51
|
Lin WC, Hsu TW, Lu CH, Chen HL. Alterations in sympathetic and parasympathetic brain networks in obstructive sleep apnea. Sleep Med 2020; 73:135-142. [PMID: 32827886 DOI: 10.1016/j.sleep.2020.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE/BACKGROUND Obstructive sleep apnea (OSA) patients experience hypoxia and, potentially, autonomic impairments stemming from neural damage. In this study, the executive control networks (ECNs), salience networks (SNs), and default mode networks (DMNs) of adult OSA patients, as well as their relationships with autonomic impairment, were investigated through independent component analysis (ICA). PATIENTS/METHODS A total of 41 OSA patients and 19 healthy controls volunteers were recruited and subjected to polysomnography to ascertain their degree, if any, of sleep apnea. Each participant also underwent a cardiovascular autonomic survey, with the participant's baroreflex sensitivity (BRS) being determined based on heart rate and blood pressure alterations. The resting fMRI data of the participants was separated using probabilistic ICA, and six autonomic resting-state networks were established for group comparisons. The differences in autonomic parameters, autonomic functional connectivity (FC), and clinical severity were then correlated. RESULTS The OSA group had significantly worse BRS values than the controls, as well as lower FC in the posterior and anterior SNs, bilateral ECNs, and the ventral DMN, and higher FC in the left ECN. These intrinsic connectivity networks showed dissociable correlations with greater baroreflex impairment and clinical disease severity. The higher FC in the left ECN was associated with the lower FC in the ventral DMN. CONCLUSIONS Our findings suggest that autonomic dysfunction in OSA might be accompanied by central autonomic network alterations. The stronger sympathetic-associated regions in ECNs and the weaker parasympathetic-associated regions in DMNs may represent intrinsic neural architecture fluctuations underlining their consequent processes in OSA.
Collapse
Affiliation(s)
- Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tun-Wei Hsu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| |
Collapse
|
52
|
Wu Y, Zhao W, Chen X, Wan X, Lei X. Aberrant Awake Spontaneous Brain Activity in Obstructive Sleep Apnea: A Review Focused on Resting-State EEG and Resting-State fMRI. Front Neurol 2020; 11:768. [PMID: 32849223 PMCID: PMC7431882 DOI: 10.3389/fneur.2020.00768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022] Open
Abstract
As one of the most common sleep-related respiratory disorders, obstructive sleep apnea (OSA) is characterized by excessive snoring, repetitive apnea, arousal, sleep fragmentation, and intermittent nocturnal hypoxemia. Focused on the resting-state brain imaging techniques, we reviewed the OSA-related resting-state electroencephalogram and resting-state functional magnetic resonance imaging (rsfMRI) studies. Compared with the healthy control group, patients with OSA presented increased frontal and central δ/θ powers during resting-state wakefulness, and their slow-wave activity showed a positive correlation with apnea–hypopnea index. For rsfMRI, the prefrontal cortex and insula may be the vital regions for OSA and are strongly related to the severity of the disease. Meanwhile, some large-scale brain networks, such as the default-mode network, salience network, and central executive network, play pivotal roles in the pathology of OSA. We then discussed the contribution of resting-state brain imaging as an evaluation approach for disease interventions. Finally, we briefly introduced the effects of OSA-related physiological and mental diseases and discussed some future research directions from the perspective of resting-state brain imaging.
Collapse
Affiliation(s)
- Yue Wu
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Wenrui Zhao
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Xinyuan Chen
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Xiaoyong Wan
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Xu Lei
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China.,Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| |
Collapse
|
53
|
Caporale M, Palmeri R, Corallo F, Muscarà N, Romeo L, Bramanti A, Marino S, Lo Buono V. Cognitive impairment in obstructive sleep apnea syndrome: a descriptive review. Sleep Breath 2020; 25:29-40. [PMID: 32447633 DOI: 10.1007/s11325-020-02084-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/27/2020] [Accepted: 04/08/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Obstructive sleep apnea syndrome is a clinical sleep disorder defined by total or partial airflow restraint during sleep that results in fragmented sleep and hypoxemia, impacting negatively with cognitive functioning. This review was conducted on studies investigating structural brain alteration and cognitive impairment in obstructive sleep apnea syndrome. METHOD We searched on PubMed databases and screening references of included studies and review articles for additional citations. From initial 190 publications, only 17 met search criteria and described the cognitive impairment in obstructive sleep apnea syndrome. RESULTS Findings showed that patients with this syndrome had worse performance than healthy controls in attention, memory, and executive functions, showing specific neuroanathomical features. Cognitive impairment is also related to the severity of pathology. Treatment could improve certain cognitive aspects. CONCLUSIONS Cognitive deficits seem to be mainly attributable to decreased daytime vigilance and nocturnal hypoxemia.
Collapse
Affiliation(s)
- Mina Caporale
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Rosanna Palmeri
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy.
| | - Francesco Corallo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Nunzio Muscarà
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Laura Romeo
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Alessia Bramanti
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113 Via Palermo, C.da Casazza, 98124, Messina, Italy
| |
Collapse
|
54
|
Lunsford-Avery JR, Damme KSF, Engelhard MM, Kollins SH, Mittal VA. Sleep/Wake Regularity Associated with Default Mode Network Structure among Healthy Adolescents and Young Adults. Sci Rep 2020; 10:509. [PMID: 31949189 PMCID: PMC6965093 DOI: 10.1038/s41598-019-57024-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/20/2019] [Indexed: 12/31/2022] Open
Abstract
Sleep deprivation and disorders are linked to reduced DMN connectivity. Less is known about how naturalistic sleep patterns - specifically sleep irregularity - relate to the DMN, particularly among adolescents and young adults. Additionally, no studies have utilized graph theory analysis to clarify whether sleep-related decreases in connectivity reflect global or local DMN changes. Twenty-five healthy adolescents and young adults (age range = 12-22; mean = 18.08; SD = 2.64, 56% female) completed 7 days of actigraphy and resting-state fMRI. Sleep regularity was captured by the Sleep Regularity Index (SRI) and the relationship between the SRI and DMN was examined using graph theory analysis. Analogous analyses explored relationships between the SRI and additional resting-state networks. Greater sleep regularity related to decreased path length (increased network connectivity) in DMN regions, particularly the right and left lateral parietal lobule, and the Language Network, including the left inferior frontal gyrus and the left posterior superior frontal gyrus. Findings were robust to covariates including sex and age. Sleep and DMN function may be tightly linked during adolescence and young adulthood, and reduced DMN connectivity may reflect local changes within the network. Future studies should assess how this relationship impacts cognitive development and neuropsychiatric outcomes in this age group.
Collapse
Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
| | | | - Matthew M Engelhard
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| |
Collapse
|
55
|
Wang YJ, Duan W, Lei X. Impaired Coupling of the Brain's Default Network During Sleep Deprivation: A Resting-State EEG Study. Nat Sci Sleep 2020; 12:937-947. [PMID: 33204197 PMCID: PMC7667510 DOI: 10.2147/nss.s277655] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sleep deprivation (SD) has a negative influence on mood and emotion processing, and previous studies have elucidated the impaired coupling within the default network (DN) after SD. However, the dynamic characteristic with high temporal precision was rarely investigated in the DN after SD. METHODS Here, the resting-state EEG after nocturnal sleep (NS) and SD was collected from 31 participants. The cortical electrical activities of the posterior cingulate cortex (PCC) and the anterior medial prefrontal cortex (aMPFC) were reconstructed applying the eLORETA, and the functional connectivity (FC) of PCC-aMPFC was calculated using the power envelope connectivity (PEC). RESULTS Compared with NS, the power spectrums of the PCC and the FC of PCC-aMPFC were significantly reduced in the α band after SD. Interestingly, the impaired PCC-aMPFC integration was positively correlated with the decreased positive affect, implying that the DN plays a critical role in the subjective mood state. Our moderation analysis further revealed that the intensity of the DN posterior-anterior interaction moderated sleep loss and positive affect. DISCUSSION Overall, the results reveal the strong relationship between the uncoupling of DN and the feeling down of mood. Our research may contribute towards a better understanding of the mood and cognition processing after sleep loss.
Collapse
Affiliation(s)
- Ya-Jie Wang
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, People's Republic of China.,Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, Chongqing 400715, People's Republic of China
| | - Wei Duan
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, People's Republic of China.,Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, Chongqing 400715, People's Republic of China
| | - Xu Lei
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, People's Republic of China.,Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, Chongqing 400715, People's Republic of China
| |
Collapse
|
56
|
Compensatory Neural Recruitment for Error-Related Cerebral Activity in Patients with Moderate-To-Severe Obstructive Sleep Apnea. J Clin Med 2019; 8:jcm8071077. [PMID: 31336598 PMCID: PMC6678110 DOI: 10.3390/jcm8071077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 01/14/2023] Open
Abstract
(1) Background: Although it is known that obstructive sleep apnea (OSA) impairs action-monitoring function, there is only limited information regarding the associated cerebral substrate underlying this phenomenon. (2) Methods: The modified Flanker task, error-related event-related potentials (ERPs), namely, error-related negativity (ERN) and error positivity (Pe), and functional magnetic resonance imaging (fMRI) were used to evaluate neural activities and the functional connectivity underlying action-monitoring dysfunction in patients with different severities of OSA. (3) Results: A total of 14 control (Cont) subjects, 17 patients with moderate OSA (mOSA), and 10 patients with severe OSA (sOSA) were enrolled. A significant decline in posterror correction rate was observed in the modified Flanker task when patients with mOSA were compared with Cont subjects. Comparison between patients with mOSA and sOSA did not reveal any significant difference. In the analysis of ERPs, ERN and Pe exhibited declined amplitudes in patients with mOSA compared with Cont subjects, which were found to increase in patients with sOSA. Results of fMRI revealed a decreased correlation in multiple anterior cingulate cortex functional-connected areas in patients with mOSA compared with Cont subjects. However, these areas appeared to be reconnected in patients with sOSA. (4) Conclusions: The behavioral, neurophysiological, and functional image findings obtained in this study suggest that mOSA leads to action-monitoring dysfunction; however, compensatory neural recruitment might have contributed to the maintenance of the action-monitoring function in patients with sOSA.
