Dr. Saraswat Kumarshri Shriniwas
Psychiatry
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Patient's Query
Hello doctor,
I am a 24-year-old male with mild to moderate untreated sleep apnea for two years. Will my cognitive abilities (ability to think, learn and concentrate) return to baseline after the initiation of CPAP therapy, or will there always be some permanent deficit? I took the Covid vaccine three months ago, and I wonder if this could have aggravated neuro-inflammation to the effect that I will become permanently less intelligent. I would also like to know if this could have delayed my cognitive growth because the brain does stop growing until 25 or even older. My breath rate is about 17 to 19 breaths per minute while I sleep on my back, and it goes down to 14 breaths per minute when I sleep on my stomach. Kindly help.
Hello,
Welcome to icliniq.com.
I do not see any reason for your cognitive abilities not to return to baseline after treatment for obstructive sleep apnea. The first thing to do would be to confirm obstructive sleep apnea and get proper AHI (apnea-hypopnea index) from a polysomnography study. I would not suggest going ahead without a proper sleep study. I think you are getting a bit too worried about the cognitive side effects of the condition. I do not see any reason for permanent damage or deterioration with two years of untreated mild-moderate obstructive sleep apnea at your age. I would also suggest ruling out depression as it may make you worried and pessimistic and itself has cognitive symptoms involving memory, thinking, and concentration. Based on the watch date, I would suggest going stepwise and not jumping onto CPAP (continuous positive airway pressure). I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you. I want to point out that I did the test from a take-home sleep study, not a sleep watch. I only entered "sleep watch" as a description of the evidence I attached because "sleep study" was not available as an option. If you have read the medical files I have attached, my RDI is 17.8, which is quite high. The report was also interpreted by my ENT doctor, who specializes in sleep apnea, and he said that my low AHI might have been because the device did not measure chest movements and airflow, so essentially the device missed out on the hypomanic episodes that could have shown up had those been measured. I have scheduled a new sleep study with him with a device that measures those. I do not have depression as I do not lack motivation, and my only problem is persistent fatigue, difficulty with concentration, thinking, problem-solving, and formulating sentences (I stumble over my words a lot). Due to this, I am having a problem with my studies, and I have been suffering for two years. I agree that I feel pessimistic about my prognosis because of how much I have suffered, but that is not my concern: I want to know the prognosis for a patient like myself objectively. I don't want to become less intelligent for the rest of my life due to sleep apnea which has gone untreated for the last two years. I have heard that the effects on intelligence (represented in IQ) are greater if you have sleep apnea at a young age than in old age. I am also worried that my brain could have been growing since two years ago when I was 22 and that it was slowed down because of the sleep apnea, which in effect would result in a decrease in IQ (because I would have grown slower intellectually than I used to before having sleep apnea).
Hello,
Welcome back to icliniq.com.
I appreciate your clarification. We first need to ascertain the degree of cognitive disturbance we are dealing with. I recommend a thorough battery of cognitive tests which objectively measure your score on various cognitive abilities like attention, memory, and judgment to get a baseline. You could also get a brain MRI (magnetic resonance imaging) to check for brain volume and rule out any ischemic insult. It is only after knowing the degree of cognitive disability and ruling out any structural change that we will be able to predict the prognosis. Generally, if there is no structural change in the brain and the degree of deficit in cognitive functioning is mild, you can expect a full recovery and no harm to your IQ. I hope that is the issue in your case. I hope this was helpful.
Thank you.
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Psychiatry
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