Chokesuwattanaskul Anthipa, Lertjitbanjong Ploypin, Thongprayoon Charat, Bathini Tarun, Sharma Konika, Mao Michael A, Cheungpasitporn Wisit, Chokesuwattanaskul Ronpichai
Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
Sleep Med. 2020 Apr;68:80-88. doi: 10.1016/j.sleep.2019.11.1262. Epub 2019 Dec 16.
Cerebral small vessel disease (CSVD) is a well-known cause of vascular dementia, a leading medical morbidity in the aging population. Obstructive sleep apnea (OSA) has been validated as a cardiovascular risk factor. However, the relationship between these two clinical syndromes is not well established. We aimed to assess the association between OSA and CSVD.
Databases were searched from inception through May 2019. Studies that reported incidence or odd ratios of CSVD in patients with OSA were included. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird.
A total of 14 observational studies comprising of 4335 patients were included into the analysis. Compared to patients without OSA, patients with OSA were significantly associated with CSVD magnetic resonance imaging (MRI) findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) with a pooled OR of 2.31 (95% confidence interval [CI], 1.46-3.66, I = 79%) and 1.78 (95% CI, 1.06-3.01, I = 41%), respectively. However, there was no significant association between OSA and findings of cerebral microbleeds (CMBs), with a pooled odds ratio (OR) of 2.15 (95% CI, 0.64-7.29, I = 55%).
Our study demonstrated the association between OSA and CSVD MRI findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) when compared to patients without OSA. The absence of an association of CMBs findings with OSA could be due either by a lower sensitivity of neuroimaging techniques utilized to detect CMBs or a potentially different pathogenesis of CMBs.
脑小血管病（CSVD）是血管性痴呆的一个众所周知的病因，血管性痴呆是老年人群中主要的医学发病原因。阻塞性睡眠呼吸暂停（OSA）已被确认为心血管危险因素。然而，这两种临床综合征之间的关系尚未完全明确。我们旨在评估OSA与CSVD之间的关联。
从数据库建立至2019年5月进行检索。纳入报告OSA患者中CSVD发病率或比值比的研究。使用DerSimonian和Laird的随机效应、通用逆方差方法提取并合并个体研究的效应估计值。
共有14项观察性研究（包括4335例患者）纳入分析。与无OSA的患者相比，OSA患者与CSVD磁共振成像（MRI）的白质高信号（WMH）和无症状腔隙性梗死（ALI）显著相关，合并比值比（OR）分别为2.31（95%置信区间[CI]，1.46 - 3.66，I² = 79%）和1.78（95% CI，1.06 - 3.01，I² = 41%）。然而，OSA与脑微出血（CMB）的发现之间无显著关联，合并比值比（OR）为2.15（95% CI，0.64 - 7.29，I² = 55%）。
我们的研究表明，与无OSA的患者相比，OSA与CSVD MRI的白质高信号（WMH）和无症状腔隙性梗死（ALI）发现之间存在关联。CMB发现与OSA无关联可能是由于用于检测CMB的神经影像学技术敏感性较低，或者是CMB潜在的不同发病机制。