Collapse
|
57
|
Yeung AWK. Morphometric and functional connectivity changes in the brain of patients with obstructive sleep apnea: A meta‐analysis. J Sleep Res 2019; 28:e12857. [DOI: 10.1111/jsr.12857] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andy W. K. Yeung
- Oral and Maxillofacial Radiology Applied Oral Sciences Faculty of Dentistry University of Hong Kong Hong Kong SAR China
| |
Collapse
|
58
|
Huang X, Tang S, Lyu X, Yang C, Chen X. Structural and functional brain alterations in obstructive sleep apnea: a multimodal meta-analysis. Sleep Med 2019; 54:195-204. [DOI: 10.1016/j.sleep.2018.09.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
|
59
|
Yu H, Chen L, Li H, Xin H, Zhang J, Wei Z, Peng D. Abnormal resting-state functional connectivity of amygdala subregions in patients with obstructive sleep apnea. Neuropsychiatr Dis Treat 2019; 15:977-987. [PMID: 31114206 PMCID: PMC6489564 DOI: 10.2147/ndt.s191441] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/01/2019] [Indexed: 12/03/2022] Open
Abstract
Background: The amygdala is one of the core areas of the emotional circuits. Previous neuroimaging studies have revealed that patients with obstructive sleep apnea (OSA) have aberrant structure and function in several brain areas (including the amygdala). However, the resting-state functional connectivity (rs-FC) of amgydala subregions remains uncertain. Objective: To determine whether aberrant rs-FC exists between the amygdala subregions and other brain areas and whether such abnormalities are related to emotional disorders and cognitive impairment in OSA. Methods: The resting-state functional magnetic resonance imaging (rs-fMRI) data of 40 male severe OSA patients and 40 matched healthy controls (HCs) were collected. The rs-FC between the amygdala subregions and other brain areas was compared between the two groups. The correlations between aberrant rs-FC and clinical variables and neuropsychological assessments were evaluated. Results: Compared with the HCs, the OSA patients showed significantly increased rs-FC between the left dorsal amygdala (DA) and the anterior lobe of the cerebellum, among the left ventrolateral amygdala (VA), the left inferior frontal gyrus (IFG) and the left superior temporal gyrus (STG), and between the right VA and the left IFG. However, significantly decreased rs-FC was observed between the right DA and the right prefrontal cortex (PFC) in OSA patients. No regional differences in rs-FC were found between the OSA patients and HCs in the bilateral medial amygdala (MA). Conclusion: In this study, male severe OSA patients showed complex rs-FC patterns in the amygdala subregions, which may be the result of OSA-related selective damage to the amygdala, and abnormal rs-FC between the amygdala subregions and brain regions associated with emotional, cognitive and executive functions may partly explain the affective deficits and cognitive impairment observed in male severe OSA patients.
Collapse
Affiliation(s)
- Honghui Yu
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Liting Chen
- Department of Radiology, the First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Haijun Li
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Huizhen Xin
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Juan Zhang
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Zhipeng Wei
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Dechang Peng
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi, People's Republic of China
| |
Collapse
|
60
|
邱 丽, 谭 相, 邹 梦, 劳 斌, 许 乙, 薛 耀, 高 方, 曹 瑛. [Changes in regional homogeneity of brain activity in patients with diabetic peripheral]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2018; 38:1433-1439. [PMID: 30613010 PMCID: PMC6744216 DOI: 10.12122/j.issn.1673-4254.2018.12.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the abnormalities in regional homogeneity of brain activity in patients with diabetic peripheral neuropathy (DPN) using resting-state functional magnetic resonance imaging (rs-fMRI) and explore the association between brain activity changes and DPN. METHODS A regional homogeneity (ReHo) approach was used to compare the local synchronization of rs-fMRI signals among 20 patients with painful DPN, 16 patients with painless DPN, and 16 type 2 diabetic patients without DPN (non-DPN group). RESULTS Compared with the those without DPN, the patients with painful DPN showed high ReHo in the left inferior temporal gyrus and the right central posterior gyrus, and low ReHo in the posterior cingulate gyrus, right inferior parietal gyrus, and the left superior parietal gyrus (P < 0.05);the patients with painless DPN group showed high ReHo in the left inferior temporal gyrus, the right middle temporal gyrus, and the right superior frontal gyrus, and low ReHo in the left thalamus (P < 0.05).No significant differences in ReHo were found between the patients with painful DPN and painless DPN (P>0.05). CONCLUSIONS The patients with DPN have altered ReHo in multiple brain regions and impairment of a default mode network, for which the left temporal gyrus may serve as a functional compensatory brain area. ReHo disturbance in the central right posterior gyrus may play a central role in the pain symptoms associated with painful DPN.
Collapse
Affiliation(s)
- 丽君 邱
- />南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 相良 谭
- />南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 梦晨 邹
- />南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 斌昌 劳
- />南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 乙凯 许
- />南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 耀明 薛
- />南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 方 高
- />南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 瑛 曹
- />南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| |
Collapse
|
61
|
Moon C, Melah KE, Johnson SC, Bratzke LC. Sleep-disordered breathing, brain volume, and cognition in older individuals with heart failure. Brain Behav 2018; 8:e01029. [PMID: 29920994 PMCID: PMC6043704 DOI: 10.1002/brb3.1029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/04/2018] [Accepted: 05/11/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND PURPOSE Sleep-disordered breathing is common in individuals with heart failure and may contribute to changes in the brain and decreased cognition. However, limited research has explored how the apnea-hypopnea index contributes to brain structure and cognition in this population. The aims of this study were to explore how the apnea-hypopnea index is associated with brain volume and cognition in heart failure patients. METHODS Data of 28 heart failure patients (mean age = 67.93; SD = 5.78) were analyzed for this cross-sectional observational study. We evaluated the apnea-hypopnea index using a portable multichannel sleep-monitoring device. All participants were scanned using 3.0 Tesla magnetic resonance imaging and neuropsychological tests. Brain volume was evaluated using a voxel-based morphometry method with T1-weighted images. We used multiple regressions to analyze how the apnea-hypopnea index is associated with brain volume and cognition. RESULTS We found an inverse association between apnea-hypopnea index scores and white matter volume (β = -0.002, p = 0.026), but not in gray matter volume (β = -0.001, p = 0.237). Higher apnea-hypopnea index was associated with reduced regional gray and white matter volume (p < 0.001, uncorrected). Cognitive scores were not associated with the apnea-hypopnea index (p-values were >0.05). CONCLUSION Findings from this study provide exploratory evidence that higher apnea-hypopnea index may be associated with greater brain volume reduction in heart failure patients. Future studies are needed to establish the relationship between sleep-disordered breathing, brain volume, and cognition in heart failure samples.
Collapse
Affiliation(s)
- Chooza Moon
- College of Nursing, University of Iowa, Iowa City, Iowa
| | - Kelsey E Melah
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Lisa C Bratzke
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
62
|
Chen L, Fan X, Li H, Ye C, Yu H, Gong H, Zeng X, Peng D, Yan L. Topological Reorganization of the Default Mode Network in Severe Male Obstructive Sleep Apnea. Front Neurol 2018; 9:363. [PMID: 29951028 PMCID: PMC6008385 DOI: 10.3389/fneur.2018.00363] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/04/2018] [Indexed: 11/13/2022] Open
Abstract
Impaired spontaneous regional activity and altered topology of the brain network have been observed in obstructive sleep apnea (OSA). However, the mechanisms of disrupted functional connectivity (FC) and topological reorganization of the default mode network (DMN) in patients with OSA remain largely unknown. We explored whether the FC is altered within the DMN and examined topological changes occur in the DMN in patients with OSA using a graph theory analysis of resting-state functional magnetic resonance imaging data and evaluated the relationship between neuroimaging measures and clinical variables. Resting-state data were obtained from 46 male patients with untreated severe OSA and 46 male good sleepers (GSs). We specifically selected 20 DMN subregions to construct the DMN architecture. The disrupted FC and topological properties of the DMN in patients with OSA were characterized using graph theory. The OSA group showed significantly decreased FC of the anterior-posterior DMN and within the posterior DMN, and also showed increased FC within the DMN. The DMN exhibited small-world topology in both OSA and GS groups. Compared to GSs, patients with OSA showed a decreased clustering coefficient (Cp) and local efficiency, and decreased nodal centralities in the left posterior cingulate cortex and dorsal medial prefrontal cortex, and increased nodal centralities in the ventral medial prefrontal cortex and the right parahippocampal cortex. Finally, the abnormal DMN FC was significantly related to Cp, path length, global efficiency, and Montreal cognitive assessment score. OSA showed disrupted FC within the DMN, which may have contributed to the observed topological reorganization. These findings may provide further evidence of cognitive deficits in patients with OSA.
