Journal of the International Neuropsychological Society

Effects of hypoxia on the brain: Neuroimaging and neuropsychological findings following carbon monoxide poisoning and obstructive sleep apnea

SHAWN D.  GALE  a1 c1 and RAMONA O.  HOPKINS  a2 a3
a1 Department of Clinical Neuropsychology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
a2 Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
a3 Department of Medicine, Pulmonary and Critical Care Divisions, LDS Hospital, Salt Lake City, Utah

Article author query
gale sd   [PubMed][Google Scholar] 
hopkins ro   [PubMed][Google Scholar] 


Hypoxia damages multiple organ systems especially those with high oxygen utilization such as the central nervous system. The purpose of this study was to compare the neuropathological and neuropsychological effects of hypoxia in patients with either carbon monoxide poisoning or obstructive sleep apnea. Neuroimaging revealed evidence of hippocampal atrophy in both groups although a linear relationship between hippocampal volume and memory performance was found only for selected tests and only in the sleep apnea group. There were significant correlations between hippocampal volume and performance on measures related to nonverbal/information processing. Generalized brain atrophy, as measured by the ventricle-to-brain ratio, was more common in the carbon monoxide poisoning group compared to the obstructive sleep apnea group. Performance on tests of executive function improved following treatment with nasal continuous positive airway pressure treatment in the obstructive sleep apnea group but there was no associated improvement in general intellectual function. We found that hypoxia due to obstructive sleep apnea and CO poisoning resulted in neuropathological changes and neuropsychological impairments. The observed group differences provide insight into the relationship between etiology of injury, neuropathological changes, and clinical presentation. (JINS, 2004, 10, 60–71.)

(Received January 4 2002)
(Revised April 9 2003)
(Accepted April 14 2003)

Key Words: Quantitative magnetic resonance imaging; Carbon monoxide; Obstructive sleep apnea.

c1 Reprint requests to: Shawn D. Gale, Ph.D., ABPP-Cn, Department of Clinical Neuropsychology, Barrow Neurological Institute, 222 W. Thomas Road, Suite 315, Phoenix, Arizona 85013. E-mail: