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. 2011 Jan 15;54(2):787-93.
doi: 10.1016/j.neuroimage.2010.09.065. Epub 2010 Oct 1.

Cognitive profile and brain morphological changes in obstructive sleep apnea

Federico Torelli  1 , Nicola Moscufo, Girolamo Garreffa, Fabio Placidi, Andrea Romigi, Silvana Zannino, Marco Bozzali, Fabrizio Fasano, Giovanni Giulietti, Ina Djonlagic, Atul Malhotra, Maria Grazia Marciani, Charles R G Guttmann
Affiliations

Cognitive profile and brain morphological changes in obstructive sleep apnea

Federico Torelli et al. Neuroimage. .

Abstract

Obstructive sleep apnea (OSA) is accompanied by neurocognitive impairment, likely mediated by injury to various brain regions. We evaluated brain morphological changes in patients with OSA and their relationship to neuropsychological and oximetric data. Sixteen patients affected by moderate-severe OSA (age: 55.8±6.7 years, 13 males) and fourteen control subjects (age: 57.6±5.1 years, 9 males) underwent 3.0 Tesla brain magnetic resonance imaging (MRI) and neuropsychological testing evaluating short- and long-term memory, executive functions, language, attention, praxia and non-verbal learning. Volumetric segmentation of cortical and subcortical structures and voxel-based morphometry (VBM) were performed. Patients and controls differed significantly in Rey Auditory-Verbal Learning test (immediate and delayed recall), Stroop test and Digit span backward scores. Volumes of cortical gray matter (GM), right hippocampus, right and left caudate were smaller in patients compared to controls, with also brain parenchymal fraction (a normalized measure of cerebral atrophy) approaching statistical significance. Differences remained significant after controlling for comorbidities (hypertension, diabetes, smoking, hypercholesterolemia). VBM analysis showed regions of decreased GM volume in right and left hippocampus and within more lateral temporal areas in patients with OSA. Our findings indicate that the significant cognitive impairment seen in patients with moderate-severe OSA is associated with brain tissue damage in regions involved in several cognitive tasks. We conclude that OSA can increase brain susceptibility to the effects of aging and other clinical and pathological occurrences.

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Conflict of interest statement

DISCLOSURE STATEMENT

Dr. Torelli has no conflict of interest.

Dr. Moscufo has no conflict of interest.

Dr. Garreffa has no conflict of interest.

Dr. Placidi has no conflict of interest.

Dr. Romigi has no conflict of interest.

Dr. Zannino has no conflict of interest.

Dr. Bozzali has no conflict of interest.

Dr. Fasano has no conflict of interest.

Dr. Giulietti has no conflict of interest.

Dr. Djonlagic has no conflict of interest.

Dr. Malhotra has received consulting and/or research income from Philips, Pfizer, Merck, Cephalon, Itamar, Sleep Group Solutions, Sleep HealthCenters, Apnex, Sepracor, Ethicon, Medtronic.

Prof. Marciani has no conflict of interest.

Figures

Figure 1
Figure 1. Series from 3D-Slicer segmentation module
Figure shows a same-level slice from the MPRAGE (A), FLAIR (B) and T2 (C) series and the segmentation output of 3D-Slicer module (D) which was obtained using MPRAGE and FLAIR as inputs. Colors in panel D: yellow (WM), pale blue (GM), pink (CSF), red (WMH) and white (putamen). The ICV is outlined in green (panel C) and includes cortical CSF. This figure is intended for color reproduction on the Web and in print.
Figure 2
Figure 2. VBM analysis showing regions of GM and WM reduction in patients with OSA compared to controls
Figure shows significant changes of GM volume in right hippocampus (MNI: 30; −5; −48) and changes of WM volume in an anatomically contiguous region, across groups (p Family-wise Error corrected < 0.05). This figure is intended for color reproduction on the Web and in print.
See this image and copyright information in PMC

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