriatrics. 2021 May;21(3):359-367. doi: 10.1111/psyg.12677. Epub 2021 Mar 8. PMID: 33684960.
19. Teräs T, Rovio S, Spira AP, Myllyntausta S, Pulakka A, Vahtera J, Stenholm S. Associations of accelerometer-based sleep duration and self-reported sleep difficulties with cognitive function in late mid-life: the Finnish Retirement and Aging Study. Sleep Med. 2020 Apr;68:42-49. doi: 10.1016/j.sleep.2019.08.024. Epub 2019 Sep 20. PMID: 32028225.
20. Grau-Rivera O, Operto G, Falcón C, Sánchez-Benavides G, Cacciaglia R, Brugulat-Serrat A, Gramunt N, Salvadó G, Suárez-Calvet M, Minguillon C, Iranzo Á, Gispert JD, Molinuevo JL; ALFA Study. Association between insomnia and cognitive performance, gray matter volume, and white matter microstructure in cognitively unimpaired adults. Alzheimers Res Ther. 2020 Jan 7;12(1):4. doi: 10.1186/s13195-019-0547-3. PMID: 31907066; PMCID: PMC6945611.
21. Gosselin N, Baril AA, Osorio RS, Kaminska M, Carrier J. Obstructive Sleep Apnea and the Risk of Cognitive Decline in Older Adults. Am J Respir Crit Care Med. 2019 Jan 15;199(2):142-148. doi: 10.1164/rccm.201801-0204PP. PMID: 30113864; PMCID: PMC6943882.
22. Angelelli P, Macchitella L, Toraldo DM, Abbate E, Marinelli CV, Arigliani M, De Benedetto M. The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment. Brain Sci. 2020 May 27;10(6):325. doi: 10.3390/brainsci10060325. PMID: 32471112; PMCID: PMC7349097.
23. Pan T, Liu S, Ke S, Wang E, Jiang Y, Wang S; on the behalf of Alzheimer’s Disease Neuroimaging Initiative. Association of obstructive sleep apnea with cognitive decline and age among non-demented older adults. Neurosci Lett. 2021 Jun 21;756:135955. doi: 10.1016/j.neulet.2021.135955. Epub 2021 May 9. PMID: 33979700.
24. Zhu RL, Ouyang C, Ma RL, Wang K. Obstructive sleep apnea is associated with cognitive impairment in minor ischemic stroke. Sleep Breath. 2022 Dec;26(4):1907-1914. doi: 10.1007/s11325-022-02575-5. Epub 2022 Mar 19. PMID: 35305233; PMCID: PMC9663369.
25. McCloy K, Duce B, Swarnkar V, Hukins C, Abeyratne U. Polysomnographic risk factors for vigilance-related cognitive decline and obstructive sleep apnea. Sleep Breath. 2021 Mar;25(1):75-83. doi: 10.1007/s11325-020-02050-z. Epub 2020 Mar 25. PMID: 32215832.
26. Ji P, Kou Q, Qu X, Sun G, Liu S, Zhang J. Effects of Obstructive Sleep Apnea-Hypopnea Syndrome and Cognitive Function in Ischemic Stroke Based on Linear Regression Equation. Scanning. 2022 Jun 22;2022:4105169. doi: 10.1155/2022/4105169. PMID: 35844265; PMCID: PMC9242756.
27. Qiu K, Mao M, Hu Y, Yi X, Zheng Y, Ying Z, Cheng D, Rao Y, Zhang J, Mu X, Ren C, Xu Y, Zhang W, Xu W, Zhao Y, Ren J. Gender-specific association between obstructive sleep apnea and cognitive impairment among adults. Sleep Med. 2022 Oct;98:158-166. doi: 10.1016/j.sleep.2022.07.004. Epub 2022 Jul 11. PMID: 35870305.
28. Macchitella L, Romano DL, Marinelli CV, Toraldo DM, Arigliani M, De Benedetto M, Angelelli P. Neuropsychological and socio-cognitive deficits in patients with obstructive sleep apnea. J Clin Exp Neuropsychol. 2021 Jul;43(5):514-533.
