1
|
Lee YH, Jeon S, Auh QS, Chung EJ. Automatic prediction of obstructive sleep apnea in patients with temporomandibular disorder based on multidata and machine learning. Sci Rep 2024; 14:19362. [PMID: 39169169 PMCID: PMC11339326 DOI: 10.1038/s41598-024-70432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 08/16/2024] [Indexed: 08/23/2024] Open
Abstract
Obstructive sleep apnea (OSA) is closely associated with the development and chronicity of temporomandibular disorder (TMD). Given the intricate pathophysiology of both OSA and TMD, comprehensive diagnostic approaches are crucial. This study aimed to develop an automatic prediction model utilizing multimodal data to diagnose OSA among TMD patients. We collected a range of multimodal data, including clinical characteristics, portable polysomnography, X-ray, and MRI data, from 55 TMD patients who reported sleep problems. This data was then analyzed using advanced machine learning techniques. Three-dimensional VGG16 and logistic regression models were used to identify significant predictors. Approximately 53% (29 out of 55) of TMD patients had OSA. Performance accuracy was evaluated using logistic regression, multilayer perceptron, and area under the curve (AUC) scores. OSA prediction accuracy in TMD patients was 80.00-91.43%. When MRI data were added to the algorithm, the AUC score increased to 1.00, indicating excellent capability. Only the obstructive apnea index was statistically significant in predicting OSA in TMD patients, with a threshold of 4.25 events/h. The learned features of the convolutional neural network were visualized as a heatmap using a gradient-weighted class activation mapping algorithm, revealing that it focuses on differential anatomical parameters depending on the absence or presence of OSA. In OSA-positive cases, the nasopharynx, oropharynx, uvula, larynx, epiglottis, and brain region were recognized, whereas in OSA-negative cases, the tongue, nose, nasal turbinate, and hyoid bone were recognized. Prediction accuracy and heat map analyses support the plausibility and usefulness of this artificial intelligence-based OSA diagnosis and prediction model in TMD patients, providing a deeper understanding of regions distinguishing between OSA and non-OSA.
Collapse
Affiliation(s)
- Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea.
| | - Seonggwang Jeon
- Department of Computer Science, Hanyang University, Seoul, 04763, Korea
| | - Q-Schick Auh
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University, Kyung Hee University Dental Hospital, #613 Hoegi-dong, Dongdaemun-gu, Seoul, 02447, Korea
| | - Eun-Jae Chung
- Otorhinolaryngology-Head and Neck Surgery, SNUCM Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital Otorhinolaryngology-Head & Neck Surgery, Seoul, Korea
| |
Collapse
|
2
|
Marchi NA, Daneault V, André C, Martineau‐Dussault M, Baril A, Thompson C, Montplaisir JY, Gilbert D, Lorrain D, Boré A, Descoteaux M, Carrier J, Gosselin N. Altered fornix integrity is associated with sleep apnea-related hypoxemia in mild cognitive impairment. Alzheimers Dement 2024; 20:4092-4105. [PMID: 38716833 PMCID: PMC11180866 DOI: 10.1002/alz.13833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/13/2024] [Accepted: 03/18/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The limbic system is critical for memory function and degenerates early in the Alzheimer's disease continuum. Whether obstructive sleep apnea (OSA) is associated with alterations in the limbic white matter tracts remains understudied. METHODS Polysomnography, neurocognitive assessment, and brain magnetic resonance imaging (MRI) were performed in 126 individuals aged 55-86 years, including 70 cognitively unimpaired participants and 56 participants with mild cognitive impairment (MCI). OSA measures of interest were the apnea-hypopnea index and composite variables of sleep fragmentation and hypoxemia. Microstructural properties of the cingulum, fornix, and uncinate fasciculus were estimated using free water-corrected diffusion tensor imaging. RESULTS Higher levels of OSA-related hypoxemia were associated with higher left fornix diffusivities only in participants with MCI. Microstructure of the other white matter tracts was not associated with OSA measures. Higher left fornix diffusivities correlated with poorer episodic verbal memory. DISCUSSION OSA may contribute to fornix damage and memory dysfunction in MCI. HIGHLIGHTS Sleep apnea-related hypoxemia was associated with altered fornix integrity in MCI. Altered fornix integrity correlated with poorer memory function. Sleep apnea may contribute to fornix damage and memory dysfunction in MCI.
