{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:31:46Z","timestamp":1791873106086,"version":"4.3.4"},"reference-count":67,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health\u2014Ricerca Corrente"},{"name":"Italian Ministry of Education, University and Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The mechanisms underlying cognitive impairment in obstructive sleep apnea syndrome (OSAS) remain incompletely understood. In particular, the relative contribution of daytime sleepiness versus the direct effects of hypoxia on the brain requires clarification. Objectives: This study aims to explore the association between verbal memory and problem-solving abilities, OSAS severity, self-reported daytime sleepiness, and neurofilament light chain (NfL) serum concentration, as marker of neuroaxonal injury possibly related to chronic hypoxia. Methods: In this cross-sectional study, cognitive performance was assessed in 72 patients with mild to severe OSAS using the Selective Reminding Test (SRT) and the Tower of London (ToL). The apnea\u2013hypopnea index (AHI), the Epworth Sleepiness Scale (ESS) and serum NfL concentrations were collected. Hierarchical multiple linear regression analyses adjusting for age, years of education, body mass index, and duration of continuous positive airway pressure (CPAP) treatment, were conducted for each cognitive outcome. Results. Neither AHI, ESS scores nor serum NfL concentrations were significantly associated with verbal memory or problem-solving performance. Higher age and lower education were significant predictors of lower verbal memory indices, whereas longer CPAP treatment duration was positively correlated with verbal memory performance and problem-solving speed. Conclusions: In this sample, cognitive performance was more strongly related to demographic factors and CPAP exposure compared to disease severity, subjective sleepiness, or peripheral markers of neuroaxonal injury. These findings suggest that AHI, subjective measures of sleepiness and NfL may inadequately capture neurocognitive vulnerability in OSAS. Moreover, they underscore the imperative for longitudinal and larger studies to clarify mechanisms linking OSAS and cognitive impairments.<\/jats:p>","DOI":"10.3390\/jcm15041588","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T09:22:46Z","timestamp":1771406566000},"page":"1588","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["CPAP Treatment Exposure, but Not Daytime Sleepiness or Neurofilament Light Chain, Is Associated with Cognitive Performance in Obstructive Sleep Apnea"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9888-7911","authenticated-orcid":false,"given":"Sofia","family":"Tagini","sequence":"first","affiliation":[{"name":"\u201cRita Levi Montalcini\u201d Department of Neurosciences, University of Turin, 10126 Turin, Italy"},{"name":"Laboratory of Clinical Neurobiology, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9513-5949","authenticated-orcid":false,"given":"Stefania","family":"Cattaldo","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Neurobiology, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4326-1596","authenticated-orcid":false,"given":"Federica","family":"Scarpina","sequence":"additional","affiliation":[{"name":"\u201cRita Levi Montalcini\u201d Department of Neurosciences, University of Turin, 10126 Turin, Italy"},{"name":"Laboratory of Clinical Neurobiology, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7272-7295","authenticated-orcid":false,"given":"Erica","family":"Sabattini","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Neurobiology, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0540-7123","authenticated-orcid":false,"given":"Giulia","family":"Chirchio","sequence":"additional","affiliation":[{"name":"\u201cRita Levi Montalcini\u201d Department of Neurosciences, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6487-4810","authenticated-orcid":false,"given":"Elisa","family":"Prina","sequence":"additional","affiliation":[{"name":"\u201cRita Levi Montalcini\u201d Department of Neurosciences, University of Turin, 10126 Turin, Italy"},{"name":"Laboratory of Clinical Neurobiology, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9637-0940","authenticated-orcid":false,"given":"Paolo","family":"Piter\u00e0","sequence":"additional","affiliation":[{"name":"\u201cRita Levi Montalcini\u201d Department of Neurosciences, University of Turin, 10126 Turin, Italy"},{"name":"Laboratory of Clinical