The Effect of Obstructive Sleep Apnea on Cognition: A Focus on Decision-Making

Purpose of ReviewIn this review, we discuss the impact of Obstructive Sleep Apnea (OSA), a sleep-related breathing disorder characterized by repetitive episodes of complete cessation of airflow or decreases in airflow due to upper airway obstruction leading to sleep fragmentation, on decision-making. We will first delve into how OSA affects cognition and executive functions, which are pivotal for optimal decision-making. Subsequently, we will explore its impact on decision-making itself. Unveiling these dynamics is crucial to better understand their implications on patients' well-being, aging, daily functioning, and treatment adherence.Recent FindingsPrevious research suggests that factors such as intermittent hypoxemia and sleep fragmentation may contribute to excessive daytime sleepiness, which is indeed the most prevalent daytime symptom observed in OSA. These factors also impact several neuropsychological domains, such as attention, memory, and executive functions. However, little is known about how OSA affects a complex cognitive domain like decision-making.SummaryInterestingly, compared to control subjects, OSA patients showed impaired decision-making, with the degree of the impairment associated with the severity of the disorder. The heterogeneity of results is ascribable to the utilization of different tasks across studies and the inclusion of patients with different severities of OSA. Future studies are expected to address the neuro-cognitive mechanisms contributing to decision-making impairments in OSA, the precursors of individual differences, and the efficacy of targeted interventions. Longitudinal studies are required to unveil the trajectory of decision-making deficits and their effects on clinical outcomes and quality of life in OSA patients.