Liu Xiang, Wei Zhipeng, Chen Liting, Duan Wenfeng, Li Haijun, Kong Linghong, Shu Yongqiang, Li Panmei, Li Kunyao, Xie Wei, Zeng Yaping, Huang Ling, Long Ting, Peng Dechang
Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Front Neurol. 2022 Aug 22;13:913193. doi: 10.3389/fneur.2022.913193. eCollection 2022.
White matter (WM) fiber alterations in patients with obstructive sleep apnea (OSA) is associated with cognitive impairment, which can be alleviated by continuous positive airway pressure (CPAP). In this study, we aimed to investigate the changes in WM in patients with OSA at baseline (pre-CPAP) and 3 months after CPAP adherence treatment (post-CPAP), and to provide a basis for understanding the reversible changes after WM alteration in this disease. Magnetic resonance imaging (MRI) was performed on 20 severely untreated patients with OSA and 20 good sleepers. Tract-based spatial statistics was used to evaluate the fractional anisotropy (FA), mean diffusion coefficient, axial diffusion coefficient, and radial diffusion coefficient (RD) of WM. To assess the efficacy of treatment, 20 patients with pre-CPAP OSA underwent MRI again 3 months later. A correlation analysis was conducted to evaluate the relationship between WM injury and clinical evaluation. Compared with good sleepers, patients with OSA had decreased FA and increased RD in the anterior thalamic radiation, forceps major, inferior fronto-occipital tract, inferior longitudinal tract, and superior longitudinal tract, and decreased FA in the uncinate fasciculus, corticospinal tract, and cingulate gyrus ( < 0.05). No significant change in WM in patients with post-CPAP OSA compared with those with pre-CPAP OSA. Abnormal changes in WM in untreated patients with OSA were associated with oxygen saturation, Montreal cognitive score, and the apnea hypoventilation index. WM fiber was extensively alteration in patients with severe OSA, which is associated with cognitive impairment. Meanwhile, cognitive recovery was not accompanied by reversible changes in WM microstructure after short-term CPAP therapy.
阻塞性睡眠呼吸暂停（OSA）患者的白质（WM）纤维改变与认知障碍有关，持续气道正压通气（CPAP）可缓解这种情况。在本研究中，我们旨在调查OSA患者在基线（CPAP治疗前）和CPAP依从性治疗3个月后（CPAP治疗后）WM的变化，为理解该疾病中WM改变后的可逆性变化提供依据。对20名未经治疗的重度OSA患者和20名睡眠良好者进行了磁共振成像（MRI）检查。采用基于纤维束的空间统计学方法评估WM的分数各向异性（FA）、平均扩散系数、轴向扩散系数和径向扩散系数（RD）。为评估治疗效果，20名CPAP治疗前的OSA患者在3个月后再次接受MRI检查。进行相关性分析以评估WM损伤与临床评估之间的关系。与睡眠良好者相比，OSA患者在前丘脑辐射、主要钳状束、额枕下束、下纵束和上纵束中的FA降低，RD升高，钩束、皮质脊髓束和扣带回中的FA降低（<0.05）。CPAP治疗后的OSA患者与CPAP治疗前的患者相比，WM无显著变化。未经治疗的OSA患者WM的异常变化与血氧饱和度、蒙特利尔认知评分和呼吸暂停低通气指数有关。重度OSA患者的WM纤维广泛改变，这与认知障碍有关。同时，短期CPAP治疗后认知恢复并未伴随WM微观结构的可逆性变化。