Neurobiology, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0894-4997","authenticated-orcid":false,"given":"Clara","family":"Paschino","sequence":"additional","affiliation":[{"name":"Laboratory of Clinical Neurobiology, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4663-946X","authenticated-orcid":false,"given":"Riccardo","family":"Cremascoli","sequence":"additional","affiliation":[{"name":"U.O. di Neurologia e Neuroriabilitazione, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Piancavallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1406-3398","authenticated-orcid":false,"given":"Mirna Solange Barrio","family":"Lower Daniele","sequence":"additional","affiliation":[{"name":"U.O. 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Geriatr. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s00408-021-00426-w","article-title":"Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome","volume":"199","author":"Lee","year":"2021","journal-title":"Lung"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1056\/NEJMcp1816152","article-title":"Obstructive Sleep Apnea in Adults","volume":"380","author":"Veasey","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_4","first-page":"390","article-title":"Obstructive Sleep Apnea Syndrome and the Quality of Life","volume":"89","author":"Coman","year":"2016","journal-title":"Clujul Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.sleep.2020.03.017","article-title":"Obstructive Sleep Apnea, Depression and Cognitive Impairment","volume":"72","author":"Vanek","year":"2020","journal-title":"Sleep. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/j.sleep.2007.10.017","article-title":"A multidimensional assessment of obese patients with obstructive sleep apnoea syndrome (OSAS): A study of psychological, neuropsychological and clinical relationships in a disabling multifaceted disease","volume":"9","author":"Pierobon","year":"2008","journal-title":"Sleep Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"90","DOI":"10.17116\/jnevro202012001190","article-title":"Obstructive sleep apnea syndrome and cognitive impairment","volume":"120","author":"Kemstach","year":"2020","journal-title":"Zhurnal nevrologii i psikhiatrii imeni SS Korsakova"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1046\/j.1365-2869.2002.00289.x","article-title":"Obstructive Sleep Apnea and the Prefrontal Cortex: Towards a Comprehensive Model Linking Nocturnal Upper Airway Obstruction to Daytime Cognitive and Behavioral Deficits","volume":"11","author":"Beebe","year":"2002","journal-title":"J. Sleep Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s11325-020-02084-3","article-title":"Cognitive Impairment in Obstructive Sleep Apnea Syndrome: A Descriptive Review","volume":"25","author":"Caporale","year":"2021","journal-title":"Sleep Breath."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.smrv.2017.03.005","article-title":"Cognitive Deficits in Obstructive Sleep Apnea: Insights from a Meta-Review and Comparison with Deficits Observed in COPD, Insomnia, and Sleep Deprivation","volume":"38","author":"Olaithe","year":"2018","journal-title":"Sleep Med. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1080\/13803395.2016.1253668","article-title":"Obstructive Sleep Apnea and Its Controversial Effects on Cognition","volume":"39","author":"Devita","year":"2017","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1111\/resp.13140","article-title":"Reviewing the relationship between OSA and cognition: Where do we go from here?","volume":"22","author":"Bucks","year":"2017","journal-title":"Respirology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.jsmc.2019.10.001","article-title":"Effect of Obstructive Sleep Apnea on Neurocognitive Performance","volume":"15","author":"Seda","year":"2020","journal-title":"Sleep Med. Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.sleep.2016.02.008","article-title":"A Review of Neurocognitive Function and Obstructive Sleep Apnea with or without Daytime Sleepiness","volume":"23","author":"Zhou","year":"2016","journal-title":"Sleep Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11910-021-01094-2","article-title":"Obstructive Sleep Apnea and the Brain: A Focus on Gray and White Matter Structure","volume":"21","author":"Baril","year":"2021","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.sleep.2018.09.025","article-title":"Structural and Functional Brain Alterations in Obstructive Sleep Apnea: A Multimodal Meta-Analysis","volume":"54","author":"Huang","year":"2019","journal-title":"Sleep Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e70384","DOI":"10.1111\/cns.70384","article-title":"Chronic Intermittent Hypoxia-Induced Neural Injury: Pathophysiology, Neurodegenerative Implications, and Therapeutic Insights","volume":"31","author":"Jia","year":"2025","journal-title":"CNS Neurosci. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/S2213-2600(15)00090-9","article-title":"Review Sleep Apnoea and the Brain: A Complex Relationship","volume":"3","author":"Rosenzweig","year":"2015","journal-title":"Lancet Respir. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.sleep.2020.04.029","article-title":"Cerebrovascular Reactivity in Young and Old Patients with Obstructive Sleep Apnea","volume":"73","author":"Li","year":"2020","journal-title":"Sleep Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ferini-Strambi, L., and Salsone, M. (2024). \u201cGlymphatic\u201d Neurodegeneration: Is Sleep the Missing Key?. Clin. Transl. Neurosci., 8.","DOI":"10.3390\/ctn8020023"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Roy, B., Nunez, A., Aysola, R.S., Kang, D.W., Vacas, S., and Kumar, R. (2022). Impaired Glymphatic System Actions in Obstructive Sleep Apnea Adults. Front. Neurosci., 16.","DOI":"10.3389\/fnins.2022.884234"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Rahman, Z., Nazim, A., Mroke, P., Ali, K., Allam, M.P., Mahato, A., Maheshwari, M., Sanchez Cruz, C., Baig, I., and Calderon Martinez, E. (2024). Long-Term Management of Sleep Apnea-Hypopnea Syndrome: Efficacy and Challenges of Continuous Positive Airway Pressure Therapy\u2014A Narrative Review. Med. Sci., 13.","DOI":"10.3390\/medsci13010004"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Vaioli, G., Tagini, S., Scarpina, F., Cremascoli, R., Priano, L., Cornacchia, M., Fanari, P., and Mauro, A. (2023). Short-Term Benefits of Continuous Positive Airway Pressure Treatment on Cognition in the Obstructive Sleep Apnea Syndrome: A Retrospective Study. Brain Sci., 13.","DOI":"10.3390\/brainsci13010124"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1080\/01688638908400912","article-title":"Selective Reminding Tests: A Normative Study of Verbal Learning in Adults","volume":"11","author":"Ruff","year":"1989","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/1073191120961834","article-title":"Italian Normative Data for the Original Version of the Tower of London Test: A Bivariate Analysis on Speed and Accuracy Scores","volume":"29","author":"Bruni","year":"2022","journal-title":"Assessment"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.neucli.2016.04.002","article-title":"Syndrome d\u2019apn\u00e9es obstructives du sommeil et cognition: Une revue","volume":"46","author":"Daurat","year":"2016","journal-title":"Neurophysiol. Clin.\/Clin. Neurophysiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s100720300004","article-title":"Italian Version of the Epworth Sleepiness Scale: External Validity","volume":"23","author":"Vignatelli","year":"2003","journal-title":"Neurol. Sci."},{"key":"ref_28","first-page":"zsx011","article-title":"Obstructive Sleep Apnea Is Associated With Early but Possibly Modifiable Alzheimer\u2019s Disease Biomarkers Changes","volume":"40","author":"Liguori","year":"2017","journal-title":"Sleep"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.smrv.2018.08.001","article-title":"Biomarkers of Dementia in Obstructive Sleep Apnea","volume":"42","author":"Baril","year":"2018","journal-title":"Sleep Med. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1111\/coa.70035","article-title":"Exploration of Plasma Biomarkers of Neurodegeneration in Obstructive Sleep Apnea\u2014Related Mild Cognitive Impairment","volume":"51","author":"Ma","year":"2025","journal-title":"Clin. Otolaryngol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Jaromirska, J., Kaczmarski, P., Strzelecki, D., Sochal, M., Bia\u0142asiewicz, P., and Gabryelska, A. (2023). Shedding Light on Neurofilament Involvement in Cognitive Decline in Obstructive Sleep Apnea and Its Possible Role as a Biomarker. Front. Psychiatry, 14.","DOI":"10.3389\/fpsyt.2023.1289367"},{"key":"ref_32","first-page":"1077","article-title":"Intermittent hypoxia from obstructive sleep apnea may cause neuronal impairment and dysfunction in central nervous system: The potential roles played by microglia","volume":"9","author":"Yang","year":"2013","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/ana.24954","article-title":"Serum Neurofilament Light: A Biomarker of Neuronal Damage in Multiple Sclerosis","volume":"81","author":"Disanto","year":"2017","journal-title":"Ann. Neurol."