社区老年人中的阻塞性睡眠呼吸暂停与脑小血管疾病：阿司匹林在减少老年人成像亚研究事件中的作用
Obstructive sleep apnea and cerebral small vessel disease in community-based older people: an aspirin in reducing events in the elderly imaging substudy.
作者信息
Ward Stephanie A, Storey Elsdon, Naughton Matthew T, Wolfe Rory, Hamilton Garun S, Law Meng, Kawasaki Ryo, Abhayaratna Walter P, Webb Katherine L, O'Donoghue Fergal J, Gasevic Danijela, Stocks Nigel P, Trevaks Ruth E, Robman Liubov D, Kolbe Scott, Fitzgerald Sharyn M, Orchard Suzanne G, Wong Tien Y, McNeil John J, Reid Christopher M, Sinclair Ben, Woods Robyn L
机构信息
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Kensington, NSW, Australia.
出版信息
Sleep. 2025 Feb 10;48(2). doi: 10.1093/sleep/zsae204.
STUDY OBJECTIVES
Obstructive sleep apnea (OSA) may increase the risk of dementia. A potential pathway for this risk is through cerebral small vessel disease (CSVD). In the context of an existing randomized trial of aspirin for primary prevention, we aimed to investigate OSA's impact on CSVD imaging measures and explore whether aspirin effects these measures over 3 years that differ in the presence or absence of OSA.
METHODS
A substudy of the aspirin in reducing events in the elderly (ASPREE) randomized placebo-controlled trial of low-dose aspirin. Community-dwelling participants aged 70 years and above, without cognitive impairment, cardiovascular disease, or known OSA completed an unattended limited-channel sleep study that calculated the oxygen desaturation index and apnea-hypopnea index. At baseline and 3 years later, volumes of white matter hyperintensities (WMH) and silent brain infarctions (SBI) were measured on 1.5 Tesla brain magnetic resonance imaging, and retinal vessel calibers were calculated from retinal vascular imaging.
RESULTS
Mild and moderate/severe OSA was detected in 48.9% and 29.9%, respectively, of the 311 participants, who had a mean age of 73.7 years (SD 3.4 years), 38.6% female. OSA of any severity was not associated with WMH volumes, SBI, nor retinal vessel calibers at baseline, nor with change in these measures in the 277 participants with repeated measures acquired after 3 years. OSA of any severity did not interact with aspirin on change in these measures over 3 years.
CONCLUSIONS
In healthy older adults undiagnosed OSA was not associated with retinal vascular calibers and neuroimaging measures of CSVD.
CLINICAL TRIAL INFORMATION
ASPREE trial has registration with the International Standard Randomized Controlled Trial Number (ISRCTN) www.isrctn.com, ISRCTN83772183 and with www.clinicaltrials.gov, NCT01038583. SNORE-ASA has registration with the Australian New Zealand Clinical Trials Registry (ANZCTR) at www.anzctr.org.au, ACTRN12612000891820.
研究目的
阻塞性睡眠呼吸暂停（OSA）可能会增加患痴呆症的风险。这种风险的一个潜在途径是通过脑小血管疾病（CSVD）。在一项现有的阿司匹林用于一级预防的随机试验背景下，我们旨在研究OSA对CSVD影像学指标的影响，并探讨阿司匹林在3年时间里对这些指标的影响在有无OSA的情况下是否存在差异。
方法
阿司匹林用于减少老年人事件（ASPREE）低剂量阿司匹林随机安慰剂对照试验的一项子研究。年龄在70岁及以上、无认知障碍、心血管疾病或已知OSA的社区居住参与者完成了一项无人值守的有限通道睡眠研究，该研究计算了氧减饱和指数和呼吸暂停低通气指数。在基线和3年后，通过1.5特斯拉脑磁共振成像测量白质高信号（WMH）和无症状脑梗死（SBI）的体积，并从视网膜血管成像计算视网膜血管口径。
结果
在311名参与者中，分别有48.9%和29.9%检测出轻度和中度/重度OSA，这些参与者的平均年龄为73.7岁（标准差3.4岁），女性占38.6%。任何严重程度的OSA在基线时均与WMH体积、SBI或视网膜血管口径无关，在3年后进行重复测量的277名参与者中，也与这些指标的变化无关。任何严重程度的OSA在3年时间里对这些指标变化与阿司匹林之间均无相互作用。
结论
在未被诊断出OSA的健康老年人中，OSA与视网膜血管口径及CSVD的神经影像学指标无关。
临床试验信息
ASPREE试验已在国际标准随机对照试验编号（ISRCTN）网站www.isrctn.com注册，编号为ISRCTN83772183，同时也在www.clinicaltrials.gov注册，编号为NCT01038583。SNORE - ASA已在澳大利亚新西兰临床试验注册中心（ANZCTR）网站www.anzctr.org.au注册，编号为ACTRN12612000891820。
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