What question did this study set out to answer?

This study aims to investigate the relationship between residual excessive daytime sleepiness and cognitive performance in treated obstructive sleep apnea patients.

April 18, 2026Open Access

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

Key Points

This study aims to investigate the relationship between residual excessive daytime sleepiness and cognitive performance in treated obstructive sleep apnea patients.
Cross-sectional study design
Participants included PAP-adherent patients with obstructive sleep apnea
Cognitive function assessed via NeuroTrax® battery and psychomotor vigilance task used to measure daytime sleepiness
General linear models adjusted for sex, diagnosis duration, and sleep duration were employed
Residual excessive daytime sleepiness linked to significantly poorer global cognition (β = -4.09, p < .001)
Worse memory (β = -3.97, p = .001) and executive functioning (β = -3.91, p = .004) were also noted
Attention (β = -2.68, p = .036) and processing speed (β = -4.89, p = .012) showed similar associations
Cognitive performance deficits were approximately equivalent to a reduction of 1–2 points on common assessment scales like MoCA or MMSE

Abstract

Abstract 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 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. Brief summary 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.

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