},{"key":"ref_34","first-page":"967","article-title":"Brain Structural Changes in Obstructive Sleep Apnea","volume":"31","author":"Macey","year":"2008","journal-title":"Sleep"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.neubiorev.2016.03.026","article-title":"Structural and Functional Neural Adaptations in Obstructive Sleep Apnea: An Activation Likelihood Estimation Meta-Analysis","volume":"65","author":"Tahmasian","year":"2016","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Shi, Y., Feng, Y., Chen, X., Ma, L., Cao, Z., Shang, L., Zhao, B., She, N., Zhang, Y., and Si, C. (2022). Serum Neurofilament Light Reflects Cognitive Dysfunctions in Children with Obstructive Sleep Apnea. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03514-9"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1002\/lio2.683","article-title":"The Evaluation of Serum Brain-derived Neurotrophic Factor and Neurofilament Light Chain Levels in Patients with Obstructive Sleep Apnea Syndrome","volume":"6","author":"Arslan","year":"2021","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"597","DOI":"10.5664\/jcsm.2172","article-title":"Rules for Scoring Respiratory Events in Sleep: Update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events","volume":"08","author":"Berry","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Sarg\u00e9nius, H.L., Lydersen, S., and Hestad, K. (2017). Neuropsychological Function in Individuals with Morbid Obesity: A Cross-Sectional Study. BMC Obes., 4.","DOI":"10.1186\/s40608-017-0143-7"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1111\/crj.13175","article-title":"The Relationship between Obstructive Sleep Apnea Syndrome and Obesity: A New Perspective on the Pathogenesis in Terms of Organ Crosstalk","volume":"14","author":"Kuvat","year":"2020","journal-title":"Clin. Respir. J."},{"key":"ref_41","unstructured":"JASP Team (2026, February 10). JASP (Version 0.95.3) [Computer software]. Available online: https:\/\/jasp-stats.org\/."},{"key":"ref_42","unstructured":"Hillsdale, N.L.E. (1988). Statistical Power Analysis for the Behavioral Sciences, Routledge. [2nd ed.]."},{"key":"ref_43","unstructured":"Cook, R.D., and Weisberg, S. (1982). Residuals and Influence in Regression, Taylor & Francis Group."},{"key":"ref_44","unstructured":"Hair, J.F., Black, W.C., Babin, B.J., and Anderson, R.E. (2014). Multivariate Data Analysis, Pearson Educational. [7th ed.]."},{"key":"ref_45","unstructured":"Tabachnick, B.G., Fidell, L.S., and Ullman, J.B. (2007). Using Multivariate Statistics, Pearson."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Su, K., Feng, Z., Wang, L., Zhao, G., and Li, J. (2025). Prevalence of cognitive impairment among adults with obstructive sleep apnea: A systematic review and meta-analysis. Sleep and Breathing, Springer Science and Business Media Deutschland GmbH.","DOI":"10.1007\/s11325-025-03509-7"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1186\/s40064-016-3609-z","article-title":"Factors Affecting Executive Functions in Obstructive Sleep Apnea Syndrome and Volumetric Changes in the Prefrontal Cortex","volume":"5","author":"Voyvoda","year":"2016","journal-title":"Springerplus"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.sleep.2024.08.028","article-title":"Verbal Memory Is Linked to Average Oxygen Saturation during Sleep, Not the Apnea-Hypopnea Index nor Novel Hypoxic Load Variables","volume":"123","author":"Thorisdottir","year":"2024","journal-title":"Sleep Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1002\/ana.25728","article-title":"Mean Oxygen Saturation during Sleep Is Related to Specific Brain Atrophy Pattern","volume":"87","author":"Marchi","year":"2020","journal-title":"Ann. Neurol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"5503","DOI":"10.1007\/s00405-024-08756-0","article-title":"Impact of Excessive Daytime Sleepiness on Attention Impairment in Obstructive Sleep Apnea: A Cross-Sectional Observational Study","volume":"281","author":"Li","year":"2024","journal-title":"Eur. Arch. Oto-Rhino-Laryngol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s11325-023-02854-9","article-title":"Excessive Daytime Sleepiness in Young and Middle-Aged Chinese Adults with Obstructive Sleep Apnea: Implications for Cognitive Dysfunction","volume":"28","author":"Cai","year":"2024","journal-title":"Sleep Breath."