Collapse
Affiliation(s)
- Liting Chen
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaole Fan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Haijun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chenglong Ye
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Honghui Yu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Honghan Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xianjun Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Dechang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Liping Yan
- Department of Cardiology, People's Hospital of Jiangxi Province, Nanchang, Jiangxi, China
| |
Collapse
|
63
|
Liu YT, Zhang HX, Li HJ, Chen T, Huang YQ, Zhang L, Huang ZC, Liu B, Yang M. Aberrant Interhemispheric Connectivity in Obstructive Sleep Apnea-Hypopnea Syndrome. Front Neurol 2018; 9:314. [PMID: 29867724 PMCID: PMC5951937 DOI: 10.3389/fneur.2018.00314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/20/2018] [Indexed: 01/06/2023] Open
Abstract
Objective To determine the changes in interhemispheric functional coordination in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) relative to controls, using a recently introduced method of analysis: voxel-mirrored homotopic connectivity (VMHC). Methods Twenty-nine patients with OSAHS and twenty-six normal sex-, age-, and education-matched controls were recruited and resting-state functional magnetic resonance imaging data were obtained. We employed VMHC to analyze the interhemispheric functional connectivity differences between groups. The z-values of alterations in VMHC in brain region were correlated with clinical characteristics. Results Compared with controls, patients with OSAHS had significantly higher scores for body mass index (t = 5.749, P < 0.001), apnea–hypopnea index (AHI; t = 7.706, P < 0.001), oxygen desaturation index (t = 6.041, P < 0.001), and Epworth sleepiness scale (t = 3.711, P < 0.001), but significantly lower scores on the Rey–Osterrieth complex figure test-immediate recall (t = −3.727, P < 0.05). On the same basis, the VMHC showed significant increases in bilateral calcarine cortex and precuneus. Moreover, significant, positive correlations were found in only these areas between the AHI and the VMHC change coefficients (r = 0.399, P = 0.032; r = 0.378, P = 0.043). Conclusion We found a memory defect in patients with OSAHS. The correlation between the abnormal VMHC and the AHI in patients with OSAHS suggested that AHI might be a key factor in cognitive dysfunction, which might offer new insights into the neural pathophysiology underlying OSAHS-related cognitive deficits.
Collapse
Affiliation(s)
- Yu-Ting Liu
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hui-Xin Zhang
- School of Medicine, Southeast University, Nanjing, China
| | - Hui-Jun Li
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Chen
- School of Medicine, Southeast University, Nanjing, China
| | - Ya-Qing Huang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Lian Zhang
- Department of Otolaryngology-Head and Neck Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhi-Chun Huang
- Department of Otolaryngology-Head and Neck Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bin Liu
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
64
|
Chen LT, Fan XL, Li HJ, Ye CL, Yu HH, Xin HZ, Gong HH, Peng DC, Yan LP. Aberrant brain functional connectome in patients with obstructive sleep apnea. Neuropsychiatr Dis Treat 2018; 14:1059-1070. [PMID: 29713176 PMCID: PMC5912371 DOI: 10.2147/ndt.s161085] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is accompanied by widespread abnormal spontaneous regional activity related to cognitive deficits. However, little is known about the topological properties of the functional brain connectome of patients with OSA. This study aimed to use the graph theory approaches to investigate the topological properties and functional connectivity (FC) of the functional connectome in patients with OSA, based on resting-state functional magnetic resonance imaging (rs-fMRI). METHODS Forty-five male patients with newly diagnosed untreated severe OSA and 45 male good sleepers (GSs) underwent a polysomnography (PSG), clinical evaluations, and rs-fMRI scans. The automated anatomical labeling (AAL) atlas was used to construct the functional brain connectome. The topological organization and FC of brain functional networks in patients with OSA were characterized using graph theory methods and investigated the relationship between functional network topology and clinical variables. RESULTS Both the patients with OSA and the GSs exhibited high-efficiency "small-world" network attributes. However, the patients with OSA exhibited decreased σ, γ, Eglob; increased Lp, λ; and abnormal nodal centralities in several default-mode network (DMN), salience network (SN), and central executive network (CEN) regions. However, the patients with OSA exhibited abnormal functional connections between the DMN, SN, and CEN. The disrupted FC was significantly positive correlations with the global network metrics γ and σ. The global network metrics were significantly correlated with the Epworth Sleepiness Scale (ESS) score, Montreal Cognitive Assessment (MoCA) score, and oxygen desaturation index. CONCLUSION The findings suggest that the functional connectome of patients with OSA exhibited disrupted functional integration and segregation, and functional disconnections of the DMN, SN, and CEN. The aberrant topological attributes may be associated with disrupted FC and cognitive functions. These topological abnormalities and disconnections might be potential biomarkers of cognitive impairments in patients with OSA.
Collapse
Affiliation(s)
- Li-Ting Chen
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiao-Le Fan
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hai-Jun Li
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Cheng-Long Ye
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hong-Hui Yu
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hui-Zhen Xin
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hong-Han Gong
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - De-Chang Peng
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Li-Ping Yan
- Department of Cardiology, People’s Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China
| |
Collapse
|
65
|
A Meta-analysis of Voxel-based Brain Morphometry Studies in Obstructive Sleep Apnea. Sci Rep 2017; 7:10095. [PMID: 28855654 PMCID: PMC5577238 DOI: 10.1038/s41598-017-09319-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/18/2017] [Indexed: 02/05/2023] Open
Abstract
Gray matter (GM) anomalies may represent a critical pathology underlying obstructive sleep apnea (OSA). However, the evidence regarding their clinical relevance is inconsistent. We conducted a meta-analysis of voxel-based morphometry (VBM) studies of patients with OSA to identify their brain abnormalities. A systematic search was conducted based on PRISMA guidelines, and a meta-analysis was performed using the anisotropic effect-size-based algorithms (ASE-SDM) to quantitatively estimate regional GM changes in patients with OSA. Fifteen studies with 16 datasets comprising 353 untreated patients with OSA and 444 healthy controls were included. Our results revealed GM reductions in the bilateral anterior cingulate/paracingulate gyri (ACG/ApCG), left cerebellum (lobules IV/V and VIII), bilateral superior frontal gyrus (SFG, medial rostral part), right middle temporal gyrus (MTG), and right premotor cortex. Moreover, GM reductions in the bilateral ACG/ApCG were positively associated with body mass index (BMI) and age among patients with OSA, and GM reductions in the SFG (medial rostral part) were negatively associated with Epworth sleepiness scale (ESS) scores and sex (male). These abnormalities may represent structural brain underpinnings of neurocognitive abnormalities and respiratory-related abnormalities in OSA. In particular, this study adds to Psychoradiology, which is a promising subspecialty of clinical radiology mainly for psychiatric disorders.
Collapse
|
66
|
Baril AA, Gagnon K, Brayet P, Montplaisir J, De Beaumont L, Carrier J, Lafond C, L'Heureux F, Gagnon JF, Gosselin N. Gray Matter Hypertrophy and Thickening with Obstructive Sleep Apnea in Middle-aged and Older Adults. Am J Respir Crit Care Med 2017; 195:1509-1518. [PMID: 28060546 DOI: 10.1164/rccm.201606-1271oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Obstructive sleep apnea causes intermittent hypoxemia, hemodynamic fluctuations, and sleep fragmentation, all of which could damage cerebral gray matter that can be indirectly assessed by neuroimaging. OBJECTIVES To investigate whether markers of obstructive sleep apnea severity are associated with gray matter changes among middle-aged and older individuals. METHODS Seventy-one subjects (ages, 55-76 yr; apnea-hypopnea index, 0.2-96.6 events/h) were evaluated by magnetic resonance imaging. Two techniques were used: (1) voxel-based morphometry, which measures gray matter volume and concentration; and (2) FreeSurfer (an open source software suite) automated segmentation, which estimates the volume of predefined cortical/subcortical regions and cortical thickness. Regression analyses were performed between gray matter characteristics and markers of obstructive sleep apnea severity (hypoxemia, respiratory disturbances, and sleep fragmentation). MEASUREMENTS AND MAIN RESULTS Subjects had few symptoms, that is, sleepiness, depression, anxiety, and cognitive deficits. Although no association was found with voxel-based morphometry, FreeSurfer revealed increased gray matter with obstructive sleep apnea. Higher levels of hypoxemia correlated with increased volume and thickness of the left lateral prefrontal cortex as well as increased thickness of the right frontal pole, the right lateral parietal lobules, and the left posterior cingulate cortex. Respiratory disturbances positively correlated with right amygdala volume, and more severe sleep fragmentation was associated with increased thickness of the right inferior frontal gyrus. CONCLUSIONS Gray matter hypertrophy and thickening were associated with hypoxemia, respiratory disturbances, and sleep fragmentation. These structural changes in a group of middle-aged and older individuals may represent adaptive/reactive brain mechanisms attributed to a presymptomatic stage of obstructive sleep apnea.
Collapse
Affiliation(s)
- Andrée-Ann Baril
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,2 Département de psychiatrie
| | - Katia Gagnon
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,3 Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Pauline Brayet
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,3 Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,2 Département de psychiatrie
| | - Louis De Beaumont
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,4 Département de chirurgie
| | - Julie Carrier
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,5 Département de psychologie, and
| | - Chantal Lafond
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Francis L'Heureux
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,6 Département de Neurosciences, Université de Montréal, Montreal, Quebec, Canada; and
| | - Jean-François Gagnon
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,3 Département de psychologie, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Nadia Gosselin
- 1 Centre d'études avancées en médecine du sommeil, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.,5 Département de psychologie, and
| |
Collapse
|
67
|
Alex RM, Mousavi ND, Zhang R, Gatchel RJ, Behbehani K. Obstructive sleep apnea: Brain hemodynamics, structure, and function. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/jabr.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Raichel M. Alex
- Department of Bioengineering; University of Texas at Arlington; Arlington TX USA
| | | | - Rong Zhang
- Department of Neurology and Neurotherapeutics; University of Texas Southwestern Medical Center; Dallas TX USA
- Institute for Exercise and Environmental Medicine; Texas Health Hospital Dallas; Dallas TX USA
| | - Robert J. Gatchel
- Department of Psychology; University of Texas at Arlington; Arlington TX USA
| | - Khosrow Behbehani
- Department of Bioengineering; University of Texas at Arlington; Arlington TX USA
| |
Collapse
|
68
|
Khazaie H, Veronese M, Noori K, Emamian F, Zarei M, Ashkan K, Leschziner GD, Eickhoff CR, Eickhoff SB, Morrell MJ, Osorio RS, Spiegelhalder K, Tahmasian M, Rosenzweig I. Functional reorganization in obstructive sleep apnoea and insomnia: A systematic review of the resting-state fMRI. Neurosci Biobehav Rev 2017; 77:219-231. [PMID: 28344075 PMCID: PMC6167921 DOI: 10.1016/j.neubiorev.2017.03.013] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/24/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022]
Abstract
Resting state functional MRI studies is a promising non-invasive tool for better understanding of the pathophysiology of sleep disorders. The salience network is involved in hyperarousal and affective symptoms in insomnia. The posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea. Disruption of intrinsic networks have been demonstrated in major depression, which is a common co-morbidity of sleep disorders.
