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      Effects of Continuous Positive Airway Pressure on White Matter Microstructure in Patients With Obstructive Sleep Apnea

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      https://www.riss.kr/link?id=A108531228

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      다국어 초록 (Multilingual Abstract)

      Background and Objective Obstructive sleep apnea (OSA) has significant effects on quality of life and may lead to cognitive impairments. Continuous positive airway pressure (CPAP) is the standard treatment for OSA and has been shown to improve sleep disturbances and daytime dysfunction. In this study, we aimed to assess the effects of CPAP on white matter (WM) integrity using longitudinal diffusion tensor imaging (DTI) tests.Methods Twenty-two male patients with moderate to severe OSA were recruited, and thepatients underwent DTI scanning before and 6–44 months after CPAP treatment. Sixteen male patients with untreated OSA who were not compliant with CPAP were included as a reference group. We compared the functional anisotropy (FA) values between baseline and follow-up magnetic resonance imaging in both the CPAP and untreated groups using tract-specific statistical analysis (TSSA) method.Results The TSSA analysis showed that FA values in the middle part of the right corticospinal tract were increased after treatment in the CPAP group. In the untreated group, no significant change in FA value was observed between baseline and follow-up. In the CPAP group, the post-treatment FA value in the anterior part of the right anterior thalamic radiation was significantly correlated with the duration of CPAP therapy, after controlling for age, body mass index, and baseline FA value.Conclusions Our study suggests that long-term CPAP treatment could gradually reverse OSA-induced injury to the WM microstructure, particularly WM associated with the motor and limbic systems. The study findings provide new insights into the mechanisms of cognitive improvement after CPAP treatment in patients with OSA.
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      Background and Objective Obstructive sleep apnea (OSA) has significant effects on quality of life and may lead to cognitive impairments. Continuous positive airway pressure (CPAP) is the standard treatment for OSA and has been shown to improve sleep d...

      Background and Objective Obstructive sleep apnea (OSA) has significant effects on quality of life and may lead to cognitive impairments. Continuous positive airway pressure (CPAP) is the standard treatment for OSA and has been shown to improve sleep disturbances and daytime dysfunction. In this study, we aimed to assess the effects of CPAP on white matter (WM) integrity using longitudinal diffusion tensor imaging (DTI) tests.Methods Twenty-two male patients with moderate to severe OSA were recruited, and thepatients underwent DTI scanning before and 6–44 months after CPAP treatment. Sixteen male patients with untreated OSA who were not compliant with CPAP were included as a reference group. We compared the functional anisotropy (FA) values between baseline and follow-up magnetic resonance imaging in both the CPAP and untreated groups using tract-specific statistical analysis (TSSA) method.Results The TSSA analysis showed that FA values in the middle part of the right corticospinal tract were increased after treatment in the CPAP group. In the untreated group, no significant change in FA value was observed between baseline and follow-up. In the CPAP group, the post-treatment FA value in the anterior part of the right anterior thalamic radiation was significantly correlated with the duration of CPAP therapy, after controlling for age, body mass index, and baseline FA value.Conclusions Our study suggests that long-term CPAP treatment could gradually reverse OSA-induced injury to the WM microstructure, particularly WM associated with the motor and limbic systems. The study findings provide new insights into the mechanisms of cognitive improvement after CPAP treatment in patients with OSA.

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      참고문헌 (Reference)

      1 Park HR, "White matter tract-specific alterations in patients with primary restless legs syndrome" 11 : 16116-, 2021

      2 Koo DL, "White matter tract-specific alterations in male patients with untreated obstructive sleep apnea are associated with worse cognitive function" 43 : zsz247-, 2020

      3 Castronovo V, "White matter integrity in obstructive sleep apnea before and after treatment" 37 : 1465-1475, 2014

      4 Chen HL, "White matter damage and systemic inflammation in obstructive sleep apnea" 38 : 361-370, 2015

      5 Huynh NT, "Volumetric brain morphometry changes in patients with obstructive sleep apnea syndrome : effects of CPAP treatment and literature review" 5 : 58-, 2014

      6 Jung NY, "Tract-specific correlates of neuropsychological deficits in patients with subcortical vascular cognitive impairment" 50 : 1125-1135, 2016

      7 O’Donnell LJ, "Tract-based morphometry for white matter group analysis" 45 : 832-844, 2009

      8 Sforza E, "Sleep apnea syndrome and cognition" 3 : 87-, 2012

      9 Mamiya PC, "Right forceps minor and anterior thalamic radiation predict executive function skills in young bilingual adults" 9 : 118-, 2018

      10 Joo EY, "Reduced cerebral blood flow during wakefulness in obstructive sleep apnea-hypopnea syndrome" 30 : 1515-1520, 2007

      1 Park HR, "White matter tract-specific alterations in patients with primary restless legs syndrome" 11 : 16116-, 2021

      2 Koo DL, "White matter tract-specific alterations in male patients with untreated obstructive sleep apnea are associated with worse cognitive function" 43 : zsz247-, 2020

