Effects of long-term treatment on brain volume in patients with obstructive sleep apnea syndrome.
Effects of long-term treatment on brain volume in patients with obstructive sleep apnea syndrome.
复制标题
长期治疗对阻塞性睡眠呼吸暂停综合征患者脑体积的影响。
DOI：
10.1002/hbm.23038
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发表时间：
2016-01
影响因子：
4.8
通讯作者：
Hong SB
中科院分区：
文献类型：
--
作者：
Kim H;Joo E;Suh S;Kim JH;Kim ST;Hong SB
我们评估阻塞性睡眠呼吸暂停综合征（OSA）患者（男性21例）的脑结构损伤及长期持续气道正压通气（CPAP）治疗（18.2±12.4个月；8-44个月）对脑结构的影响，并探讨OSA严重程度与治疗效果的关系。使用基于变形的形态测量法测量局部体积变化，我们发现与对照组相比，未经治疗的患者广泛存在新皮质和小脑萎缩（男性59例；Cohen’s D = 0.6; FDR < 0.05）。治疗前后纵向扫描磁共振成像（MRI）扫描分析显示，治疗后脑容量增加（FDR < 0.05）。体积增加与治疗时间较长的皮质区域相关，这些区域与最初的萎缩有很大的重叠。治疗后海马齿状回和小脑齿状核上覆区域体积增大。非常严重的OSA患者（AHI bbbb64）表现为前额叶萎缩，并在治疗后显示该区域的额外体积增加。治疗前工作记忆受损程度较高的患者与治疗后前额叶体积增加相关。初始脑损伤与治疗后恢复程度之间的巨大重叠表明非永久性结构损伤部分恢复。齿状回和齿状核的体积增加可能表明代偿性神经发生是对氧化应激减少的反应。其他脑结构的这种变化可以解释神经胶质瘤、树突体积增加或炎症。本研究提供了神经影像学证据，揭示了长期CPAP治疗对OSA患者的积极作用。
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 non-permanent 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.