Alterações vasculares e declínio cognitivo em idosos hipertensos com apnéia obstrutiva do sono

Abstract

The elderly population is growing rapidly in Brazil. The prevalence of hypertension, obstructive sleep apnea (OSA) and cognitive disorders is high in this population. The objective of this study was to verify if there is an association between obstructive sleep apnea and cognitive performance in elderly hypertensive individuals. Elderly patients aged ≥ 60 to <80 years old were divided into two groups: hypertensive patients with absent / mild OSA and hypertensive patients with moderate / severe OSA. Cognitive performance was assessed through the Wechsler Adult Intelligence Scale v.3 (WAIS III) subtests, the Rey Auditory Verbal Learning Test (RAVLT), and the "Trail Making Tests A (TMT-A) and B (TMT-B). SF-36 was used to assess quality of life and general health status and the Beck scale for depression screening. Vascular tests were performed: pulse wave velocity (PWV), flow-mediated dilatation (DMF) of the brachial artery, determination of central aortic pressure through the SphygmoCor system and ultrasonographic evaluation of the intima-medial thickness (IMT). The Watch PAT 200 was used for the diagnosis of OSA and to determine its severity. The sample was homogeneous in relation to age, schooling and blood pressure.In WAIS-III, the group with moderate to severe OSA presented a lower performance when compared to baseline values and after study follow-up: in the estimated IQ (90 ± 5 vs 88 ± 5, p = 0, 010), subtest Vocabulary subtest (29.5 ± 6.7 vs 28.1 ± 6.6, p = 0.016), subtest Codes (25.0 ± 11.3 vs. 23.5 ± 11.3, p = 0.003) ) and also in TMT-A (55 ± 15 vs 58 ± 16, p = <0.001) and in TMT-B (140 ± 40 vs 144 ± 39 sec, p = 0.002), a significant increase was also observed in this group a significant increase in mean cr-PWV (10.4 ± 2.8 vs 10.7 ± 3.0 m / s, p = 0.037), mean IMT (0.96 ± 0.13 vs 1.00 ± 0.14, p = 0.006), systolic aortic pressure (146 ± 19 vs 150 ± 17 mmHg, p = 0.038), aortic pulse pressure (66 ± 14 vs 69 ± 12 mmHg, p = 0.046), augmentation pressure (AP) (26 ± 7 vs 28 ± 7 mmHg, p = <0.001), augmentation index (AIX) ( 41 ± 7 vs 43 ± 7,% p = <0.001), AIx @ HR75,% (37 ± 7 vs 38 ± 6%, p = 0.021). In the SF-36, both groups showed a significant worsening during this follow-up in the Mental Health item: absent / mild OSA (96 ± 2 vs 80 ± 7, p = 0.047) and moderate / severe OSA (93 ± 1 vs 71 ± 8 , p = 0.044). And RAVLT: the absent / mild AOS group (46 ± 6 vs 44 ± 6, p = 0.026) and the moderate severe AOS group (42 ± 3vs 39 ± 3, p = 0.008). In conclusion, in this longitudinal study, they demonstrated that OSA severity interferes in both cognitive performance and vascular structure in hypertensive elderly.