Regional Cerebral Blood Flow during Wakeful Rest in Older Subjects with Mild to Severe Obstructive Sleep Apnea
Regional Cerebral Blood Flow during Wakeful Rest in Older Subjects with Mild to Severe Obstructive Sleep Apnea
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DOI：
10.5665/sleep.4986
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发表时间：
2015-09-01
期刊：
影响因子：
5.6
通讯作者：
Gosselin, Nadia
中科院分区：
文献类型：
--
作者：
Baril, Andree-Ann;Gagnon, Katia;Gosselin, Nadia
目的：评估轻度至重度阻塞性睡眠呼吸暂停（OSA）老年受试者和健康对照者清醒休息时局部脑血流量（rCBF）的变化，并确定预测rCBF改变的OSA严重程度标志物。设计：清醒休息时高分辨率Tc-99 m-HMPAO SPECT成像。设置：大学医院附属睡眠研究实验室。参与者：50名年龄在55岁至85岁之间的未治疗OSA患者，分为轻度，中度和重度OSA，以及20名年龄匹配的健康对照。干预措施：N/A。测量：使用统计参数映射，比较各组之间的rCBF，并与临床，呼吸和睡眠变量相关。而在轻度和中度组中没有观察到rCBF的变化，与对照组相比，重度OSA参与者的左顶叶小叶，左中央前回，双侧中央后回和右楔前叶的rCBF减少。这些区域以及双侧额叶和左颞叶皮质区域的rCBF降低与更多的呼吸不足、打鼾、低氧血症和嗜睡相关。更高的呼吸暂停，微觉醒，和体重指数相关的基底神经节，大脑中动脉和边缘系统的rCBF增加。结论：虽然老年人严重阻塞性睡眠呼吸暂停（OSA）有低灌注的感觉和顶叶区，呼吸变量和主观嗜睡与扩展区域的低灌注在外侧皮质。有趣的是，阻塞性睡眠呼吸暂停的严重程度、睡眠片段和肥胖与皮质下和内侧皮质区域的灌注增加相关。具有这种分布的异常可能导致认知缺陷，并反映血管调节受损、神经元完整性改变和/或经历神经退行性过程。
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 Tc-99m-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.