29. Zhang XL, Gao B, Han T, Xiang BY, Liu X. Moderate-to-Severe Obstructive Sleep Apnea and Cognitive Function Impairment in Patients with COPD. Int J Chron Obstruct Pulmon Dis. 2020 Jul 27;15:1813-1822. doi: 10.2147/COPD.S257796. PMID: 32801679; PMCID: PMC7396955.
30. Bilyukov RG, Nikolov MS, Pencheva VP, Petrova DS, Georgiev OB, Mondeshki TL, Milanova VK. Cognitive Impairment and Affective Disorders in Patients With Obstructive Sleep Apnea Syndrome. Front Psychiatry. 2018 Aug 7;9:357. doi: 10.3389/fpsyt.2018.00357. PMID: 30131730; PMCID: PMC6091233.
31. Gagnon K, Baril AA, Montplaisir J, Carrier J, De Beaumont L, D'Aragon C, Chami S, Pelleieux S, Poirier J, Gauthier S, Lafond C, Gagnon JF, Gosselin N. Disconnection Between Self-Reported and Objective Cognitive Impairment in Obstructive Sleep Apnea. J Clin Sleep Med. 2019 Mar 15;15(3):409-415. doi: 10.5664/jcsm.7664. PMID: 30853044; PMCID: PMC6411171.
32. Olaithe M, Pushpanathan M, Hillman D, Eastwood PR, Hunter M, Skinner T, James A, Wesnes KA, Bucks RS. Cognitive profiles in obstructive sleep apnea: a cluster analysis in sleep clinic and community samples. J Clin Sleep Med. 2020 Sep 15;16(9):1493-1505. doi: 10.5664/jcsm.8564. PMID: 32400387; PMCID: PMC7970596.
33. Gagnon K, Baril AA, Montplaisir J, Carrier J, Chami S, Gauthier S, Lafond C, Gagnon JF, Gosselin N. Detection of mild cognitive impairment in middle-aged and older adults with obstructive sleep apnoea. Eur Respir J. 2018 Nov 1;52(5):1801137. doi: 10.1183/13993003.01137-2018. PMID: 30190270.
34. Lal C, Ayappa I, Ayas N, Beaudin AE, Hoyos C, Kushida CA, Kaminska M, Mullins A, Naismith SL, Osorio RS, Phillips CL, Parekh A, Stone KL, Turner AD, Varga AW. The Link between Obstructive Sleep Apnea and Neurocognitive Impairment: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2022 Aug;19(8):1245-1256. doi: 10.1513/AnnalsATS.202205-380ST. PMID: 35913462; PMCID: PMC9353960.
35. Blackman J, Swirski M, Clynes J, Harding S, Leng Y, Coulthard E. Pharmacological and non-pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer's disease: A systematic review. J Sleep Res. 2021 Aug;30(4):e13229. doi: 10.1111/jsr.13229. Epub 2020 Dec 2. PMID: 33289311; PMCID: PMC8365694.
36. Roniger DDG, Lechuga YA, León EE, Robles ROG, Escandón ÓS, Pérez GJT, Moctezuma JV. Cognitive behavioral therapy for insomnia helps to reverse cognitive impairment in insomnia patients. Sleep Sci. 2022 Apr-Jun;15(Spec 2):355-360. doi: 10.5935/1984-0063.20210026. PMID: 35371411; PMCID: PMC8906373.
37. Cassidy-Eagle E, Siebern A, Unti L, Glassman J, O'Hara R. Neuropsychological Functioning in Older Adults with Mild Cognitive Impairment and Insomnia Randomized to CBT-I or Control Group. Clin Gerontol. 2018 Mar-Apr;41(2):136-144. doi: 10.1080/07317115.2017.1384777. Epub 2017 Dec 8. PMID: 29220627.