Collapse
Affiliation(s)
- Nicola Andrea Marchi
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
- Center for Investigation and Research in SleepDepartment of MedicineLausanne University Hospital and University of LausanneLausanneVaudSwitzerland
- Laboratory for Research in NeuroimagingDepartment of Clinical NeurosciencesLausanne University Hospital and University of LausanneLausanneVaudSwitzerland
| | - Véronique Daneault
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS du Centre‐Sud‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
| | - Claire André
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
| | - Marie‐Ève Martineau‐Dussault
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
| | - Andrée‐Ann Baril
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of MedicineFaculty of MedicineUniversité de MontréalMontrealQuebecCanada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
| | - Jacques Yves Montplaisir
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychiatryUniversité de MontréalMontrealQuebecCanada
| | - Danielle Gilbert
- Department of RadiologyRadio‐oncology and Nuclear Medicine, Université de MontréalMontrealQuebecCanada
- Department of RadiologyHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
| | - Dominique Lorrain
- Research Center on AgingInstitut Universitaire de Gériatrie de Sherbrooke, CIUSSS de l'EstrieSherbrookeQuebecCanada
- Department of PsychologyUniversité de SherbrookeSherbrookeQuebecCanada
| | - Arnaud Boré
- Sherbrooke Connectivity Imaging LabUniversité de SherbrookeSherbrookeQuebecCanada
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging LabUniversité de SherbrookeSherbrookeQuebecCanada
| | - Julie Carrier
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep MedicineHôpital du Sacré‐Coeur de Montréal, CIUSSS du Nord‐de‐l'Ile‐de‐MontréalMontrealQuebecCanada
- Department of PsychologyUniversité de MontréalMontrealQuebecCanada
| |
Collapse
|
3
|
Liu X, Wei Z, Ting L, Liu X, Shu Y, Ling H, Li L, Liu Y, Xia G, Peng D, Li H. Microstructural Changes in the Cerebral White Matter After 12 Months of CPAP Treatment for Moderate to Severe Obstructive Sleep Apnoea: A TBSS Study. Nat Sci Sleep 2024; 16:531-542. [PMID: 38827391 PMCID: PMC11141711 DOI: 10.2147/nss.s460919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Continuous positive airway pressure (CPAP) therapy improves clinical symptoms in patients with obstructive sleep apnea (OSA); however, the mechanism of this clinical improvement and how it may be associated with the restoration of white matter (WM) structures in the brain is unclear. Therefore, this study investigated the relationship between the structural recovery of brain WM and improvements in cognitive function and emotion after long-term (12 months) CPAP treatment in patients with OSA. Methods We collected data from 17 patients with OSA before and 12 months after CPAP treatment, including sleep monitoring, clinical assessment, and diffusion tensor imaging (DTI) magnetic resonance imaging. Results We observed a partial reversible recovery of brain WM (mean and radial diffusion coefficients) after treatment. This recovery involved the commissural fibers (cingulum, body of corpus callosum), projection fibers (retrolenticular part of the internal capsule, posterior thalamic radiation, posterior limb of the internal capsule, superior corona radiata, posterior corona radiata), association fibers (external capsule, superior longitudinal fasciculus, inferior longitudinal fasciculus), and other regions. In addition, the improvements in WM fibers in one part of the brain significantly were correlated with the Hamilton Anxiety Scale and Hamilton Depression Scale scores. Discussion Our results suggest that reversible recovery of reduced brain WM integrity due to OSA may require longer CPAP treatment. Moreover, changes in the integrity of the commissural fibers were associated with emotion regulation. These restored WM areas may explain the cognitive and mood improvements observed after OSA treatment.
