Zhou Li, Shan Xiaoxiao, Peng Yating, Liu Guiqian, Guo Wenbin, Luo Hong, Li Huabing, Zong Dandan, Ouyang Ruoyun
Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan, 410011, China.
Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China; National Clinical Research Center on Mental Disorders, Changsha, Hunan, 410011, China.
Sleep Med. 2020 Nov;75:418-427. doi: 10.1016/j.sleep.2020.09.009. Epub 2020 Sep 15.
Neurocognitive dysfunction and abnormal regional homogeneity (ReHo) have been reported in patients with obstructive sleep apnea (OSA). However, little is known about whether brain functional alteration could be used to differentiate from healthy controls (HCs) and its correlation with neurocognitive impairment.
Thirty-three treatment-naive patients with moderate-to-severe OSA and 22 HCs with matched age, sex and education underwent the evaluation of Epworth sleepiness scale, neurocognitive function, full night polysomnography and resting-state functional magnetic resonance imaging scan. ReHo, support vector machine, and correlation with neurocognitive function were administrated to analyze the data.
Compared with HCs, patients with OSA showed decreased ReHo in the bilateral superior frontal gyrus (FG), bilateral superior medial prefrontal cortex (PFC)/right supplementary motor area (SMA), left middle FG, and right precentral/postcentral gyrus. Negative correlations were observed between the ReHo values in the left superior FG/middle FG and apnea hypopnea index, oxygen desaturation index in the OSA group. The scores of Stroop word test, Stroop color-word test, symbol coding test were all negatively correlated with the ReHo values in the right precentral gyrus/postcentral gyrus in patients. Scores of the animal naming fluency test were positively correlated with the ReHo values in the left superior FG/middle FG in patients. Moreover, support vector machine analysis showed the ReHo values in the left superior FG/middle FG or bilateral superior medial PFC/right SMA both could discriminate patients from HCs with good accuracies, sensitivities, and specificities (85.45%, 87.88%, 81.82% and 81.82%, 84.85%, 77.27%, respectively).
Dysfunction in the frontal lobe is a potentially pivotal neuro-pathophysiological mechanism of neurocognitive impairment in patients with moderate-to-severe OSA. And significantly lower ReHo values in the left superior FG/middle FG and/or superior medial PFC/SMA are promising imaging biomarkers to discriminate moderate-to-severe patients with OSA from HCs.
阻塞性睡眠呼吸暂停（OSA）患者中已报道存在神经认知功能障碍和异常的局部一致性（ReHo）。然而，关于脑功能改变是否可用于与健康对照（HCs）进行区分及其与神经认知障碍的相关性，目前所知甚少。
33例未经治疗的中重度OSA患者和22例年龄、性别及教育程度匹配的HCs接受了Epworth嗜睡量表、神经认知功能、整夜多导睡眠图及静息态功能磁共振成像扫描评估。采用ReHo、支持向量机以及与神经认知功能的相关性分析数据。
与HCs相比，OSA患者双侧额上回（FG）、双侧额内侧前额叶皮质（PFC）/右侧辅助运动区（SMA）、左侧额中回及右侧中央前/中央后回的ReHo降低。OSA组左侧额上回/额中回的ReHo值与呼吸暂停低通气指数、氧饱和度下降指数呈负相关。患者的Stroop单词测试、Stroop颜色-单词测试、符号编码测试得分均与右侧中央前回/中央后回的ReHo值呈负相关。患者的动物命名流畅性测试得分与左侧额上回/额中回的ReHo值呈正相关。此外，支持向量机分析显示，左侧额上回/额中回或双侧额内侧PFC/右侧SMA的ReHo值均能以良好的准确率、敏感性和特异性（分别为85.45%、87.88%、81.82%和81.82%、84.85%、77.27%）将患者与HCs区分开来。
额叶功能障碍是中重度OSA患者神经认知障碍潜在的关键神经病理生理机制。左侧额上回/额中回和/或额内侧PFC/SMA显著降低的ReHo值有望成为将中重度OSA患者与HCs区分开来的影像学生物标志物。