38. McCrae CS, Curtis AF, Williams JM, Dautovich ND, McNamara JPH, Stripling A, Dzierzewski JM, Chan WS, Berry RB, McCoy KJM, Marsiske M. Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes. Sleep Med. 2018 Nov;51:153-166. doi: 10.1016/j.sleep.2018.05.018. Epub 2018 Jun 2. PMID: 30195661; PMCID: PMC6513321.
39. Perrault AA, Pomares FB, Smith D, Cross NE, Gong K, Maltezos A, McCarthy M, Madigan E, Tarelli L, McGrath JJ, Savard J, Schwartz S, Gouin JP, Dang-Vu TT. Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition. Sleep Med. 2022 Sep;97:13-26. doi: 10.1016/j.sleep.2022.05.010. Epub 2022 May 23. PMID: 35691208.
40. Mattos MK, Manning CA, Quigg M, Davis EM, Barnes L, Sollinger A, Eckstein M, Ritterband LM. Feasibility and Preliminary Efficacy of an Internet-Delivered Intervention for Insomnia in Individuals with Mild Cognitive Impairment. J Alzheimers Dis. 2021;84(4):1539-1550. doi: 10.3233/JAD-210657. PMID: 34690141.
41. Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, Sateia MJ, Troxel WM, Zhou ES, Kazmi U, Heald JL, Martin JL. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Feb 1;17(2):255-262. doi: 10.5664/jcsm.8986. PMID: 33164742; PMCID: PMC7853203.
42. Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013 Oct 1;159(7):471-83. doi: 10.7326/0003-4819-159-7-201310010-00704. PMID: 24061345.
43. Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019 Oct;18(3):337-352. doi: 10.1002/wps.20674. PMID: 31496087; PMCID: PMC6732697.
44. Rosenberg R, Citrome L, Drake CL. Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies. Neuropsychiatr Dis Treat. 2021 Aug 6;17:2549-2566. doi: 10.2147/NDT.S297504. PMID: 34393484; PMCID: PMC8354724.
45. Picton JD, Marino AB, Nealy KL. Benzodiazepine use and cognitive decline in the elderly. Am J Health Syst Pharm. 2018 Jan 1;75(1):e6-e12. doi: 10.2146/ajhp160381. PMID: 29273607.
46. Guo F, Yi L, Zhang W, Bian ZJ, Zhang YB. Association Between Z Drugs Use and Risk of Cognitive Impairment in Middle-Aged and Older Patients With Chronic Insomnia. Front Hum Neurosci. 2021 Dec 9;15:775144. doi: 10.3389/fnhum.2021.775144. PMID: 34955792; PMCID: PMC8696350.
47. Sumsuzzman DM, Choi J, Jin Y, Hong Y. Neurocognitive effects of melatonin treatment in healthy adults and individuals with Alzheimer's disease and insomnia: A systematic review and meta-analysis of randomized controlled trials. Neurosci Biobehav Rev. 2021 Aug;127:459-473. doi: 10.1016/j.neubiorev.2021.04.034. Epub 2021 May 3. PMID: 33957167.
48. Jean-Louis, G., von Gizycki, H., Zizi, F., 1998. Melatonin effects on sleep, mood, and cognition in elderly with mild cognitive impairment. J. Pineal Res. 25, 177–183. doi: 10.1111/j.1600-079x.1998.tb00557.x. PMID: 9745987.
49. Luthringer, R., Muzet, M., Zisapel, N., Staner, L., 2009. The effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomnia. Int. Clin. Psychopharmacol. 24, 239–249. https://doi.org/10.1097/ YIC.0b013e32832e9b08.
50. Jiang X, Wang Z, Hu N, Yang Y, Xiong R, Fu Z. Cognition effectiveness of continuous positive airway pressure treatment in obstructive sleep apnea syndrome patients with cognitive impairment: a meta-analysis. Exp Brain Res. 2021 Dec;239(12):3537-3552. doi: 10.1007/s00221-021-06225-2. Epub 2021 Sep 21. PMID: 34546386.