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Schwab, A., Keenan, B.T., Basner, M., and Bae, C.J. (2025). Psychomotor Vigilance Test and Epworth Sleepiness Scale in Participants Being Evaluated for Sleep Disorders. medRxiv.","DOI":"10.1101\/2025.06.03.25328917"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1111\/j.0963-7214.2004.00293.x","article-title":"What and When of Cognitive Aging","volume":"13","author":"Salthouse","year":"2004","journal-title":"Curr. Dir. Psychol. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s12124-024-09821-3","article-title":"Cognition and Cognitive Reserve","volume":"58","author":"Savarimuthu","year":"2024","journal-title":"Integr. Psychol. Behav. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1196\/annals.1417.002","article-title":"Sleep Deprivation and Vigilant Attention","volume":"1129","author":"Lim","year":"2008","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e14164","DOI":"10.1111\/jsr.14164","article-title":"Effects of Obstructive Sleep Apnea Treatment on Neurodegenerative Biomarker Neurofilament Light Chain and Cognitive Performance","volume":"33","author":"Sehr","year":"2024","journal-title":"J. Sleep Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1136\/jnnp-2018-320106","article-title":"Neurofilament Light Chain as a Biomarker in Neurological Disorders","volume":"90","author":"Gaetani","year":"2019","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/acn3.50972","article-title":"Confounding effect of blood volume and body mass index on blood neurofilament light chain levels","volume":"7","author":"Manouchehrinia","year":"2020","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1186\/s13195-022-01134-0","article-title":"Association of neurofilament light chain with renal function: Mechanisms and clinical implications","volume":"14","author":"Tang","year":"2022","journal-title":"Alzheimer\u2019s Res. Ther."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1093\/brain\/awac328","article-title":"The multifaceted role of neurofilament light chain protein in non-primary neurological diseases","volume":"146","author":"Abdelhak","year":"2023","journal-title":"Brain"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Stavrou, V.T., Pitris, K., Constantinidou, F., Adamide, T., Frangopoulos, F., and Bargiotas, P. (2024). The impact of a 12-week tele-exercise program on cognitive function and cerebral oxygenation in patients with OSA: Randomized controlled trial\u2014Protocol study. Front. Sports Act. Living, 6.","DOI":"10.3389\/fspor.2024.1418439"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"100484","DOI":"10.1016\/j.obmed.2023.100484","article-title":"Mechanisms of aerobic exercise in attenuating obesity-induced cognitive impairment: A brief review","volume":"39","author":"Bourbeau","year":"2023","journal-title":"Obes. Med."},{"key":"ref_63","first-page":"411","article-title":"What you see may not be what you get: A brief, nontechnical introduction to overfitting in regression-type models","volume":"66","author":"Babyak","year":"2004","journal-title":"Psychosom. Med."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Younas, H., Gu, C., Rathore, A., Jun, J.C., and Polotsky, V.Y. (2019). Metabolic syndrome and sleep apnea: A bidirectional relationship. Mechanisms and Manifestations of Obesity in Lung Disease, Elsevier.","DOI":"10.1016\/B978-0-12-813553-2.00008-7"},{"key":"ref_65","first-page":"167","article-title":"Obstructive sleep apnea syndrome and cardiovascular diseases","volume":"46","author":"Mazza","year":"2007","journal-title":"Minerva Pneumol."},{"key":"ref_66","first-page":"494","article-title":"Cognitive impairments in metabolic syndrome","volume":"38","author":"Ivanova","year":"2025","journal-title":"Adv. Gerontol. = Uspekhi Gerontol."},{"key":"ref_67","first-page":"e025076720","article-title":"Pathophysiological mechanisms in the relationship between cardiovascular disease and cognitive impairment","volume":"54","author":"Mallet","year":"2025","journal-title":"Rev. Cuba. Med. Militar"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1588\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T09:29:49Z","timestamp":1772011789000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,18]]},"references-count":67,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041588"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041588","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,18]]}}}