Brain white matter changes in CPAP-treated obstructive sleep apnea patients with residual sleepiness.
Brain white matter changes in CPAP-treated obstructive sleep apnea patients with residual sleepiness.
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DOI：
10.1002/jmri.25463
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发表时间：
2017-05
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影响因子：
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通讯作者：
Weaver TE
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作者：
Xiong Y;Zhou XJ;Nisi RA;Martin KR;Karaman MM;Cai K;Weaver TE
目的应用弥散张量成像(DTI)研究阻塞性睡眠呼吸暂停(OSA)患者持续正压(CPAP)治疗后白质(WM)结构改变。探讨了DTI指标和两种嗜睡临床评估之间可能的定量关系。纳入29名确诊为阻塞性睡眠呼吸暂停综合征的男性患者(年龄30-55岁)。患者仅接受CPAP治疗。在CPAP治疗后进行精神运动警戒任务(PVT)和Epworth嗜睡量表(ESS)，并在MRI扫描时加用。根据PVT结果，将患者分为不嗜睡组(Lapses≤5)和嗜睡组(Lapses&Gt；5)。在3T时进行弥散张量成像检查，然后使用基于轨迹的空间统计学方法分析两组之间的分数各向异性(FA)、平均弥散率(MD)、轴向弥散率(λ1)和径向弥散率(λ23)的差异。在WM的全脑TBSS分析中，嗜睡组的MD(p<；0.05)高于非嗜睡组。MD增加(17.8%的纤维束；p<；0.05)主要是由λ23升高引起的。轴向弥散系数(λ1)无显著差异(p>；0.17)。单个纤维束的FA或MD的改变主要发生在内/外囊、放射冠、胼胝体和矢状层区域。所有患者的FA和MD值与PVT和ESS评分呈正相关(R≥0.517.0 5，p<；0.0 5)。DTI揭示的全球和地区性西医改变可能是解释为什么高水平使用CPAP的OSA患者对治疗有不同反应的可能机制。髓鞘受损，表现为放射状弥散系数增加，可能与潜在的WM改变有关。
To investigate white matter (WM) structural alterations using diffusion tensor imaging (DTI) in obstructive sleep apnea (OSA) patients, with or without residual sleepiness, following adherent continuous positive airway pressure (CPAP) treatment. Possible quantitative relationships were explored between the DTI metrics and two clinical assessments of somnolence. Twenty nine male patients (30–55 years old) with a confirmed diagnosis of OSA were recruited. The patients were treated with CPAP therapy only. The Psychomotor Vigilance Task (PVT) and Epworth Sleepiness Scale (ESS) were performed after CPAP treatment and additionally administered at the time of MRI scan. Based on the PVT results, the patients were divided into a non-sleepy group (lapses≤5) and a sleepy group (lapses > 5). DTI was performed at 3T, followed by an analysis using tract-based spatial statistics (TBSS) to investigate the differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (λ1), and radial diffusivity (λ23) between the two groups. A higher MD (p < 0.05) was observed in the sleepy group than the non-sleepy group in the whole-brain TBSS analysis in the WM. The increased MD (17.8% of the fiber tracts; p<0.05) was caused primarily by an elevated λ23. Axial diffusivity (λ1) exhibited no significant difference (p > 0.17). The alterations in FA or MD of individual fiber tracts occurred mainly in the internal/external capsule, corona radiata, corpus callosum, and sagittal stratum regions. The FA and MD values correlated with the PVT and ESS assessments from all patients (R ≥ 0.517, p < 0.05). Global and regional WM alterations, as revealed by DTI, can be a possible mechanism to explain why OSA patients with high levels of CPAP use can have differing responses to treatment. Compromised myelin sheath, indicated by increased radial diffusivity, can be involved in the underlying WM changes.