51. Wang G, Goebel JR, Li C, Hallman HG, Gilford TM, Li W. Therapeutic effects of CPAP on cognitive impairments associated with OSA. J Neurol. 2020 Oct;267(10):2823-2828. doi: 10.1007/s00415-019-09381-2. Epub 2019 May 20. PMID: 31111204.
52. Liguori C, Cremascoli R, Maestri M, Fernandes M, Izzi F, Tognoni G, Scarpina F, Siciliano G, Mercuri NB, Priano L, Bonanni E, Placidi F. Obstructive sleep apnea syndrome and Alzheimer's disease pathology: may continuous positive airway pressure treatment delay cognitive deterioration? Sleep Breath. 2021 Dec;25(4):2135-2139. doi: 10.1007/s11325-021-02320-4. Epub 2021 Feb 22. PMID: 33619666.
2. American Academy of Sleep Medicine. International classification of sleep disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine 2014.
3. Sutton EL. Insomnia. Ann Intern Med. 2021 Mar;174(3):ITC33-ITC48. doi: 10.7326/AITC202103160. Epub 2021 Mar 9. PMID: 33683929.
4. Zaheed AB, Chervin RD, Spira AP, Zahodne LB. Mental and Physical Health Pathways Linking Insomnia Symptoms to Cognitive Performance 14 Years Later. Sleep. 2022 Oct 30:zsac262. doi: 10.1093/sleep/zsac262. Epub ahead of print. PMID: 36309871.
5. Resciniti NV, Yelverton V, Kase BE, Zhang J, Lohman MC. Time-Varying Insomnia Symptoms and Incidence of Cognitive Impairment and Dementia among Older US Adults. Int J Environ Res Public Health. 2021 Jan 5;18(1):351. doi: 10.3390/ijerph18010351. PMID: 33466468; PMCID: PMC7796486.
6. Beydoun HA, Beydoun MA, Weiss J, Hossain S, Huang S, Alemu BT, Zonderman AB. Insomnia as a predictor of diagnosed memory problems: 2006-2016 Health and Retirement Study. Sleep Med. 2021 Apr;80:158-166. doi: 10.1016/j.sleep.2021.01.038. Epub 2021 Feb 2. PMID: 33601227.
7. Xu W, Tan CC, Zou JJ, Cao XP, Tan L; Alzheimer’s Disease Neuroimaging Initiative. Insomnia Moderates the Relationship Between Amyloid-β and Cognitive Decline in Late-Life Adults without Dementia. J Alzheimers Dis. 2021;81(4):1701-1710. doi: 10.3233/JAD-201582. PMID: 33967043.
8. Baril AA, Beiser AS, Sanchez E, Mysliwiec V, Redline S, Gottlieb DJ, O'Connor GT, Gonzales MM, Himali D, Seshadri S, Himali JJ, Pase MP. Insomnia symptom severity and cognitive performance: Moderating role of APOE genotype. Alzheimers Dement. 2022 Mar;18(3):408-421. doi: 10.1002/alz.12405. Epub 2021 Jul 26. PMID: 34310026; PMCID: PMC8802306.
9. Olaithe M, Ree M, McArdle N, Donaldson S, Pushpanathan M, Eastwood PR, Bucks RS. Cognitive Dysfunction in Insomnia Phenotypes: Further Evidence for Different Disorders. Front Psychiatry. 2021 Jul 19;12:688672. doi: 10.3389/fpsyt.2021.688672. PMID: 34349682; PMCID: PMC8326515.
10. Khassawneh BY, Bathgate CJ, Tsai SC, Edinger JD. Neurocognitive performance in insomnia disorder: The impact of hyperarousal and short sleep duration. J Sleep Res. 2018 Dec;27(6):e12747. doi: 10.1111/jsr.12747. Epub 2018 Aug 1. PMID: 30069961.
