Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
Institute of Parkinson and Movement Disorder, Zhengzhou University, Zhengzhou, 450052, Henan, China.
J Neurol. 2023 Apr;270(4):2204-2216. doi: 10.1007/s00415-022-11530-z. Epub 2023 Jan 20.
Obstructive sleep apnea (OSA) is highly prevalent but easily undiagnosed and is an independent risk factor for cognitive impairment. However, it remains unclear how OSA is linked to cognitive impairment. In the present study, we found the correlation between morphological changes of perivascular spaces (PVSs) and cognitive impairment in OSA patients. Moreover, we developed a novel set of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) methods to evaluate the fluid dynamics of glymphatic drainage system. We found that the inflow and outflow parameters of the glymphatic drainage system in patients with OSA were obviously changed, indicating impairment of glymphatic drainage due to excessive perfusion accompanied with deficient drainage in OSA patients. Moreover, parameters of the outflow were associated with the degree of cognitive impairment, as well as the hypoxia level. In addition, continuous positive airway pressure (CPAP) enhances performance of the glymphatic drainage system after 1 month treatment in OSA patients. We proposed that ventilation improvement might be a new strategy to ameliorate the impaired drainage of glymphatic drainage system due to OSA-induced chronic intermittent hypoxia, and consequently improved the cognitive decline.
阻塞性睡眠呼吸暂停（OSA）患病率高，但易漏诊，是认知障碍的独立危险因素。然而，OSA 如何与认知障碍相关仍不清楚。在本研究中，我们发现了 OSA 患者血管周围空间（PVS）形态变化与认知障碍之间的相关性。此外，我们开发了一套新的动态对比增强磁共振成像（DCE-MRI）方法来评估脑淋巴系统的流体动力学。我们发现 OSA 患者脑淋巴系统的流入和流出参数明显改变，表明由于过度灌注伴随 OSA 患者的引流不足，导致脑淋巴引流受损。此外，流出参数与认知障碍程度以及缺氧程度有关。另外，持续气道正压通气（CPAP）在 OSA 患者治疗 1 个月后可增强脑淋巴引流系统的功能。我们提出，通气改善可能是一种新的策略，可以改善由于 OSA 引起的慢性间歇性缺氧导致的脑淋巴引流系统受损，从而改善认知能力下降。