Functional neuroimaging techniques have accelerated progress in the study of sleep disorders. Considering the striking prevalence of these disorders in the general population, however, as well as their strong bidirectional relationship with major neuropsychiatric disorders, including major depressive disorder, their numbers are still surprisingly low. This review examines the contribution of resting state functional MRI to current understanding of two major sleep disorders, insomnia disorder and obstructive sleep apnoea. An attempt is made to learn from parallels of previous resting state functional neuroimaging findings in major depressive disorder. Moreover, shared connectivity biomarkers are suggested for each of the sleep disorders. Taken together, despite some inconsistencies, the synthesis of findings to date highlights the importance of the salience network in hyperarousal and affective symptoms in insomnia. Conversely, dysfunctional connectivity of the posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea.
Collapse
Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mattia Veronese
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK
| | - Khadijeh Noori
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Farnoosh Emamian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Keyoumars Ashkan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Department of Neurosurgery, King's College Hospital, London, UK
| | - Guy D Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Institute of Clinical Neuroscience & Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Mary J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust,Sydney Street, London, SW3 6NP, UK
| | - Ricardo S Osorio
- Center for Brain Health, NYU School of Medicine, New York, NY, United States
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany
| | - Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
| |
Collapse
|
69
|
Chen LT, Fan XL, Li HJ, Nie S, Gong HH, Zhang W, Zeng XJ, Long P, Peng DC. Disrupted small-world brain functional network topology in male patients with severe obstructive sleep apnea revealed by resting-state fMRI. Neuropsychiatr Dis Treat 2017; 13:1471-1482. [PMID: 28652747 PMCID: PMC5473494 DOI: 10.2147/ndt.s135426] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder that can damage cognitive function. However, the functional network organization remains poorly understood. The aim of this study was to investigate the topological properties of OSA patients using a graph theoretical analysis. PATIENTS AND METHODS A total of 30 male patients with untreated severe OSA and 25 male education- and age-matched good sleepers (GSs) underwent functional magnetic resonance imaging (MRI) examinations. Clinical and cognitive evaluations were conducted by an experienced psychologist. GRETNA (a toolbox for topological analysis of imaging connectomics) was used to construct the brain functional network and calculate the small-world properties (γ, λ, σ, Eglob, and Eloc). Relationships between these small-world properties and clinical and neuropsychological assessments were investigated in OSA patients. RESULTS The networks of both OSA patients and GSs exhibited efficient small-world topology over the sparsity range of 0.05-0.40. Compared with GSs, the OSA group had significantly decreased γ, but significantly increased λ and σ. The OSA group's brain network showed significantly decreased Eglob (P<0.05) over the sparsity range of 0.09-0.15, but significantly increased Eloc over the sparsity range of 0.23-0.40. In OSA patients, γ was significantly negatively correlated with apnea-hypopnea index (AHI; r=-0.326, P=0.015) and Epworth Sleepiness Scale (ESS; r=-0.274, P=0.043), λ was significantly positively correlated with AHI (r=0.373, P=0.005) and ESS (r=0.269, P=0.047), and σ was significantly negatively correlated with AHI (r=-0.363, P=0.007) and ESS (r=-0.295, P=0.029). CONCLUSION Our results suggest that the high degree of local integration and integrity of the brain connections in OSA patients may be disrupted. The topological alterations of small-world properties may be the mechanism of cognitive impairment in OSA patients. In addition, σ, γ, and λ could be used as a quantitative physiological index for auxiliary clinical diagnoses.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Ping Long
- Department of Otolaryngology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | | |
Collapse
|
70
|
Abnormal Intrinsic Functional Hubs in Severe Male Obstructive Sleep Apnea: Evidence from a Voxel-Wise Degree Centrality Analysis. PLoS One 2016; 11:e0164031. [PMID: 27723821 PMCID: PMC5056709 DOI: 10.1371/journal.pone.0164031] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/19/2016] [Indexed: 01/09/2023] Open
Abstract
Purpose Obstructive sleep apnea (OSA) has been associated with changes in brain structure and regional function in certain brain areas. However, the functional features of network organization in the whole brain remain largely uncertain. The purpose of this study was to identify the OSA-related spatial centrality distribution of the whole brain functional network and to investigate the potential altered intrinsic functional hubs. Methods Forty male patients with newly confirmed severe OSA on polysomnography, and well-matched good sleepers, participated in this study. All participants underwent a resting-state functional MRI scan and clinical and cognitive evaluation. Voxel-wise degree centrality (DC) was measured across the whole brain, and group difference in DC was compared. The relationship between the abnormal DC value and clinical variables was assessed using a linear correlation analysis. Results Remarkably similar spatial distributions of the functional hubs (high DC) were found in both groups. However, OSA patients exhibited a pattern of significantly reduced regional DC in the left middle occipital gyrus, posterior cingulate cortex, left superior frontal gyrus, and bilateral inferior parietal lobule, and DC was increased in the right orbital frontal cortex, bilateral cerebellum posterior lobes, and bilateral lentiform nucleus, including the putamen, extending to the hippocampus, and the inferior temporal gyrus, which overlapped with the functional hubs. Furthermore, a linear correlation analysis revealed that the DC value in the posterior cingulate cortex and left superior frontal gyrus were positively correlated with Montreal cognitive assessment scores, The DC value in the left middle occipital gyrus and bilateral inferior parietal lobule were negatively correlated with apnea-hypopnea index and arousal index in OSA patients. Conclusion Our findings suggest that OSA patients exhibited specific abnormal intrinsic functional hubs including relatively reduced and increased DC. This expands our understanding of the functional characteristics of OSA, which may provide new insights into understanding the dysfunction and pathophysiology of OSA patients.
Collapse
|
71
|
Tummala S, Roy B, Park B, Kang DW, Woo MA, Harper RM, Kumar R. Associations between brain white matter integrity and disease severity in obstructive sleep apnea. J Neurosci Res 2016; 94:915-923. [PMID: 27315771 PMCID: PMC4990476 DOI: 10.1002/jnr.23788] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 12/27/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway blockage, with continued diaphragmatic efforts to breathe during sleep. Brain structural changes in OSA appear in various regions, including white matter sites that mediate autonomic, mood, cognitive, and respiratory control. However, the relationships between brain white matter changes and disease severity in OSA are unclear. This study examines associations between an index of tissue integrity, magnetization transfer (MT) ratio values (which show MT between free and proton pools associated with tissue membranes and macromolecules), and disease severity (apnea-hypopnea index [AHI]) in OSA subjects. We collected whole-brain MT imaging data from 19 newly diagnosed, treatment-naïve OSA subjects (50.4 ± 8.6 years of age, 13 males, AHI 39.7 ± 24.3 events/hr], using a 3.0-Tesla MRI scanner. With these data, whole-brain MT ratio maps were calculated, normalized to common space, smoothed, and correlated with AHI scores by using partial correlation analyses (covariates, age and gender; P < 0.005). Multiple brain sites in OSA subjects, including superior and inferior frontal regions, ventral medial prefrontal cortex and nearby white matter, midfrontal white matter, insula, cingulate and cingulum bundle, internal and external capsules, caudate nuclei and putamen, basal forebrain, hypothalamus, corpus callosum, and temporal regions, showed principally lateralized negative correlations (P < 0.005). These regions showed significant correlations even with correction for multiple comparisons (cluster-level, family-wise error, P < 0.05), except for a few superior frontal areas. Predominantly negative correlations emerged between local MT values and OSA disease severity, indicating potential usefulness of MT imaging for examining the OSA condition. These findings indicate that OSA severity plays a significant role in white matter injury. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Sudhakar Tummala
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Bhaswati Roy
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Bumhee Park
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Daniel W. Kang
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Mary A. Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Ronald M. Harper
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA 90095, USA
| |
Collapse
|
72
|
Gildeh N, Drakatos P, Higgins S, Rosenzweig I, Kent BD. Emerging co-morbidities of obstructive sleep apnea: cognition, kidney disease, and cancer. J Thorac Dis 2016; 8:E901-E917. [PMID: 27747026 DOI: 10.21037/jtd.2016.09.23] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obstructive sleep apnea (OSA) causes daytime fatigue and sleepiness, and has an established relationship with cardiovascular and metabolic disease. Recent years have seen the emergence of an evidence base linking OSA with an increased risk of degenerative neurological disease and associated cognitive impairment, an accelerated rate of decline in kidney function with an increased risk of clinically significant chronic kidney disease (CKD), and with a significantly higher rate of cancer incidence and death. This review evaluates the evidence base linking OSA with these seemingly unrelated co-morbidities, and explores potential mechanistic links underpinning their development in patients with OSA, including intermittent hypoxia (IH), sleep fragmentation, sympathetic excitation, and immune dysregulation.
