Department of Neurology, Neuroscience Center, Samsung Medical Center and Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University School of Medicine, Seoul, South Korea; Samsung Biomedical Research Institute (SBRI), Seoul, South Korea.
Department of Neurology, Daegu Health College Hospital, Daegu, South Korea.
Sleep Med. 2017 Apr;32:122-128. doi: 10.1016/j.sleep.2016.03.010. Epub 2016 May 12.
Obstructive sleep apnea (OSA) is commonly associated with neural and cognitive deficits induced by recurrent hypoxemia and sleep fragment. The aims of this study were to use statistical parametric mapping (SPM) to analyze changes in regional cerebral blood flow (rCBF) in untreated patients with severe OSA before and after nasal continuous positive airway pressure (CPAP) treatment, examine the impact of OSA-related variables on rCBF, and assess the therapeutic effect of nasal CPAP treatment.
Thirty male patients with severe OSA underwent brain single photon emission computed tomography (SPECT) scans twice before and after nasal CPAP treatment for ≥6 months, whereas 26 healthy controls underwent a single SPECT scan. The rCBF differences were compared between two OSA sub-groups (untreated and treated) and the control group, and correlations between rCBF differences and clinical parameters were analyzed.
Compared with the controls, the untreated OSA patients showed a significantly lower rCBF in multiple brain areas. After the treatment, partial reversal of the rCBF decreases was observed in the limbic and prefrontal areas. Moreover, complete reversal of the rCBF decreases was observed in the medial orbitofrontal, angular and cerebellar areas. Significant improvements in some clinical and polysomnographic variables (Epworth Sleepiness Scale, apnea-hypopnea index, CPAP duration, and arousal index) paralleled the rCBF changes after the treatment.
Decreased rCBF in severe OSA was significantly reversible by CPAP treatment and correlated with the improvements in the apnea-hypopnea index, arousal index, CPAP duration and Epworth Sleepiness Scale. These results suggest that long-term CPAP treatment improves rCBF in areas responsible for executive, affective, and memory function.
阻塞性睡眠呼吸暂停（OSA）通常与反复低氧血症和睡眠片段化引起的神经和认知功能障碍有关。本研究的目的是使用统计参数映射（SPM）分析未经治疗的重度 OSA 患者在接受鼻持续气道正压通气（CPAP）治疗前后局部脑血流（rCBF）的变化，探讨与 OSA 相关变量对 rCBF 的影响，并评估 CPAP 治疗的疗效。
30 名男性重度 OSA 患者在接受鼻 CPAP 治疗≥6 个月前后进行了两次脑单光子发射计算机断层扫描（SPECT）检查，而 26 名健康对照者仅进行了一次 SPECT 检查。比较了未经治疗和治疗后的 OSA 亚组（未治疗和治疗）与对照组之间 rCBF 的差异，并分析了 rCBF 差异与临床参数之间的相关性。
与对照组相比，未经治疗的 OSA 患者多个脑区的 rCBF 明显降低。治疗后，边缘和前额叶区域的 rCBF 降低部分得到逆转。此外，内侧眶额、角回和小脑区域的 rCBF 降低完全逆转。一些临床和多导睡眠图变量（嗜睡量表、呼吸暂停-低通气指数、CPAP 持续时间和觉醒指数）的显著改善与治疗后 rCBF 的变化相平行。
CPAP 治疗可显著逆转重度 OSA 患者的 rCBF 降低，与呼吸暂停-低通气指数、觉醒指数、CPAP 持续时间和嗜睡量表的改善相关。这些结果表明，长期 CPAP 治疗可改善与执行、情感和记忆功能相关的区域的 rCBF。