11. Etholén A, Pietiläinen O, Kouvonen A, Hänninen M, Rahkonen O, Lallukka T. Trajectories of Insomnia Symptoms Among Aging Employees and Their Associations With Memory, Learning Ability, and Concentration After Retirement - A Prospective Cohort Study (2000-2017). J Aging Health. 2022 Oct;34(6-8):916-928. doi: 10.1177/08982643221078740. Epub 2022 Apr 28. PMID: 35482013; PMCID: PMC9483690.
12. Chunhua X, Jiacui D, Xue L, Kai W. Impaired emotional memory and decision-making following primary insomnia. Medicine (Baltimore). 2019 Jul;98(29):e16512. doi: 10.1097/MD.0000000000016512. PMID: 31335727; PMCID: PMC6709269.
13. Brownlow JA, Klingaman EA, Boland EM, Brewster GS, Gehrman PR. Psychiatric disorders moderate the relationship between insomnia and cognitive problems in military soldiers. J Affect Disord. 2017 Oct 15;221:25-30. doi: 10.1016/j.jad.2017.06.023. Epub 2017 Jun 13. PMID: 28628764.
14. Dagher M, Farchakh Y, Barbar S, Haddad C, Akel M, Hallit S, Obeid S. Association between problematic social media use and memory performance in a sample of Lebanese adults: the mediating effect of anxiety, depression, stress and insomnia. Head Face Med. 2021 Feb 23;17(1):6. doi: 10.1186/s13005-021-00260-8. PMID: 33622360; PMCID: PMC7901207.
15. Borchgrevink P, Inge Landrø N. The Effect of Insomnia on Neuropsychological Functioning in Patients with Comorbid Symptoms of Pain, Fatigue, and Mood Disorders. Arch Clin Neuropsychol. 2018 Feb 1;33(1):14-23. doi: 10.1093/arclin/acx040. PMID: 28453603; PMCID: PMC5860517.
16. Cross NE, Carrier J, Postuma RB, Gosselin N, Kakinami L, Thompson C, Chouchou F, Dang-Vu TT. Association between insomnia disorder and cognitive function in middle-aged and older adults: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Sleep. 2019 Aug 1;42(8):zsz114. doi: 10.1093/sleep/zsz114. PMID: 31089710; PMCID: PMC6685318.
17. Zhao JL, Cross N, Yao CW, Carrier J, Postuma RB, Gosselin N, Kakinami L, Dang-Vu TT. Insomnia disorder increases the risk of subjective memory decline in middle-aged and older adults: a longitudinal analysis of the Canadian Longitudinal Study on Aging. Sleep. 2022 Nov 9;45(11):zsac176. doi: 10.1093/sleep/zsac176. PMID: 35877203; PMCID: PMC9644124.
18. Unsal P, Sengul Aycicek G, Deniz O, Esme M, Dikmeer A, Balcı C, Koca M, Ucar Y, Boga I, Burkuk S, Halil MG, Cankurtaran M, Dogu BB. Insomnia and falls in older adults: are they linked to executive dysfunction? Psychogeriatrics. 2021 May;21(3):359-367. doi: 10.1111/psyg.12677. Epub 2021 Mar 8. PMID: 33684960.
19. Teräs T, Rovio S, Spira AP, Myllyntausta S, Pulakka A, Vahtera J, Stenholm S. Associations of accelerometer-based sleep duration and self-reported sleep difficulties with cognitive function in late mid-life: the Finnish Retirement and Aging Study. Sleep Med. 2020 Apr;68:42-49. doi: 10.1016/j.sleep.2019.08.024. Epub 2019 Sep 20. PMID: 32028225.
20. Grau-Rivera O, Operto G, Falcón C, Sánchez-Benavides G, Cacciaglia R, Brugulat-Serrat A, Gramunt N, Salvadó G, Suárez-Calvet M, Minguillon C, Iranzo Á, Gispert JD, Molinuevo JL; ALFA Study. Association between insomnia and cognitive performance, gray matter volume, and white matter microstructure in cognitively unimpaired adults. Alzheimers Res Ther. 2020 Jan 7;12(1):4. doi: 10.1186/s13195-019-0547-3. PMID: 31907066; PMCID: PMC6945611.