Collapse
Affiliation(s)
- Nadia Gildeh
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Panagis Drakatos
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sean Higgins
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK;; Danish Epilepsy Centre, Dianalund, Denmark
| | - Brian D Kent
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK;; Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
73
|
Park B, Palomares JA, Woo MA, Kang DW, Macey PM, Yan-Go FL, Harper RM, Kumar R. Aberrant Insular Functional Network Integrity in Patients with Obstructive Sleep Apnea. Sleep 2016; 39:989-1000. [PMID: 26943471 PMCID: PMC4835320 DOI: 10.5665/sleep.5738] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/17/2015] [Indexed: 12/30/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is accompanied by tissue injury to the insular cortices, areas that regulate autonomic pain, dyspnea, and mood, all of which are affected in the syndrome. Presumably, the dysregulation of insular-related functions are mediated by aberrant functional connections with other brain regions; however, the integrity of the functional connectivity (FC) to other sites is undescribed. Our aim was to examine resting-state FC of the insular cortices to other brain areas in OSA, relative to control subjects. METHODS We collected resting-state functional magnetic resonance imaging (MRI) data from 67 newly diagnosed, treatment-naïve OSA and 75 control subjects using a 3.0-Tesla MRI scanner. After standard processing, data were analyzed for the left and right insular FC. RESULTS OSA subjects showed complex aberrant insular FC to several brain regions, including frontal, parietal, cingulate, temporal, limbic, basal ganglia, thalamus, occipital, cerebellar, and brainstem regions. Areas of altered FC in OSA showed linear relationships with magnitudes of sleep related and neuropsychologic-related variables, whereas control subjects showed no such relationships with those measures. CONCLUSIONS Brain functional connections from insular sites to other brain regions in OSA subjects represent abnormal autonomic, affective, sensorimotor, and cognitive control networks that may affect both impaired parasympathetic and sympathetic interactions, as well as abnormal sensorimotor integration, affected in the condition. The functional changes likely result from the previously reported structural changes in OSA subjects, as demonstrated by diverse neuroimaging studies.
Collapse
Affiliation(s)
- Bumhee Park
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA
| | - Jose A. Palomares
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA
| | - Mary A. Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA
| | - Daniel W. Kang
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Paul M. Macey
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA
- The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA
| | - Frisca L. Yan-Go
- Department of Neurology, University of California at Los Angeles
| | - Ronald M. Harper
- The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA
- Department of Neurobiology; University of California at Los Angeles, Los Angeles, CA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA
- The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA
| |
Collapse
|
74
|
Tahmasian M, Rosenzweig I, Eickhoff SB, Sepehry AA, Laird AR, Fox PT, Morrell MJ, Khazaie H, Eickhoff CR. Structural and functional neural adaptations in obstructive sleep apnea: An activation likelihood estimation meta-analysis. Neurosci Biobehav Rev 2016; 65:142-56. [PMID: 27039344 PMCID: PMC5103027 DOI: 10.1016/j.neubiorev.2016.03.026] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/27/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022]
Abstract
The right basolateral amygdala, the hippocampus and the right insular cortex are important nodes in obstructive sleep apnea (OSA). Functional characterization of these regions suggested associated dysfunction of emotional, sensory, and limbic processes in OSA. Connectivity analysis demonstrated that these regions are part of a joint network comprising the anterior insula, posterior-medial frontal cortex and thalamus.
Obstructive sleep apnea (OSA) is a common multisystem chronic disorder. Functional and structural neuroimaging has been widely applied in patients with OSA, but these studies have often yielded diverse results. The present quantitative meta-analysis aims to identify consistent patterns of abnormal activation and grey matter loss in OSA across studies. We used PubMed to retrieve task/resting-state functional magnetic resonance imaging and voxel-based morphometry studies. Stereotactic data were extracted from fifteen studies, and subsequently tested for convergence using activation likelihood estimation. We found convergent evidence for structural atrophy and functional disturbances in the right basolateral amygdala/hippocampus and the right central insula. Functional characterization of these regions using the BrainMap database suggested associated dysfunction of emotional, sensory, and limbic processes. Assessment of task-based co-activation patterns furthermore indicated that the two regions obtained from the meta-analysis are part of a joint network comprising the anterior insula, posterior-medial frontal cortex and thalamus. Taken together, our findings highlight the role of right amygdala, hippocampus and insula in the abnormal emotional and sensory processing in OSA.
Collapse
Affiliation(s)
- Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; National Brain Mapping Center, Shahid Beheshti University (General & Medical campus), Tehran, Iran
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK
| | - Simon B Eickhoff
- Institute of Clinical Neuroscience & Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany
| | - Amir A Sepehry
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, FL, USA
| | - Peter T Fox
- Research Imaging Institute, University of Texas Health Science Center, San Antonio, TX, USA; South Texas Veterans Health Care System,San Antonio, TX 78229, USA
| | - Mary J Morrell
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IOPPN, King's College and Imperial College, London, UK; Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK; NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, UK
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
75
|
Park B, Palomares JA, Woo MA, Kang DW, Macey PM, Yan-Go FL, Harper RM, Kumar R. Disrupted functional brain network organization in patients with obstructive sleep apnea. Brain Behav 2016; 6:e00441. [PMID: 27099802 PMCID: PMC4831421 DOI: 10.1002/brb3.441] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/30/2015] [Accepted: 12/19/2015] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) subjects show impaired autonomic, affective, executive, sensorimotor, and cognitive functions. Brain injury in OSA subjects appears in multiple sites regulating these functions, but the integrity of functional networks within the regulatory sites remains unclear. Our aim was to examine the functional interactions and the complex network organization of these interactions across the whole brain in OSA, using regional functional connectivity (FC) and brain network topological properties. METHODS We collected resting-state functional magnetic resonance imaging (MRI) data, using a 3.0-Tesla MRI scanner, from 69 newly diagnosed, treatment-naïve, moderate-to-severe OSA (age, 48.3 ± 9.2 years; body mass index, 31 ± 6.2 kg/m(2); apnea-hypopnea index (AHI), 35.6 ± 23.3 events/h) and 82 control subjects (47.6 ± 9.1 years; body mass index, 25.1 ± 3.5 kg/m(2)). Data were analyzed to examine FC in OSA over controls as interregional correlations and brain network topological properties. RESULTS Obstructive sleep apnea subjects showed significantly altered FC in the cerebellar, frontal, parietal, temporal, occipital, limbic, and basal ganglia regions (FDR, P < 0.05). Entire functional brain networks in OSA subjects showed significantly less efficient integration, and their regional topological properties of functional integration and specialization characteristics also showed declined trends in areas showing altered FC, an outcome which would interfere with brain network organization (P < 0.05; 10,000 permutations). Brain sites with abnormal topological properties in OSA showed significant relationships with AHI scores. CONCLUSIONS Our findings suggest that the dysfunction extends to resting conditions, and the altered FC and impaired network organization may underlie the impaired responses in autonomic, cognitive, and sensorimotor functions. The outcomes likely result from the prominent structural changes in both axons and nuclear structures, which occur in the condition.
Collapse
Affiliation(s)
- Bumhee Park
- Department of Anesthesiology University of California at Los Angeles Los Angeles CA 90095
| | - Jose A Palomares
- Department of Anesthesiology University of California at Los Angeles Los Angeles CA 90095
| | - Mary A Woo
- UCLA School of Nursing University of California at Los Angeles Los Angeles CA 90095
| | - Daniel W Kang
- Department of Medicine University of California at Los Angeles Los Angeles California 90095
| | - Paul M Macey
- UCLA School of Nursing University of California at Los Angeles Los Angeles CA 90095; The Brain Research Institute University of California at Los Angeles Los Angeles California 90095
| | - Frisca L Yan-Go
- Department of Neurology University of California at Los Angeles Los Angeles California 90095
| | - Ronald M Harper
- The Brain Research Institute University of California at Los Angeles Los Angeles California 90095; Department of Neurobiology University of California at Los Angeles Los Angeles California 90095
| | - Rajesh Kumar
- Department of Anesthesiology University of California at Los Angeles Los Angeles CA 90095; The Brain Research Institute University of California at Los Angeles Los Angeles California 90095; Department of Radiological Sciences University of California at Los Angeles Los Angeles California 90095; Department of Bioengineering University of California at Los Angeles Los Angeles California 90095
| |
Collapse
|
76
|
Dalmases M, Solé-Padullés C, Torres M, Embid C, Nuñez MD, Martínez-Garcia MÁ, Farré R, Bargalló N, Bartrés-Faz D, Montserrat JM. Effect of CPAP on Cognition, Brain Function, and Structure Among Elderly Patients With OSA: A Randomized Pilot Study. Chest 2016; 148:1214-1223. [PMID: 26065720 DOI: 10.1378/chest.15-0171] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Despite the increasing aging population and the high prevalence of OSA in elderly adults, little is known about cognitive effects of OSA and the effectiveness of CPAP treatment. Therefore, this study investigated whether elderly patients with OSA present cognitive deficits and functional and structural alterations of the brain that could be improved by CPAP treatment. METHODS This randomized, evaluator-blinded, parallel-group, single-center pilot study involved patients aged ≥ 65 years with newly-diagnosed severe OSA syndrome. Thirty-three patients were assigned to receive either conservative care (CC) or CPAP plus CC for 3 months. At baseline and 3 months after treatment, patients underwent a neuropsychologic evaluation and a functional and structural MRI study of connectivity within the default mode network (DMN) and of cortical thickness. RESULTS Neuropsychologic evaluation revealed no differences in cognitive performance between OSA groups at baseline. By contrast, after CPAP treatment, patients showed a significant improvement in episodic (between-group difference in change, 7.60; 95% CI, 1.66-13.55; P = .014) and short-term memory (between-group difference in change, 1.06; 95% CI, 0.10-2.01; P = .032) and in executive function (speed of mental processing, 5.74; 95% CI, 1.69-9.79; P = .007; mental flexibility, -47.64; 95% CI, -81.83 to -13.45; P = .008), whereas no changes were observed in the CC group. Neuroimaging revealed an increase in the connectivity in the right middle frontal gyrus after 3 months of CPAP treatment and a higher percentage of cortical thinning in the CC group. No association was seen between cognition and brain functional connectivity changes within the DMN. CONCLUSIONS Elderly patients with severe OSA who present with cognitive difficulties could benefit from CPAP treatment. Moreover, CPAP treatment increases the connectivity of the DMN and attenuates cortical thinning. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01826032; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Mireia Dalmases
- Sleep Unit, Pneumology Department, Hospital Clínic de Barcelona-Facultat de Medicina, Universitat de Barcelona, Barcelona; CIBERES, Madrid
| | - Cristina Solé-Padullés
- Psychiatry and Clinical Psychobiology Department, Facultat de Medicina, Universitat de Barcelona, Barcelona
| | - Marta Torres
- Sleep Unit, Pneumology Department, Hospital Clínic de Barcelona-Facultat de Medicina, Universitat de Barcelona, Barcelona; CIBERES, Madrid
| | - Cristina Embid
- Sleep Unit, Pneumology Department, Hospital Clínic de Barcelona-Facultat de Medicina, Universitat de Barcelona, Barcelona; CIBERES, Madrid
| | - Maria Dolores Nuñez
- Sleep Unit, Pneumology Department, Hospital Clínic de Barcelona-Facultat de Medicina, Universitat de Barcelona, Barcelona
| | | | - Ramon Farré
- CIBERES, Madrid; Biophysics and Bioengineering Department, Facultat de Medicina, Universitat de Barcelona - The August Pi Sunyer Biomedical Research Institute (IDIBAPS), Barcelona
| | - Nuria Bargalló
- Image Diagnostic Center, Hospital Clínic de Barcelona, Barcelona; Magnetic Resonance Image Core Facility, IDIBAPS, Barcelona, Spain
| | - David Bartrés-Faz
- Psychiatry and Clinical Psychobiology Department, Facultat de Medicina, Universitat de Barcelona, Barcelona
| | - Josep M Montserrat
- Sleep Unit, Pneumology Department, Hospital Clínic de Barcelona-Facultat de Medicina, Universitat de Barcelona, Barcelona; CIBERES, Madrid.