      3 Castronovo V, "White matter integrity in obstructive sleep apnea before and after treatment" 37 : 1465-1475, 2014

      4 Chen HL, "White matter damage and systemic inflammation in obstructive sleep apnea" 38 : 361-370, 2015

      5 Huynh NT, "Volumetric brain morphometry changes in patients with obstructive sleep apnea syndrome : effects of CPAP treatment and literature review" 5 : 58-, 2014

      6 Jung NY, "Tract-specific correlates of neuropsychological deficits in patients with subcortical vascular cognitive impairment" 50 : 1125-1135, 2016

      7 O’Donnell LJ, "Tract-based morphometry for white matter group analysis" 45 : 832-844, 2009

      8 Sforza E, "Sleep apnea syndrome and cognition" 3 : 87-, 2012

      9 Mamiya PC, "Right forceps minor and anterior thalamic radiation predict executive function skills in young bilingual adults" 9 : 118-, 2018

      10 Joo EY, "Reduced cerebral blood flow during wakefulness in obstructive sleep apnea-hypopnea syndrome" 30 : 1515-1520, 2007

      11 Joo EY, "Reduced brain gray matter concentration in patients with obstructive sleep apnea syndrome" 33 : 235-241, 2010

      12 Grimm W, "Outcome of patients with sleep apnea-associated severe bradyarrhythmias after continuous positive airway pressure therapy" 86 : 688-692, 2000

      13 Lim DC, "Obstructive sleep apnea and cognitive impairment : addressing the blood-brain barrier" 18 : 35-48, 2014

      14 Canessa N, "Obstructive sleep apnea : brain structural changes and neurocognitive function before and after treatment" 183 : 1419-1426, 2011

      15 Lal C, "Neurocognitive impairment in obstructive sleep apnea" 141 : 1601-1610, 2012

      16 Groppe DM, "Mass univariate analysis of eventrelated brain potentials/fields I : a critical tutorial review" 48 : 1711-1725, 2011

      17 Park HR, "Localizing deficits in white matter tracts of patients with narcolepsy with cataplexy : tract-specific statistical analysis" 14 : 1674-1681, 2020

      18 Mahar M, "Intrinsic mechanisms of neuronal axon regeneration" 19 : 323-337, 2018

      19 Bullmore ET, "Global, voxel, and cluster tests, by theory and permutation, for a difference between two groups of structural MR images of the brain" 18 : 32-42, 1999

      20 Jenkinson M, "FSL" 62 : 782-790, 2012

      21 Olaithe M, "Executive dysfunction in OSA before and after treatment : a meta-analysis" 36 : 1297-1305, 2013

      22 Kim H, "Effects of long-term treatment on brain volume in patients with obstructive sleep apnea syndrome" 37 : 395-409, 2016

      23 Kushida CA, "Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients : the Apnea Positive Pressure Long-term Efficacy Study(APPLES)" 35 : 1593-1602, 2012

      24 Loredo JS, "Effect of continuous positive airway pressure vs placebo continuous positive airway pressure on sleep quality in obstructive sleep apnea" 116 : 1545-1549, 1999

      25 Wang R, "Diffusion toolkit : a software package for diffusion imaging data processing and tractography" 15 : 3720-, 2007

      26 Maresky HS, "Continuous positive airway pressure alters brain microstructure and perfusion patterns in patients with obstructive sleep apnea" 57 : 61-69, 2019

      27 Han CE, "Cluster-based statistics for brain connectivity in correlation with behavioral measures" 8 : e72332-, 2013

      28 Rosenzweig I, "Changes in neurocognitive architecture in patients with obstructive sleep apnea treated with continuous positive airway pressure" 7 : 221-229, 2016

      29 O’Donoghue FJ, "Cerebral structural changes in severe obstructive sleep apnea" 171 : 1185-1190, 2005

      30 Kaneko Y, "Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea" 348 : 1233-1241, 2003

      31 Macey PM, "Brain structural changes in obstructive sleep apnea" 31 : 967-977, 2008

      32 Macey PM, "Brain morphology associated with obstructive sleep apnea" 166 : 1382-1387, 2002

      33 Biesbroek JM, "Association between subcortical vascular lesion location and cognition : a voxel-based and tract-based lesion-symptom mapping study. The SMART-MR study" 8 : e60541-, 2013

      34 Mamah D, "Anterior thalamic radiation integrity in schizophrenia : a diffusion-tensor imaging study" 183 : 144-150, 2010

      35 Yoo SW, "An example-based multi-atlas approach to automatic labeling of white matter tracts" 10 : e0133337-, 2015

      36 Pepperell JC, "Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea : a randomised parallel trial" 359 : 204-210, 2002

      37 Yan L, "Altered regional cerebral blood flow in obstructive sleep apnea is associated with sleep fragmentation and oxygen desaturation" 41 : 2712-2724, 2021

      38 Peng DC, "Altered intrinsic regional brain activity in male patients with severe obstructive sleep apnea : a resting-state functional magnetic resonance imaging study" 10 : 1819-1826, 2014

      39 Park HR, "Altered cerebrocerebellar functional connectivity in patients with obstructive sleep apnea and its association with cognitive function" 45 : zsab209-, 2022

      40 Jordan AS, "Adult obstructive sleep apnoea" 383 : 736-747, 2014

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