Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany.
Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
JAMA Netw Open. 2021 Oct 1;4(10):e2128225. doi: 10.1001/jamanetworkopen.2021.28225.
Underlying pathomechanisms of brain white matter hyperintensities (WMHs), commonly observed in older individuals and significantly associated with Alzheimer disease and brain aging, have not yet been fully elucidated. One potential contributing factor to WMH burden is chronic obstructive sleep apnea (OSA), a disorder highly prevalent in the general population with readily available treatment options.
To investigate potential associations between OSA and WMH burden.
DESIGN, SETTING, AND PARTICIPANTS: Analyses were conducted in 529 study participants of the Study of Health in Pomerania-Trend baseline (SHIP-Trend-0) study with complete WMH, OSA, and important clinical data available. SHIP-Trend-0 is a general population-based, cross-sectional, observational study to facilitate the investigation of a large spectrum of common risk factors, subclinical disorders, and clinical diseases and their relationships among each other with patient recruitment from Western Pomerania, Germany, starting on September 1, 2008, with data collected until December 31, 2012. Data analysis was performed from February 1, 2019, to January 31, 2021.
The apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were assessed during a single-night, laboratory-based polysomnography measurement.
The primary outcome was WMH data automatically segmented from 1.5-T magnetic resonance images.
Of 529 study participants (mean [SD] age, 52.15 [13.58] years; 282 female [53%]), a total of 209 (40%) or 102 (19%) individuals were diagnosed with OSA according to AHI or ODI criteria (mean [SD] AHI, 7.98 [12.55] events per hour; mean [SD] ODI, 3.75 [8.43] events per hour). Both AHI (β = 0.024; 95% CI, 0.011-0.037; P <.001) and ODI (β = 0.033; 95% CI, 0.014-0.051; P <. 001) were significantly associated with brain WMH volumes. These associations remained even in the presence of additional vascular, metabolic, and lifestyle WMH risk factors. Region-specific WMH analyses found the strongest associations between periventricular frontal WMH volumes and both AHI (β = 0.0275; 95% CI, 0.013-0.042, P < .001) and ODI (β = 0.0381; 95% CI, 0.016-0.060, P < .001) as well as periventricular dorsal WMH volumes and AHI (β = 0.0165; 95% CI, 0.004-0.029, P = .008).
This study found significant associations between OSA and brain WMHs, indicating a novel, potentially treatable WMH pathomechanism.
脑白质高信号（WMH）普遍存在于老年人中，与阿尔茨海默病和大脑老化显著相关，但目前尚未完全阐明其潜在的发病机制。WMH 负担的一个潜在促成因素是慢性阻塞性睡眠呼吸暂停（OSA），这是一种在普通人群中发病率很高的疾病，有现成的治疗方法。
研究 OSA 与 WMH 负担之间的潜在关联。
设计、地点和参与者：对 529 名研究参与者进行了分析，这些参与者来自波美拉尼亚趋势研究（SHIP-Trend-0）研究，该研究是一项基于人群的横断面观察性研究，旨在促进对常见风险因素、亚临床疾病和临床疾病的广泛研究，并从德国西北部波美拉尼亚开始招募患者，于 2008 年 9 月 1 日开始，数据收集截止到 2012 年 12 月 31 日。数据分析于 2019 年 2 月 1 日至 2021 年 1 月 31 日进行。
在一次单夜、实验室多导睡眠图测量中评估了呼吸暂停-低通气指数（AHI）和氧减饱和指数（ODI）。
主要结局是从 1.5-T 磁共振图像自动分割的 WMH 数据。
在 529 名研究参与者（平均[标准差]年龄，52.15[13.58]岁；282 名女性[53%]）中，共有 209 名（40%）或 102 名（19%）根据 AHI 或 ODI 标准诊断为 OSA（平均[标准差]AHI，7.98[12.55]次/小时；平均[标准差]ODI，3.75[8.43]次/小时）。AHI（β=0.024；95%置信区间，0.011-0.037；P<0.001）和 ODI（β=0.033；95%置信区间，0.014-0.051；P<0.001）均与脑 WMH 体积显著相关。即使存在额外的血管、代谢和生活方式的 WMH 风险因素，这些关联仍然存在。WMH 区域特异性分析发现，与脑室周围额 WMH 体积与 AHI（β=0.0275；95%置信区间，0.013-0.042，P<0.001）和 ODI（β=0.0381；95%置信区间，0.016-0.060，P<0.001）以及脑室周围背侧 WMH 体积与 AHI（β=0.0165；95%置信区间，0.004-0.029，P=0.008）之间存在最强的关联。
本研究发现 OSA 与脑 WMH 之间存在显著关联，表明存在一种新的、潜在可治疗的 WMH 发病机制。
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