新诊断阻塞性睡眠呼吸暂停患者的全球及区域脑非高斯扩散变化
Global and Regional Brain Non-Gaussian Diffusion Changes in Newly Diagnosed Patients with Obstructive Sleep Apnea.
作者信息
Tummala Sudhakar, Palomares Jose, Kang Daniel W, Park Bumhee, Woo Mary A, Harper Ronald M, Kumar Rajesh
机构信息
Department of Anesthesiology, University of California at Los Angeles. Los Angeles, CA.
Department of Medicine, University of California at Los Angeles. Los Angeles, CA.
出版信息
Sleep. 2016 Jan 1;39(1):51-7. doi: 10.5665/sleep.5316.
STUDY OBJECTIVES
Obstructive sleep apnea (OSA) patients show brain structural injury and functional deficits in autonomic, affective, and cognitive regulatory sites, as revealed by mean diffusivity (MD) and other imaging procedures. The time course and nature of gray and white matter injury can be revealed in more detail with mean kurtosis (MK) procedures, which can differentiate acute from chronic injury, and better show extent of damage over MD procedures. Our objective was to examine global and regional MK changes in newly diagnosed OSA, relative to control subjects.
METHODS
Two diffusion kurtosis image series were collected from 22 recently-diagnosed, treatment-naïve OSA and 26 control subjects using a 3.0-Tesla MRI scanner. MK maps were generated, normalized to a common space, smoothed, and compared voxel-by-voxel between groups using analysis of covariance (covariates; age, sex).
RESULTS
No age or sex differences appeared, but body mass index, sleep, neuropsychologic, and cognitive scores significantly differed between groups. MK values were significantly increased globally in OSA over controls, and in multiple localized sites, including the basal forebrain, extending to the hypothalamus, hippocampus, thalamus, insular cortices, basal ganglia, limbic regions, cerebellar areas, parietal cortices, ventral temporal lobe, ventrolateral medulla, and midline pons. Multiple sites, including the insular cortices, ventrolateral medulla, and midline pons showed more injury over previously identified damage with MD procedures, with damage often lateralized.
CONCLUSIONS
Global mean kurtosis values are significantly increased in obstructive sleep apnea (OSA), suggesting acute tissue injury, and these changes are principally localized in critical sites mediating deficient functions in the condition. The mechanisms for injury likely include altered perfusion and hypoxemia-induced processes, leading to acute tissue changes in recently diagnosed OSA.
研究目的
平均扩散率（MD）和其他成像检查显示，阻塞性睡眠呼吸暂停（OSA）患者在自主神经、情感和认知调节部位存在脑结构损伤和功能缺陷。平均峰度（MK）检查能更详细地揭示灰质和白质损伤的时间进程及性质，可区分急性损伤与慢性损伤，相较于MD检查能更好地显示损伤范围。我们的目的是研究新诊断的OSA患者相对于对照组的全脑和局部MK变化。
方法
使用3.0特斯拉磁共振成像扫描仪，从22名新诊断的、未接受过治疗的OSA患者和26名对照者中采集了两个扩散峰度图像序列。生成MK图，将其归一化到一个公共空间，进行平滑处理，并使用协方差分析（协变量：年龄、性别）在组间逐体素比较。
结果
未出现年龄或性别差异，但两组间的体重指数、睡眠、神经心理和认知评分存在显著差异。OSA患者的MK值在全脑显著高于对照组，且在多个局部部位升高，包括基底前脑，延伸至下丘脑、海马体、丘脑、岛叶皮质、基底神经节、边缘区域、小脑区域、顶叶皮质、颞叶腹侧、延髓腹外侧和脑桥中线。包括岛叶皮质、延髓腹外侧和脑桥中线在内的多个部位，相较于之前MD检查所确定的损伤，显示出更严重的损伤，且损伤常呈单侧性。
结论
阻塞性睡眠呼吸暂停（OSA）患者的全脑平均峰度值显著升高，提示急性组织损伤，且这些变化主要局限于该疾病中介导功能缺陷的关键部位。损伤机制可能包括灌注改变和低氧血症诱导的过程，导致新诊断的OSA患者出现急性组织变化。
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