21. Gosselin N, Baril AA, Osorio RS, Kaminska M, Carrier J. Obstructive Sleep Apnea and the Risk of Cognitive Decline in Older Adults. Am J Respir Crit Care Med. 2019 Jan 15;199(2):142-148. doi: 10.1164/rccm.201801-0204PP. PMID: 30113864; PMCID: PMC6943882.
22. Angelelli P, Macchitella L, Toraldo DM, Abbate E, Marinelli CV, Arigliani M, De Benedetto M. The Neuropsychological Profile of Attention Deficits of Patients with Obstructive Sleep Apnea: An Update on the Daytime Attentional Impairment. Brain Sci. 2020 May 27;10(6):325. doi: 10.3390/brainsci10060325. PMID: 32471112; PMCID: PMC7349097.
23. Pan T, Liu S, Ke S, Wang E, Jiang Y, Wang S; on the behalf of Alzheimer’s Disease Neuroimaging Initiative. Association of obstructive sleep apnea with cognitive decline and age among non-demented older adults. Neurosci Lett. 2021 Jun 21;756:135955. doi: 10.1016/j.neulet.2021.135955. Epub 2021 May 9. PMID: 33979700.
24. Zhu RL, Ouyang C, Ma RL, Wang K. Obstructive sleep apnea is associated with cognitive impairment in minor ischemic stroke. Sleep Breath. 2022 Dec;26(4):1907-1914. doi: 10.1007/s11325-022-02575-5. Epub 2022 Mar 19. PMID: 35305233; PMCID: PMC9663369.
25. McCloy K, Duce B, Swarnkar V, Hukins C, Abeyratne U. Polysomnographic risk factors for vigilance-related cognitive decline and obstructive sleep apnea. Sleep Breath. 2021 Mar;25(1):75-83. doi: 10.1007/s11325-020-02050-z. Epub 2020 Mar 25. PMID: 32215832.
26. Ji P, Kou Q, Qu X, Sun G, Liu S, Zhang J. Effects of Obstructive Sleep Apnea-Hypopnea Syndrome and Cognitive Function in Ischemic Stroke Based on Linear Regression Equation. Scanning. 2022 Jun 22;2022:4105169. doi: 10.1155/2022/4105169. PMID: 35844265; PMCID: PMC9242756.
27. Qiu K, Mao M, Hu Y, Yi X, Zheng Y, Ying Z, Cheng D, Rao Y, Zhang J, Mu X, Ren C, Xu Y, Zhang W, Xu W, Zhao Y, Ren J. Gender-specific association between obstructive sleep apnea and cognitive impairment among adults. Sleep Med. 2022 Oct;98:158-166. doi: 10.1016/j.sleep.2022.07.004. Epub 2022 Jul 11. PMID: 35870305.
28. Macchitella L, Romano DL, Marinelli CV, Toraldo DM, Arigliani M, De Benedetto M, Angelelli P. Neuropsychological and socio-cognitive deficits in patients with obstructive sleep apnea. J Clin Exp Neuropsychol. 2021 Jul;43(5):514-533.
29. Zhang XL, Gao B, Han T, Xiang BY, Liu X. Moderate-to-Severe Obstructive Sleep Apnea and Cognitive Function Impairment in Patients with COPD. Int J Chron Obstruct Pulmon Dis. 2020 Jul 27;15:1813-1822. doi: 10.2147/COPD.S257796. PMID: 32801679; PMCID: PMC7396955.
30. Bilyukov RG, Nikolov MS, Pencheva VP, Petrova DS, Georgiev OB, Mondeshki TL, Milanova VK. Cognitive Impairment and Affective Disorders in Patients With Obstructive Sleep Apnea Syndrome. Front Psychiatry. 2018 Aug 7;9:357. doi: 10.3389/fpsyt.2018.00357. PMID: 30131730; PMCID: PMC6091233.
