Ghaderi Sadegh, Mohammadi Sana, Fatehi Farzad
Neuromuscular Research Center, Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Neuromuscular Research Center, Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Sleep Med. 2025 Jul;131:106528. doi: 10.1016/j.sleep.2025.106528. Epub 2025 Apr 21.
Obstructive sleep apnea (OSA), a sleep disorder, is associated with cognitive decline and is potentially linked to glymphatic system dysfunction. This meta-analysis investigates glymphatic function in severe OSA (apnea-hypopnea index ≥30) using the Diffusion Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) index.
This study followed PRISMA guidelines for systematic reviews and meta-analyses. A comprehensive search of PubMed, Web of Science, Scopus, and Embase was conducted from inception to January 20, 2024. Studies investigating the ALPS index in OSA using DTI were included. Analyses included a random-effects meta-analysis, sensitivity analysis, meta-regression, publication bias evaluation (funnel plot, Egger's test, and Begg's test), and risk of bias assessment.
Systematic review identified four studies (137 patients with severe OSA and 170 healthy controls (HCs)). Pooled analysis revealed a significant reduction in the DTI-ALPS index in severe OSA patients compared to HCs (standardized mean difference: -0.95, 95 % CI: -1.46 to -0.44, p < 0.001), indicating impaired glymphatic function. Heterogeneity was moderate to high (I = 76.07 %), but sensitivity analyses confirmed robustness. Meta-regression analyses identified the sources of heterogeneity as the apnea-hypopnea index (β = -0.039, p = 0.009) and the Epworth Sleepiness Scale (β = -0.150, p = 0.032), with no effects observed for age or male ratio. Qualitative (funnel plot) and quantitative publication bias assessments (Egger's and Begg's tests) showed no significant bias, and risk of bias evaluations using the Newcastle-Ottawa Scale indicated high methodological quality across studies.
These findings suggest that severe OSA disrupts glymphatic activity. The DTI-ALPS index emerges as a promising tool for assessing glymphatic dysfunction in OSA.
阻塞性睡眠呼吸暂停（OSA）是一种睡眠障碍，与认知功能下降相关，并且可能与脑淋巴系统功能障碍有关。本荟萃分析使用沿血管周围间隙的扩散张量成像分析（DTI-ALPS）指数来研究重度OSA（呼吸暂停低通气指数≥30）患者的脑淋巴功能。
本研究遵循系统评价和荟萃分析的PRISMA指南。对PubMed、科学网、Scopus和Embase进行了从创刊至2024年1月20日的全面检索。纳入了使用DTI研究OSA患者ALPS指数的研究。分析包括随机效应荟萃分析、敏感性分析、荟萃回归、发表偏倚评估（漏斗图、Egger检验和Begg检验）以及偏倚风险评估。
系统评价确定了四项研究（137例重度OSA患者和170例健康对照（HCs））。汇总分析显示，与HCs相比，重度OSA患者的DTI-ALPS指数显著降低（标准化均值差：-0.95，95%CI：-1.46至-0.44，p<0.001），表明脑淋巴功能受损。异质性为中度至高度（I=76.07%），但敏感性分析证实了结果的稳健性。荟萃回归分析确定异质性来源为呼吸暂停低通气指数（β=-0.039，p=0.009）和爱泼沃斯嗜睡量表（β=-0.150，p=0.032），未观察到年龄或男性比例的影响。定性（漏斗图）和定量发表偏倚评估（Egger检验和Begg检验）均未显示显著偏倚，使用纽卡斯尔渥太华量表进行的偏倚风险评估表明各研究的方法学质量较高。
这些发现表明重度OSA会破坏脑淋巴活动。DTI-ALPS指数成为评估OSA患者脑淋巴功能障碍的一种有前景的工具。