| |
Collapse
|
77
|
Macey PM, Ogren JA, Kumar R, Harper RM. Functional Imaging of Autonomic Regulation: Methods and Key Findings. Front Neurosci 2016; 9:513. [PMID: 26858595 PMCID: PMC4726771 DOI: 10.3389/fnins.2015.00513] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/22/2015] [Indexed: 01/06/2023] Open
Abstract
Central nervous system processing of autonomic function involves a network of regions throughout the brain which can be visualized and measured with neuroimaging techniques, notably functional magnetic resonance imaging (fMRI). The development of fMRI procedures has both confirmed and extended earlier findings from animal models, and human stroke and lesion studies. Assessments with fMRI can elucidate interactions between different central sites in regulating normal autonomic patterning, and demonstrate how disturbed systems can interact to produce aberrant regulation during autonomic challenges. Understanding autonomic dysfunction in various illnesses reveals mechanisms that potentially lead to interventions in the impairments. The objectives here are to: (1) describe the fMRI neuroimaging methodology for assessment of autonomic neural control, (2) outline the widespread, lateralized distribution of function in autonomic sites in the normal brain which includes structures from the neocortex through the medulla and cerebellum, (3) illustrate the importance of the time course of neural changes when coordinating responses, and how those patterns are impacted in conditions of sleep-disordered breathing, and (4) highlight opportunities for future research studies with emerging methodologies. Methodological considerations specific to autonomic testing include timing of challenges relative to the underlying fMRI signal, spatial resolution sufficient to identify autonomic brainstem nuclei, blood pressure, and blood oxygenation influences on the fMRI signal, and the sustained timing, often measured in minutes of challenge periods and recovery. Key findings include the lateralized nature of autonomic organization, which is reminiscent of asymmetric motor, sensory, and language pathways. Testing brain function during autonomic challenges demonstrate closely-integrated timing of responses in connected brain areas during autonomic challenges, and the involvement with brain regions mediating postural and motoric actions, including respiration, and cardiac output. The study of pathological processes associated with autonomic disruption shows susceptibilities of different brain structures to altered timing of neural function, notably in sleep disordered breathing, such as obstructive sleep apnea and congenital central hypoventilation syndrome. The cerebellum, in particular, serves coordination roles for vestibular stimuli and blood pressure changes, and shows both injury and substantially altered timing of responses to pressor challenges in sleep-disordered breathing conditions. The insights into central autonomic processing provided by neuroimaging have assisted understanding of such regulation, and may lead to new treatment options for conditions with disrupted autonomic function.
Collapse
Affiliation(s)
- Paul M Macey
- UCLA School of Nursing, University of California at Los AngelesLos Angeles, CA, USA; Brain Research Institute, University of California at Los AngelesLos Angeles, CA, USA
| | - Jennifer A Ogren
- Department of Neurobiology, University of California at Los Angeles Los Angeles, CA, USA
| | - Rajesh Kumar
- Brain Research Institute, University of California at Los AngelesLos Angeles, CA, USA; Department of Anesthesiology, University of California at Los AngelesLos Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at University of California at Los AngelesLos Angeles, CA, USA; Department of Bioengineering, University of California at Los AngelesLos Angeles, CA, USA
| | - Ronald M Harper
- Brain Research Institute, University of California at Los AngelesLos Angeles, CA, USA; Department of Neurobiology, University of California at Los AngelesLos Angeles, CA, USA
| |
Collapse
|
78
|
Li HJ, Nie X, Gong HH, Zhang W, Nie S, Peng DC. Abnormal resting-state functional connectivity within the default mode network subregions in male patients with obstructive sleep apnea. Neuropsychiatr Dis Treat 2016; 12:203-12. [PMID: 26855576 PMCID: PMC4725694 DOI: 10.2147/ndt.s97449] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Abnormal resting-state functional connectivity (rs-FC) between the central executive network and the default mode network (DMN) in patients with obstructive sleep apnea (OSA) has been reported. However, the effect of OSA on rs-FC within the DMN subregions remains uncertain. This study was designed to investigate whether the rs-FC within the DMN subregions was disrupted and determine its relationship with clinical symptoms in patients with OSA. METHODS Forty male patients newly diagnosed with severe OSA and 40 male education- and age-matched good sleepers (GSs) underwent functional magnetic resonance imaging (fMRI) examinations and clinical and neuropsychologic assessments. Seed-based region of interest rs-FC method was used to analyze the connectivity between each pair of subregions within the DMN, including the medial prefrontal cortex (MPFC), posterior cingulate cortex (PCC), hippocampus formation (HF), inferior parietal cortices (IPC), and medial temporal lobe (MTL). The abnormal rs-FC strength within the DMN subregions was correlated with clinical and neuropsychologic assessments using Pearson correlation analysis in patients with OSA. RESULTS Compared with GSs, patients with OSA had significantly decreased rs-FC between the right HF and the PCC, MPFC, and left MTL. However, patients with OSA had significantly increased rs-FC between the MPFC and left and right IPC, and between the left IPC and right IPC. The rs-FC between the right HF and left MTL was positively correlated with rapid eye movement (r=0.335, P=0.035). The rs-FC between the PCC and right HF was negatively correlated with delayed memory (r=-0.338, P=0.033). CONCLUSION OSA selectively impairs the rs-FC between right HF and PCC, MPFC, and left MTL within the DMN subregions, and provides an imaging indicator for assessment of cognitive dysfunction in OSA patients.
Collapse
Affiliation(s)
- Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Xiao Nie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Hong-Han Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Wei Zhang
- Department of Pneumology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - Si Nie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| | - De-Chang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China
| |
Collapse
|
79
|
Altered functional connectivity in lesional peduncular hallucinosis with REM sleep behavior disorder. Cortex 2015; 74:96-106. [PMID: 26656284 DOI: 10.1016/j.cortex.2015.10.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/14/2015] [Accepted: 10/23/2015] [Indexed: 01/05/2023]
Abstract
Brainstem lesions causing peduncular hallucinosis (PH) produce vivid visual hallucinations occasionally accompanied by sleep disorders. Overlapping brainstem regions modulate visual pathways and REM sleep functions via gating of thalamocortical networks. A 66-year-old man with paroxysmal atrial fibrillation developed abrupt-onset complex visual hallucinations with preserved insight and violent dream enactment behavior. Brain MRI showed restricted diffusion in the left rostrodorsal pons suggestive of an acute ischemic stroke. REM sleep behavior disorder (RBD) was diagnosed on polysomnography. We investigated the integrity of ponto-geniculate-occipital circuits with seed-based resting-state functional connectivity MRI (rs-fcMRI) in this patient compared to 46 controls. Rs-fcMRI revealed significantly reduced functional connectivity between the lesion and lateral geniculate nuclei (LGN), and between LGN and visual association cortex compared to controls. Conversely, functional connectivity between brainstem and visual association cortex, and between visual association cortex and prefrontal cortex (PFC) was significantly increased in the patient. Focal damage to the rostrodorsal pons is sufficient to cause RBD and PH in humans, suggesting an overlapping mechanism in both syndromes. This lesion produced a pattern of altered functional connectivity consistent with disrupted visual cortex connectivity via de-afferentation of thalamocortical pathways.