Collapse
Affiliation(s)
- Xiang Liu
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Zhipeng Wei
- Department of Radiology, the Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Long Ting
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Xuming Liu
- Department of Radiology, Wenzhou People’s Hospital, Wenzhou, Zhejiang, 325000, People’s Republic of China
| | - Yongqiang Shu
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Huang Ling
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Lifeng Li
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Yumeng Liu
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Guojin Xia
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Dechang Peng
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| | - Haijun Li
- Department of Radiology, the First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Jiangxi, People’s Republic of China
| |
Collapse
|
4
|
Huang L, Li H, Shu Y, Li K, Xie W, Zeng Y, Long T, Zeng L, Liu X, Peng D. Changes in Functional Connectivity of Hippocampal Subregions in Patients with Obstructive Sleep Apnea after Six Months of Continuous Positive Airway Pressure Treatment. Brain Sci 2023; 13:brainsci13050838. [PMID: 37239310 DOI: 10.3390/brainsci13050838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Previous studies have shown that the structural and functional impairments of hippocampal subregions in patients with obstructive sleep apnea (OSA) are related to cognitive impairment. Continuous positive airway pressure (CPAP) treatment can improve the clinical symptoms of OSA. Therefore, this study aimed to investigate functional connectivity (FC) changes in hippocampal subregions of patients with OSA after six months of CPAP treatment (post-CPAP) and its relationship with neurocognitive function. We collected and analyzed baseline (pre-CPAP) and post-CPAP data from 20 patients with OSA, including sleep monitoring, clinical evaluation, and resting-state functional magnetic resonance imaging. The results showed that compared with pre-CPAP OSA patients, the FC between the right anterior hippocampal gyrus and multiple brain regions, and between the left anterior hippocampal gyrus and posterior central gyrus were reduced in post-CPAP OSA patients. By contrast, the FC between the left middle hippocampus and the left precentral gyrus was increased. The changes in FC in these brain regions were closely related to cognitive dysfunction. Therefore, our findings suggest that CPAP treatment can effectively change the FC patterns of hippocampal subregions in patients with OSA, facilitating a better understanding of the neural mechanisms of cognitive function improvement, and emphasizing the importance of early diagnosis and timely treatment of OSA.
Collapse
Affiliation(s)
- Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
- PET Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Yaping Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
- PET Center, The First Affiliated Hospital of Nanchang University, Nanchang 330000, China
| |
Collapse
|
5
|
Zhu Q, Chen L, Xu Q, Xu J, Zhang L, Wang J. Association between obstructive sleep apnea and risk for post-stroke anxiety: A Chinese hospital-based study in noncardiogenic ischemic stroke patients. Sleep Med 2023; 107:55-63. [PMID: 37119621 DOI: 10.1016/j.sleep.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/11/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This study explored the role of obstructive sleep apnea (OSA) in post stroke anxiety (PSA) in noncardiogenic ischemic stroke patients. METHODS 180 patients with noncardiogenic ischemic stroke were consecutively enrolled from January 2019 to December 2019. All patients underwent polysomnography (PSG) to assess for OSA. OSA severity was identified based on the apnea hypopnea index (AHI), i.e., no OSA (AHI <5), mild OSA (5 = AHI <15), and moderate to severe OSA (AHI ≥15). Neuropsychological assessments were performed at acute phase and 6 months later to evaluate anxiety (Chinese version of the Zung self-rating anxiety scale [SAS], and Beck Anxiety Inventory [BAI]), depression (Patient Health Questionnaire-9, [PHQ-9]), and cognition (Mini-mental state examination, [MMSE], and Montreal Cognitive Assessment, [MOCA]). Clinical diagnoses of PSA were made based on interviews and the anxiety scales. The correlations between PSA and OSA were investigated in Logistic regression analysis. RESULTS The prevalence of acute-phase and 6-month PSA were 27 (15%) and 52 (28.9%) respectively. Moderate to severe OSA and post-stroke depression (PSD) were the influencing factors of acute-phase PSA. 6-Month PSA was not associated with OSA but was associated with acute-phase anxiety, education status and MOCA. Logistic regression analysis including respiratory and sleeping parameters showed that AHI and micro-arousal index contributed to acute-phase PSA. CONCLUSIONS Acute-phase PSA was associated with OSA severity, potentially through OSA-caused sleep discontinuity. While 6-month PSA was associated with acute-phase anxiety, highlighting the need for integration of screening for and management of OSA and PSA at acute phase.
