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(1) Background: Although it is known that obstructive sleep apnea (OSA) impairs action-monitoring function, there is only limited information regarding the associated cerebral substrate underlying this phenomenon. (2) Methods: The modified Flanker task, error-related event-related potentials (ERPs), namely, error-related negativity (ERN) and error positivity (Pe), and functional magnetic resonance imaging (fMRI) were used to evaluate neural activities and the functional connectivity underlying action-monitoring dysfunction in patients with different severities of OSA. (3) Results: A total of 14 control ( Cont ) subjects, 17 patients with moderate OSA ( m OSA), and 10 patients with severe OSA ( s OSA) were enrolled. A significant decline in posterror correction rate was observed in the modified Flanker task when patients with m OSA were compared with Cont subjects. Comparison between patients with m OSA and s OSA did not reveal any significant difference. In the analysis of ERPs, ERN and Pe exhibited declined amplitudes in patients with m OSA compared with Cont subjects, which were found to increase in patients with s OSA. Results of fMRI revealed a decreased correlation in multiple anterior cingulate cortex functional-connected areas in patients with m OSA compared with Cont subjects. However, these areas appeared to be reconnected in patients with s OSA. (4) Conclusions: The behavioral, neurophysiological, and functional image findings obtained in this study suggest that m OSA leads to action-monitoring dysfunction; however, compensatory neural recruitment might have contributed to the maintenance of the action-monitoring function in patients with s OSA.

Compensatory Neural Recruitment for Error-Related Cerebral Activity in Patients with Moderate-To-Severe Obstructive Sleep Apnea