Collapse
|
80
|
Kim H, Joo E, Suh S, Kim JH, Kim ST, Hong SB. Effects of long-term treatment on brain volume in patients with obstructive sleep apnea syndrome. Hum Brain Mapp 2015; 37:395-409. [PMID: 26503297 DOI: 10.1002/hbm.23038] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/16/2015] [Indexed: 12/11/2022] Open
Abstract
We assessed structural brain damage in obstructive sleep apnea syndrome (OSA) patients (21 males) and the effects of long-term continuous positive airway pressure (CPAP) treatment (18.2 ± 12.4 months; 8-44 months) on brain structures and investigated the relationship between severity of OSA and effects of treatment. Using deformation-based morphometry to measure local volume changes, we identified widespread neocortical and cerebellar atrophy in untreated patients compared to controls (59 males; Cohen's D = 0.6; FDR < 0.05). Analysis of longitudinally scanned magnetic resonance imaging (MRI) scans both before and after treatment showed increased brain volume following treatment (FDR < 0.05). Volume increase was correlated with longer treatment in the cortical areas that largely overlapped with the initial atrophy. The areas overlying the hippocampal dentate gyrus and the cerebellar dentate nucleus displayed a volume increase after treatment. Patients with very severe OSA (AHI > 64) presented with prefrontal atrophy and displayed an additional volume increase in this area following treatment. Higher impairment of working memory in patients prior to treatment correlated with prefrontal volume increase after treatment. The large overlap between the initial brain damage and the extent of recovery after treatment suggests partial recovery of nonpermanent structural damage. Volume increases in the dentate gyrus and the dentate nucleus possibly likely indicate compensatory neurogenesis in response to diminishing oxidative stress. Such changes in other brain structures may explain gliosis, dendritic volume increase, or inflammation. This study provides neuroimaging evidence that revealed the positive effects of long-term CPAP treatment in patients with OSA.
Collapse
Affiliation(s)
- Hosung Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - EunYeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea.,Department of Psychiatry, Stanford University, Redwood City, California
| | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Bong Hong
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea
| |
Collapse
|
81
|
Luo YG, Wang D, Liu K, Weng J, Guan Y, Chan KCC, Chu WCW, Shi L. Brain Structure Network Analysis in Patients with Obstructive Sleep Apnea. PLoS One 2015; 10:e0139055. [PMID: 26413809 PMCID: PMC4587669 DOI: 10.1371/journal.pone.0139055] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 09/07/2015] [Indexed: 11/19/2022] Open
Abstract
Childhood obstructive sleep apnea (OSA) is a sleeping disorder commonly affecting school-aged children and is characterized by repeated episodes of blockage of the upper airway during sleep. In this study, we performed a graph theoretical analysis on the brain morphometric correlation network in 25 OSA patients (OSA group; 5 female; mean age, 10.1 ± 1.8 years) and investigated the topological alterations in global and regional properties compared with 20 healthy control individuals (CON group; 6 females; mean age, 10.4 ± 1.8 years). A structural correlation network based on regional gray matter volume was constructed respectively for each group. Our results revealed a significantly decreased mean local efficiency in the OSA group over the density range of 0.32-0.44 (p < 0.05). Regionally, the OSAs showed a tendency of decreased betweenness centrality in the left angular gyrus, and a tendency of decreased degree in the right lingual and inferior frontal (orbital part) gyrus (p < 0.005, uncorrected). We also found that the network hubs in OSA and controls were distributed differently. To the best of our knowledge, this is the first study that characterizes the brain structure network in OSA patients and invests the alteration of topological properties of gray matter volume structural network. This study may help to provide new evidence for understanding the neuropathophysiology of OSA from a topological perspective.
Collapse
Affiliation(s)
- Yun-gang Luo
- Department of Stomatology, The Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
- * E-mail: (YL); (LS)
| | - Defeng Wang
- Research Center for Medical Image Computing, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- CUHK Shenzhen research institute, Shenzhen, China
- Department of Biomedical Engineering and Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Kai Liu
- Research Center for Medical Image Computing, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- Department of Biomedical Engineering and Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Jian Weng
- Research Center for Medical Image Computing, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Yuefeng Guan
- Department of Stomatology, The Second Hospital of Jilin University, Changchun, 130041, Jilin Province, China
- CUHK Shenzhen research institute, Shenzhen, China
| | - Kate C. C. Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Winnie C. W. Chu
- Research Center for Medical Image Computing, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- CUHK Shenzhen research institute, Shenzhen, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
- * E-mail: (YL); (LS)
| |
Collapse
|
82
|
Zhang Q, Qin W, He X, Li Q, Chen B, Zhang Y, Yu C. Functional disconnection of the right anterior insula in obstructive sleep apnea. Sleep Med 2015; 16:1062-70. [DOI: 10.1016/j.sleep.2015.04.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/06/2015] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
|
83
|
Baril AA, Gagnon K, Arbour C, Soucy JP, Montplaisir J, Gagnon JF, Gosselin N. Regional Cerebral Blood Flow during Wakeful Rest in Older Subjects with Mild to Severe Obstructive Sleep Apnea. Sleep 2015; 38:1439-49. [PMID: 25761981 DOI: 10.5665/sleep.4986] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/31/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To evaluate changes in regional cerebral blood flow (rCBF) during wakeful rest in older subjects with mild to severe obstructive sleep apnea (OSA) and healthy controls, and to identify markers of OSA severity that predict altered rCBF. DESIGN High-resolution (99m)Tc-HMPAO SPECT imaging during wakeful rest. SETTING Research sleep laboratory affiliated with a University hospital. PARTICIPANTS Fifty untreated OSA patients aged between 55 and 85 years, divided into mild, moderate, and severe OSA, and 20 age-matched healthy controls. INTERVENTIONS N/A. MEASUREMENTS Using statistical parametric mapping, rCBF was compared between groups and correlated with clinical, respiratory, and sleep variables. RESULTS Whereas no rCBF change was observed in mild and moderate groups, participants with severe OSA had reduced rCBF compared to controls in the left parietal lobules, left precentral gyrus, bilateral postcentral gyri, and right precuneus. Reduced rCBF in these regions and in areas of the bilateral frontal and left temporal cortex was associated with more hypopneas, snoring, hypoxemia, and sleepiness. Higher apnea, microarousal, and body mass indexes were correlated to increased rCBF in the basal ganglia, insula, and limbic system. CONCLUSIONS While older individuals with severe obstructive sleep apnea (OSA) had hypoperfusion in the sensorimotor and parietal areas, respiratory variables and subjective sleepiness were correlated with extended regions of hypoperfusion in the lateral cortex. Interestingly, OSA severity, sleep fragmentation, and obesity correlated with increased perfusion in subcortical and medial cortical regions. Anomalies with such a distribution could result in cognitive deficits and reflect impaired vascular regulation, altered neuronal integrity, and/or undergoing neurodegenerative processes.
Collapse
Affiliation(s)
- Andrée-Ann Baril
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychiatry, Montreal, Quebec, Canada
| | - Katia Gagnon
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université du Québec à Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Caroline Arbour
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Jean-Paul Soucy
- McGill University, McConnell Brain Imaging Centre, Montreal, Quebec, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychiatry, Montreal, Quebec, Canada
| | - Jean-François Gagnon
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université du Québec à Montréal, Department of Psychology, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine (CARSM), Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.,Université de Montréal, Department of Psychology, Montreal, Quebec, Canada
| |
Collapse
|
84
|
Sun R, Xu F, Wang C, Dong E. NSFC spurs significant basic research progress of respiratory medicine in China. CLINICAL RESPIRATORY JOURNAL 2015; 11:271-284. [PMID: 26176299 PMCID: PMC7159156 DOI: 10.1111/crj.12351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/10/2015] [Accepted: 07/13/2015] [Indexed: 12/24/2022]
Abstract
Over the years, research in respiratory medicine has progressed rapidly in China. This commentary narrates the role of the National Natural Science Foundation of China (NSFC) in supporting the basic research of respiratory medicine, summarizes the major progress of respiratory medicine in China, and addresses the main future research directions sponsored by the NSFC.
Collapse
Affiliation(s)
- Ruijuan Sun
- Department of Health Sciences, National Natural Science Foundation of China, Beijing, China
| | - Feng Xu
- Department of Health Sciences, National Natural Science Foundation of China, Beijing, China.,Department of Infectious Diseases, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen Wang
- Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Erdan Dong
- Department of Health Sciences, National Natural Science Foundation of China, Beijing, China
| |
Collapse
|
85
|
Desperately seeking grey matter volume changes in sleep apnea: A methodological review of magnetic resonance brain voxel-based morphometry studies. Sleep Med Rev 2015; 25:112-20. [PMID: 26140868 DOI: 10.1016/j.smrv.2015.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 03/11/2015] [Accepted: 03/11/2015] [Indexed: 11/21/2022]
Abstract
Cognitive impairment related to obstructive sleep apnea might be explained by subtle changes in brain anatomy. This has been mainly investigated using magnetic resonance brain scans coupled with a voxel-based morphometry analysis. However, this approach is prone to several methodological pitfalls that may explain the large discrepancy in the results reported in the literature. We critically reviewed twelve papers addressing grey matter volume modifications in association with obstructive sleep apnea. Finally, based on strict methodological criteria, only three studies reported robust, but conflicting, results. No clear evidence has emerged and exploring brain alteration due to obstructive sleep apnea should thus be considered as an open field. We provide recommendations for designing additional robust voxel-based morphometry studies, notably the use of larger cohorts, which is the only way to solve the underpowered issue and the underestimated role of confounders in neuroimaging studies.
Collapse
|
86
|
Li HJ, Dai XJ, Gong HH, Nie X, Zhang W, Peng DC. Aberrant spontaneous low-frequency brain activity in male patients with severe obstructive sleep apnea revealed by resting-state functional MRI. Neuropsychiatr Dis Treat 2015; 11:207-14. [PMID: 25653530 PMCID: PMC4311758 DOI: 10.2147/ndt.s73730] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The majority of previous neuroimaging studies have demonstrated both structural and functional abnormalities in obstructive sleep apnea (OSA). However, few studies have focused on the regional intensity of spontaneous fluctuations during the resting state and the relationship between the abnormal properties and the behavioral performances. In the present study, we employed the amplitude of low-frequency fluctuation (ALFF) method to explore the local features of spontaneous brain activity in OSA patients (OSAs). METHODS Twenty-five untreated male severe OSAs and 25 age-matched and years-of-education-matched male good sleepers (GSs) were included in this study. The ALFF method was used to assess the local features of spontaneous brain activity. The mean signal values of the altered ALFF areas were analyzed with receiver operating characteristic curve. Partial correlation analysis was used to explore the relationship between the observed mean ALFF values of the different areas and the behavioral performances. RESULTS Compared with GSs, OSAs had significantly higher scores for body mass index, apnea-hypopnea index, arterial oxygen saturation <90%, arousal index, and Epworth Sleepiness Scale (ESS) score; furthermore, OSAs had significantly lower scores for rapid eye movement sleep and in the Montreal Cognitive Assessment (MoCA). Compared with GSs, OSAs showed significant lower-ALFF areas in the cluster of the right precuneus and bilateral posterior cingulate gyrus, as well as a higher-ALFF area in the left inferior frontal gyrus. The area under the curve values of the lower- and higher-ALFF areas were 0.90 and 0.93, respectively. Further diagnostic analysis exhibited that the sensibility and specificity of the two clusters were 80% and 92%, respectively. The mean signal value of the lower-ALFF cluster displayed significant positive correlations with lowest oxygen saturation (r=0.447, P=0.025) and MoCA score (r =0.405, P=0.045). CONCLUSION OSAs may involve in a dysfunction in the default mode network and an adaptive compensatory response in the frontal lobe, which reflect the underlying pathophysiology of cognitive impairment.
