Abstract
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. 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.
Highlights
Of 529 study participants, a total of 209 (40%) or 102 (19%) individuals were diagnosed with obstructive sleep apnea (OSA) according to apnea-hypopnea index (AHI) or oxygen desaturation index (ODI) criteria
Region-specific white matter hyperintensities (WMHs) 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)
Baseline Characteristics of the Study Sample Of 529 study participants, a total of 209 (40%) or 102 (19%) individuals were diagnosed with OSA according to AHI or ODI criteria (Table 1)
Summary
Brain white matter hyperintensities (WMHs) are commonly observed on magnetic resonance imaging (MRI) of older individuals, those with dementia, and patients with stroke.[1,2,3,4,5] Brain WMHs are typically suggested to be a marker of cerebral small vessel disease, alongside other lesions, such as lacunar infarctions or microbleeds.[1,2,4] White matter hyperintensities are associated with an increased risk of dementia, cognitive decline, stroke, death, abnormal gait, disturbed balance, and depression.[1,2,4,6,7] Habes et al[5,8] reported higher WMH burden to be associated with advanced brain aging and increased brain atrophy patterns related to Alzheimer disease (AD) in the Study of Health in Pomerania (SHIP). A recent longitudinal study[9] reported associations between greater WMH burden and accelerated cognitive, neuropsychiatric, and functional decline independent of traditional AD risk factors and MRI biomarkers. The search for preventive and therapeutic strategies to reduce WMH burden is ongoing.[3]
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