Collapse
Affiliation(s)
- Qiongbin Zhu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Leihui Chen
- Department of Internal Medicine, The Wuyun Mountain Hospital of Hangzhou(The Health Promotion Institute of Hangzhou), Hangzhou, Zhejiang, China
| | - Qinglin Xu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiahui Xu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lisan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jin Wang
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| |
Collapse
|
6
|
Harper RM. Exploring the brain with sleep-related injuries, and fixing it. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad007. [PMID: 37193272 PMCID: PMC10148654 DOI: 10.1093/sleepadvances/zpad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Indexed: 05/18/2023]
Abstract
The focus of my research efforts rests with determining dysfunctional neural systems underlying disorders of sleep, and identifying interventions to overcome those disorders. Aberrant central and physiological control during sleep exerts serious consequences, including disruptions in breathing, motor control, blood pressure, mood, and cognition, and plays a major role in sudden infant death syndrome, congenital central hypoventilation, and sudden unexpected death in epilepsy, among other concerns. The disruptions can be traced to brain structural injury, leading to inappropriate outcomes. Identification of failing systems arose from the assessment of single neuron discharge in intact, freely moving and state-changing human and animal preparations within multiple systems, including serotonergic action and motor control sites. Optical imaging of chemosensitive, blood pressure and other breathing regulatory areas, especially during development, were useful to show integration of regional cellular action in modifying neural output. Identification of damaged neural sites in control and afflicted humans through structural and functional magnetic resonance imaging procedures helped to identify the sources of injury, and the nature of interactions between brain sites that compromise physiological systems and lead to failure. Interventions to overcome flawed regulatory processes were developed, and incorporate noninvasive neuromodulatory means to recruit ancient reflexes or provide peripheral sensory stimulation to assist breathing drive to overcome apnea, reduce the frequency of seizures, and support blood pressure in conditions where a failure to perfuse can lead to death.
Collapse
Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Brain Research Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
7
|
Zhao FJ, Chen QW, Wu Y, Xie X, Xu Z, Ni X. Facial Emotion Recognition Deficit in Children with Moderate/Severe Obstructive Sleep Apnea. Brain Sci 2022; 12:1688. [PMID: 36552148 PMCID: PMC9776404 DOI: 10.3390/brainsci12121688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Although previous studies have reported a facial expression classification deficit among adults with SDB, we do not know whether these findings can be generalized to children. In our study, children with sleep-disordered breathing (SDB) were divided into three groups: primary snoring (n = 51), mild obstructive sleep apnea (OSA) (n = 39), and moderate/severe OSA (n = 26). All participants, including 20 healthy controls, underwent an overnight polysomnography recording and the Emotional Expression Recognition Task. Psychosocial problems were evaluated using the parent-reported Strengths and Difficulties Questionnaire (SDQ). There was a borderline significant interaction between expression category and group on reaction times. Further analysis revealed that positive classification advantage (PCA) disappeared in the moderate/severe OSA group, whereas it persisted in the control, primary snoring, and mild OSA groups. Emotional symptoms were positively correlated with OAHI. In both the happy and sad conditions, RT was negatively related to age and body mass index (BMI) but was independent of the obstructive apnea-hypopnea index (OAHI), arterial oxygen (SaO2) and total sleep time. The accuracy of identifying a sad expression was negatively related to conduct problems. Children with moderate/severe OSA exhibited dysfunction in facial expression categorization, which could potentially affect social communication ability.