31. Gagnon K, Baril AA, Montplaisir J, Carrier J, De Beaumont L, D'Aragon C, Chami S, Pelleieux S, Poirier J, Gauthier S, Lafond C, Gagnon JF, Gosselin N. Disconnection Between Self-Reported and Objective Cognitive Impairment in Obstructive Sleep Apnea. J Clin Sleep Med. 2019 Mar 15;15(3):409-415. doi: 10.5664/jcsm.7664. PMID: 30853044; PMCID: PMC6411171.
32. Olaithe M, Pushpanathan M, Hillman D, Eastwood PR, Hunter M, Skinner T, James A, Wesnes KA, Bucks RS. Cognitive profiles in obstructive sleep apnea: a cluster analysis in sleep clinic and community samples. J Clin Sleep Med. 2020 Sep 15;16(9):1493-1505. doi: 10.5664/jcsm.8564. PMID: 32400387; PMCID: PMC7970596.
33. Gagnon K, Baril AA, Montplaisir J, Carrier J, Chami S, Gauthier S, Lafond C, Gagnon JF, Gosselin N. Detection of mild cognitive impairment in middle-aged and older adults with obstructive sleep apnoea. Eur Respir J. 2018 Nov 1;52(5):1801137. doi: 10.1183/13993003.01137-2018. PMID: 30190270.
34. Lal C, Ayappa I, Ayas N, Beaudin AE, Hoyos C, Kushida CA, Kaminska M, Mullins A, Naismith SL, Osorio RS, Phillips CL, Parekh A, Stone KL, Turner AD, Varga AW. The Link between Obstructive Sleep Apnea and Neurocognitive Impairment: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2022 Aug;19(8):1245-1256. doi: 10.1513/AnnalsATS.202205-380ST. PMID: 35913462; PMCID: PMC9353960.
35. Blackman J, Swirski M, Clynes J, Harding S, Leng Y, Coulthard E. Pharmacological and non-pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer's disease: A systematic review. J Sleep Res. 2021 Aug;30(4):e13229. doi: 10.1111/jsr.13229. Epub 2020 Dec 2. PMID: 33289311; PMCID: PMC8365694.
36. Roniger DDG, Lechuga YA, León EE, Robles ROG, Escandón ÓS, Pérez GJT, Moctezuma JV. Cognitive behavioral therapy for insomnia helps to reverse cognitive impairment in insomnia patients. Sleep Sci. 2022 Apr-Jun;15(Spec 2):355-360. doi: 10.5935/1984-0063.20210026. PMID: 35371411; PMCID: PMC8906373.
37. Cassidy-Eagle E, Siebern A, Unti L, Glassman J, O'Hara R. Neuropsychological Functioning in Older Adults with Mild Cognitive Impairment and Insomnia Randomized to CBT-I or Control Group. Clin Gerontol. 2018 Mar-Apr;41(2):136-144. doi: 10.1080/07317115.2017.1384777. Epub 2017 Dec 8. PMID: 29220627.
38. McCrae CS, Curtis AF, Williams JM, Dautovich ND, McNamara JPH, Stripling A, Dzierzewski JM, Chan WS, Berry RB, McCoy KJM, Marsiske M. Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes. Sleep Med. 2018 Nov;51:153-166. doi: 10.1016/j.sleep.2018.05.018. Epub 2018 Jun 2. PMID: 30195661; PMCID: PMC6513321.
39. Perrault AA, Pomares FB, Smith D, Cross NE, Gong K, Maltezos A, McCarthy M, Madigan E, Tarelli L, McGrath JJ, Savard J, Schwartz S, Gouin JP, Dang-Vu TT. Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition. Sleep Med. 2022 Sep;97:13-26. doi: 10.1016/j.sleep.2022.05.010. Epub 2022 May 23. PMID: 35691208.
40. Mattos MK, Manning CA, Quigg M, Davis EM, Barnes L, Sollinger A, Eckstein M, Ritterband LM. Feasibility and Preliminary Efficacy of an Internet-Delivered Intervention for Insomnia in Individuals with Mild Cognitive Impairment. J Alzheimers Dis. 2021;84(4):1539-1550. doi: 10.3233/JAD-210657. PMID: 34690141.
41. Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, Sateia MJ, Troxel WM, Zhou ES, Kazmi U, Heald JL, Martin JL. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021 Feb 1;17(2):255-262. doi: 10.5664/jcsm.8986. PMID: 33164742; PMCID: PMC7853203.
42. Qaseem A, Holty JE, Owens DK, Dallas P, Starkey M, Shekelle P; Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013 Oct 1;159(7):471-83. doi: 10.7326/0003-4819-159-7-201310010-00704. PMID: 24061345.
43. Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019 Oct;18(3):337-352. doi: 10.1002/wps.20674. PMID: 31496087; PMCID: PMC6732697.
44. Rosenberg R, Citrome L, Drake CL. Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies. Neuropsychiatr Dis Treat. 2021 Aug 6;17:2549-2566. doi: 10.2147/NDT.S297504. PMID: 34393484; PMCID: PMC8354724.
45. Picton JD, Marino AB, Nealy KL. Benzodiazepine use and cognitive decline in the elderly. Am J Health Syst Pharm. 2018 Jan 1;75(1):e6-e12. doi: 10.2146/ajhp160381. PMID: 29273607.
46. Guo F, Yi L, Zhang W, Bian ZJ, Zhang YB. Association Between Z Drugs Use and Risk of Cognitive Impairment in Middle-Aged and Older Patients With Chronic Insomnia. Front Hum Neurosci. 2021 Dec 9;15:775144. doi: 10.3389/fnhum.2021.775144. PMID: 34955792; PMCID: PMC8696350.
47. Sumsuzzman DM, Choi J, Jin Y, Hong Y. Neurocognitive effects of melatonin treatment in healthy adults and individuals with Alzheimer's disease and insomnia: A systematic review and meta-analysis of randomized controlled trials. Neurosci Biobehav Rev. 2021 Aug;127:459-473. doi: 10.1016/j.neubiorev.2021.04.034. Epub 2021 May 3. PMID: 33957167.
48. Jean-Louis, G., von Gizycki, H., Zizi, F., 1998. Melatonin effects on sleep, mood, and cognition in elderly with mild cognitive impairment. J. Pineal Res. 25, 177–183. doi: 10.1111/j.1600-079x.1998.tb00557.x. PMID: 9745987.
49. Luthringer, R., Muzet, M., Zisapel, N., Staner, L., 2009. The effect of prolonged-release melatonin on sleep measures and psychomotor performance in elderly patients with insomnia. Int. Clin. Psychopharmacol. 24, 239–249. https://doi.org/10.1097/ YIC.0b013e32832e9b08.
50. Jiang X, Wang Z, Hu N, Yang Y, Xiong R, Fu Z. Cognition effectiveness of continuous positive airway pressure treatment in obstructive sleep apnea syndrome patients with cognitive impairment: a meta-analysis. Exp Brain Res. 2021 Dec;239(12):3537-3552. doi: 10.1007/s00221-021-06225-2. Epub 2021 Sep 21. PMID: 34546386.
51. Wang G, Goebel JR, Li C, Hallman HG, Gilford TM, Li W. Therapeutic effects of CPAP on cognitive impairments associated with OSA. J Neurol. 2020 Oct;267(10):2823-2828. doi: 10.1007/s00415-019-09381-2. Epub 2019 May 20. PMID: 31111204.
52. Liguori C, Cremascoli R, Maestri M, Fernandes M, Izzi F, Tognoni G, Scarpina F, Siciliano G, Mercuri NB, Priano L, Bonanni E, Placidi F. Obstructive sleep apnea syndrome and Alzheimer's disease pathology: may continuous positive airway pressure treatment delay cognitive deterioration? Sleep Breath. 2021 Dec;25(4):2135-2139. doi: 10.1007/s11325-021-02320-4. Epub 2021 Feb 22. PMID: 33619666.