Collapse
Affiliation(s)
- Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xi-Jian Dai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China ; Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Hong-Han Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xiao Nie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Wei Zhang
- Department of Pneumology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - De-Chang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| |
Collapse
|
87
|
Gagnon K, Baril AA, Gagnon JF, Fortin M, Décary A, Lafond C, Desautels A, Montplaisir J, Gosselin N. Cognitive impairment in obstructive sleep apnea. ACTA ACUST UNITED AC 2014; 62:233-40. [PMID: 25070768 DOI: 10.1016/j.patbio.2014.05.015] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/13/2014] [Indexed: 11/19/2022]
Abstract
Obstructive sleep apnea (OSA) is characterised by repetitive cessation or reduction of airflow due to upper airway obstructions. These respiratory events lead to chronic sleep fragmentation and intermittent hypoxemia. Several studies have shown that OSA is associated with daytime sleepiness and cognitive dysfunctions, characterized by impairments of attention, episodic memory, working memory, and executive functions. This paper reviews the cognitive profile of adults with OSA and discusses the relative role of altered sleep and hypoxemia in the aetiology of these cognitive deficits. Markers of cognitive dysfunctions such as those measured with waking electroencephalography and neuroimaging are also presented. The effects of continuous positive airway pressure (CPAP) on cognitive functioning and the possibility of permanent brain damage associated with OSA are also discussed. Finally, this paper reviews the evidence suggesting that OSA is a risk factor for developing mild cognitive impairment and dementia in the aging population and stresses the importance of its early diagnosis and treatment.
Collapse
Affiliation(s)
- K Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada; Department of Psychology, Université du Québec à Montréal, 2101, Jeanne-Mance, Montréal, QC, H2X 2J6 Canada
| | - A-A Baril
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada; Faculty of Medicine, Université de Montréal, 2900, Boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4 Canada
| | - J-F Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada; Department of Psychology, Université du Québec à Montréal, 2101, Jeanne-Mance, Montréal, QC, H2X 2J6 Canada
| | - M Fortin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada; Department of Psychology, Université de Montréal, 2900, Boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4 Canada
| | - A Décary
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada; Memory Clinic, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada
| | - C Lafond
- Department of Pulmonology, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada
| | - A Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada; Faculty of Medicine, Université de Montréal, 2900, Boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4 Canada
| | - J Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada; Faculty of Medicine, Université de Montréal, 2900, Boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4 Canada
| | - N Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, 5400, Boulevard Gouin Ouest, Montréal, QC, H4J 1C5 Canada; Department of Psychology, Université de Montréal, 2900, Boulevard Édouard-Montpetit, Montréal, QC, H3T 1J4 Canada.
| |
Collapse
|
88
|
Peng DC, Dai XJ, Gong HH, Li HJ, Nie X, Zhang W. Altered intrinsic regional brain activity in male patients with severe obstructive sleep apnea: a resting-state functional magnetic resonance imaging study. Neuropsychiatr Dis Treat 2014; 10:1819-26. [PMID: 25278755 PMCID: PMC4179755 DOI: 10.2147/ndt.s67805] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that obstructive sleep apnea (OSA) is associated with abnormal brain structural deficits. However, little is known about the changes in local synchronization of spontaneous activity in patients with OSA. The primary aim of the present study was to investigate spontaneous brain activity in patients with OSA compared with good sleepers (GSs) using regional homogeneity (ReHo) analysis based on resting-state functional magnetic resonance imaging (MRI). METHODS Twenty-five untreated male patients with severe OSA and 25 male GSs matched for age and years of education were included in this study. The ReHo method was calculated to assess the strength of local signal synchrony and was compared between the two groups. The observed mean ReHo values were entered into Statistical Package for the Social Sciences software to assess their correlation with behavioral performance. RESULTS Compared with GSs, patients with OSA showed significantly lower ReHo in the right medial frontal gyrus (BA11), right superior frontal gyrus (BA10), right cluster of the precuneus and angular gyrus (BA39), and left superior parietal lobule (BA7), and higher ReHo in the right posterior lobe of the cerebellum, right cingulate gyrus (BA23), and bilateral cluster covering the lentiform nucleus, putamen, and insula (BA13). The lower mean ReHo value in the right cluster of the precuneus and angular gyrus had a significant negative correlation with sleep time (r=-0.430, P=0.032), and higher ReHo in the right posterior lobe of the cerebellum showed a significant positive correlation with stage 3 sleep (r=0.458, P=0.021) and in the right cingulate gyrus showed a significant positive correlation with percent rapid eye movement sleep (r=0.405, P=0.045). CONCLUSION Patients with OSA showed significant regional spontaneous activity deficits in default mode network areas. The ReHo method is a useful noninvasive imaging tool for detection of early changes in cerebral ReHo in patients with OSA.
Collapse
Affiliation(s)
- De-Chang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| | - Xi-Jian Dai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China ; Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China
| | - Hong-Han Gong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| | - Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| | - Xiao Nie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| | - Wei Zhang
- Department of Pneumology, The First Affiliated Hospital of Nanchang University, Jiangxi, People's Republic of China
| |
Collapse
|
89
|
Kim PY, McCarty DE, Wang L, Frilot C, Chesson AL, Marino AA. Two-group classification of patients with obstructive sleep apnea based on analysis of brain recurrence. Clin Neurophysiol 2013; 125:1174-81. [PMID: 24290851 DOI: 10.1016/j.clinph.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/18/2013] [Accepted: 11/02/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To demonstrate that the severity of obstructive sleep apnea (OSA) could be predicted algorithmically by means of recurrence analysis of the sleep-staged electroencephalogram (EEG). METHODS A randomly selected cohort of 20 sleep-staged patients with OSA (apnea-hypopnea index (AHI) 5-30) was divided into mild and moderate sub-cohorts (AHI 5-15, 16-30, respectively), and the sleep EEG (C3) was analyzed using analysis of brain recurrence (ABR) (LSU cohort). Twenty distinct but related markers for sleep depth and fragmentation were computed from four ABR variables, and a marker function capable of classifying each patient into one of the two sub-cohorts was determined by linear discriminant analysis. Classification accuracy of individual patients was evaluated using area under the receiver operator characteristics curve (AUROC). As a control procedure, 20 additional sleep-staged patients with OSA whose polysomnographic data was obtained from an independent database were also evaluated (SHHS cohort). RESULTS On average, markers for sleep depth were reduced and those for sleep fragmentation were increased in the patients with moderate OSA, as expected. All patients in both cohorts were correctly classified using as few as 5-6 markers. SIGNIFICANCE The degree of severity of OSA was reflected in objective changes in the sleep EEG. Recurrence analysis of the EEG potentially has uses beyond identification of the degree of OSA.
Collapse
Affiliation(s)
- Paul Y Kim
- Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA, United States
| | - David E McCarty
- Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA, United States
| | - Lei Wang
- Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA, United States
| | - Clifton Frilot
- School of Allied Health Professions, LSU Health Sciences Center, Shreveport, LA, United States
| | - Andrew L Chesson
- Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA, United States
| | - Andrew A Marino
- Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA, United States.
| |
Collapse
|
90
|
Bates ML, Pillers DAM, Palta M, Farrell ET, Eldridge MW. Ventilatory control in infants, children, and adults with bronchopulmonary dysplasia. Respir Physiol Neurobiol 2013; 189:329-37. [PMID: 23886637 DOI: 10.1016/j.resp.2013.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/16/2013] [Accepted: 07/16/2013] [Indexed: 12/17/2022]
Abstract
Bronchopulmonary dysplasia (BPD), or chronic lung disease of prematurity, occurs in ~30% of preterm infants (15,000 per year) and is associated with a clinical history of mechanical ventilation and/or high inspired oxygen at birth. Here, we describe changes in ventilatory control that exist in patients with BPD, including alterations in chemoreceptor function, respiratory muscle function, and suprapontine control. Because dysfunction in ventilatory control frequently revealed when O2 supply and CO2 elimination are challenged, we provide this information in the context of four important metabolic stressors: stresses: exercise, sleep, hypoxia, and lung disease, with a primary focus on studies of human infants, children, and adults. As a secondary goal, we also identify three key areas of future research and describe the benefits and challenges of longitudinal human studies using well-defined patient cohorts.
Collapse
Affiliation(s)
- Melissa L Bates
- Department of Pediatrics, Division of Critical Care, University of Wisconsin, Madison, WI, USA; John Rankin Laboratory of Pulmonary Medicine, University of Wisconsin, Madison, WI, USA.
| | | | | | | | | |
Collapse
|
91
|
Dang-Vu TT. Prefrontal dysfunction in obstructive sleep apnea: a biomarker of disease severity? Sleep 2013; 36:631-2. [PMID: 23633742 DOI: 10.5665/sleep.2610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|