Collapse
Affiliation(s)
- Fu-Jun Zhao
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing 100045, China
| | - Qing-Wei Chen
- National Center for International Research on Green Optoelectronics, South China Normal University, Guangzhou 510006, China
- Lab of Light and Physio-Psychological Health, School of Psychology, South China Normal University, Guangzhou 510631, China
- Guangdong Provincial Key Laboratory of Optical Information Materials and Technology & Institute of Electronic Paper Displays, South China Academy of Advanced Optoelectronics, South China Normal University, Guangzhou 510006, China
| | - Yunxiao Wu
- Beijing Key Laboratory of Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing 100045, China
| | - Xiaohong Xie
- Division of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing 400014, China
- International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing 400715, China
| | - Zhifei Xu
- Department of Respiratory Medicine, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing 100045, China
| | - Xin Ni
- Department of Otolaryngology, Head and Neck Surgery, Beijing Children’s Hospital, National Center for Children’s Health, Capital Medical University, Beijing 100045, China
| |
Collapse
|
8
|
Roy B, Sahib AK, Kang D, Aysola RS, Kumar R. Brain tissue integrity mapping in adults with obstructive sleep apnea using T1-weighted and T2-weighted images. Ther Adv Neurol Disord 2022; 15:17562864221137505. [PMID: 36419869 PMCID: PMC9677310 DOI: 10.1177/17562864221137505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/21/2022] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is accompanied by both gray and white matter differences in brain areas that regulate autonomic, cognitive, and mood functions, which are deficient in the condition. Such tissue changes have been examined through diffusion tensor and diffusion kurtosis imaging-based procedures. However, poor in-plane spatial resolution of these techniques precludes precise determination of the extent of tissue injury. Tissue texture maps derived from the ratio of T1-weighted and T2-weighted images can provide more adequate in-plane assessment of brain tissue differences. OBJECTIVES To examine brain tissue integrity in recently diagnosed, treatment-naïve OSA subjects, relative to age- and sex-comparable control subjects using T1-weighted and T2-weighted images. DESIGN A cross-sectional study. METHODS We examined the extent of tissue changes in 106 OSA over 115 control subjects using high-resolution T1- and T2-weighted images collected from a 3.0-Tesla scanner (analysis of covariance; covariates: age, sex, body-mass-index, Pittsburgh sleep quality index, Epworth sleepiness scale, Beck Anxiety Inventory, and Beck Depression Inventory II; false discovery rate corrected; p < 0.01). RESULTS OSA subjects showed significantly lowered tissue integrity in several brain regions, including the frontal, cingulate and insular cortices, cingulum bundle, thalamus, corpus callosum, caudate and putamen, pons, temporal, occipital, and parietal sites, cerebellar peduncles, and medial medullary sites, compared with controls. CONCLUSION OSA subjects show widespread lowered tissue integrity in autonomic, mood, and cognitive control sites over healthy controls. The pathological processes contributing to the alterations may include repetitive hypoxic and hypercarbic processes and excitotoxic injury, leading to altered brain tissue integrity in OSA.
