How obstructive sleep apnea affects memory and brain function

Obstructive sleep apnea (OSA), commonly associated with cardiovascular and metabolic diseases, also plays a significant but less recognized role in memory decline, according to a new review published in Sleep Medicine Reviews.

Researchers from the Marshall University Joan C. Edwards School of Medicine and Shanghai Jiao Tong University School of Medicine reviewed evidence from human and animal studies showing that OSA patients often experience notable memory impairments, particularly in visual and verbal working memory.

They report that key features of OSA—intermittent hypoxia (IH) and sleep fragmentation (SF)—trigger biological processes such as neuroinflammation, oxidative stress, neuronal injury, altered synaptic plasticity, and blood-brain barrier dysfunction, all of which contribute to cognitive decline. Disease severity and duration are strongly linked to poorer memory performance, with measures like the oxygen desaturation index (ODI) correlating with the extent of impairment.

While continuous positive airway pressure (CPAP) therapy remains the most effective treatment for protecting cognitive function, the authors stress the need for additional therapies and more precise diagnostic tools to identify and manage OSA-related memory dysfunction. Early changes observed through brain imaging, EEG, and blood biomarkers may serve as emerging predictors of cognitive decline.

The review was co-authored by Drs. Xiaoman Zhang, Huajun Xu, and Shankai Yin of Shanghai Jiao Tong University, and Drs. David Gozal and Abdelnaby Khalyfa of Marshall University. Dr. Zhang completed a six-month research scholar program in Khalyfa’s lab at Marshall University, collaborating with Khalyfa and the team to develop this review article.

The authors also highlight future research directions, including the role of gut microbiota, genetic factors, and epigenetic changes in OSA-related memory decline. They suggest that multidimensional clinical profiling could support the development of personalized treatment strategies.