Collapse
Affiliation(s)
- Bhaswati Roy
- Department of Anesthesiology, University of
California, Los Angeles, Los Angeles, CA, USA
| | - Ashish K. Sahib
- Department of Anesthesiology, University of
California, Los Angeles, Los Angeles, CA, USA
| | - Daniel Kang
- Department of Medicine, University of
California, Los Angeles, Los Angeles, CA, USA
| | - Ravi S. Aysola
- Department of Medicine, University of
California, Los Angeles, Los Angeles, CA, USA
| | - Rajesh Kumar
- Department of Anesthesiology, David Geffen
School of Medicine at UCLA, University of California, Los Angeles, 56-141
CHS, 10833 Le Conte Ave., Los Angeles, CA 90095-1763, USA
- Department of Radiological Sciences, University
of California, Los Angeles, Los Angeles, CA, USA
- Department of Bioengineering, University of
California, Los Angeles, Los Angeles, CA, USA
- Brain Research Institute, University of
California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
9
|
Puech C, Badran M, Runion AR, Barrow MB, Qiao Z, Khalyfa A, Gozal D. Explicit memory, anxiety and depressive like behavior in mice exposed to chronic intermittent hypoxia, sleep fragmentation, or both during the daylight period. Neurobiol Sleep Circadian Rhythms 2022; 13:100084. [PMID: 36254342 PMCID: PMC9568859 DOI: 10.1016/j.nbscr.2022.100084] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/01/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic and highly prevalent condition characterized by chronic intermittent hypoxia (IH) and sleep fragmentation (SF), and can lead to a vast array of end-organ morbidities, particularly affecting cardiovascular, metabolic and neurobehavioral functioning. OSA can induce cognitive and behavioral and mood deficits. Male C57Bl/6J 8-week-old mice were housed in custom-designed cages with a silent motorized mechanical sweeper traversing the cage floor at 2-min intervals (SF) during daylight for four weeks. Sleep control (SC) consisted of keeping sweeper immobile. IH consisted of cycling FiO2 21% 90 seconds-6.3% 90s or room air (RA; FiO2 21%) for sixteen weeks and combined SF-IH was conducted for nine weeks. Open field novel object recognition (NOR) testing, elevated-plus maze test (EPMT), and forced swimming test (FST) were performed. SF induced cognitive NOR performance impairments in mice along with reduced anxiety behaviors while IH induced deficits in NOR performance, but increased anxiety behaviors. SF-IH induced impaired performance in NOR test of similar magnitude to IH or SF alone. Combined SF-IH exposures did not affect anxiety behaviors. Thus, both SF an IH altered cognitive function while imposing opposite effects on anxiety behaviors. SF-IH did not magnify the detrimental effects of isolated SF or IH and canceled out the effects on anxiety. Based on these findings, the underlying pathophysiologic processes underlying IH and SF adverse effects on cognitive function appear to differ, while those affecting anxiety counteract each other.
Collapse
Affiliation(s)
- Clementine Puech
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Mohammad Badran
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Alexandra R Runion
- Undergraduate Student Research Program, University of Missouri, Columbia, MO, USA
| | - Max B Barrow
- Undergraduate Student Research Program, University of Missouri, Columbia, MO, USA
| | - Zhuanhong Qiao
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - Abdelnaby Khalyfa
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
| | - David Gozal
- Child Health Research Institute, Department of Child Health, School of Medicine, University of Missouri, Columbia, MO, USA
| |
Collapse
|
10
|
Gharsalli H, Harizi C, Zaouche R, Sahnoun I, Saffar F, Maalej S, Douik El Gharbi L. Prevalence of depression and anxiety in obstructive sleep apnea. LA TUNISIE MEDICALE 2022; 100:525-533. [PMID: 36571741 PMCID: PMC9703910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Organic comorbidities of obstructive sleep apnea (OSA) have been widely studied. However, psychiatric disorders, especially depression and anxiety, have not attracted so much attention. AIM The primary aim was to determine the prevalence and the predictive factors of depression and anxiety in OSA patients. The secondary aim was to investigate the association between OSA severity and these psychiatric disorders. METHODS A cross-sectional study including untreated OSA patients without mental illness history was conducted. Patients were administered the Hospital Anxiety (HADS-A) and Depression Scale (HADS-D). Depression and anxiety were diagnosed for HAD-D and HAD-A scores ≥ 8. RESULTS Eighty patients were included (mean age: 54.83 ± 13.12 yr; female: 52 (65%); mean Body mass index (BMI) :34.7±6.14 kg/m2). The prevalence of depression and anxiety was 35 % and 43.8% of patients respectively. Both depressive and anxious OSA patients had more libido disorder ( p=0.011, p=0.0007 ;respectively), anhedonia (p= 10-4, p= 10-4respectively ) and suicidal ideas(p= 0.002 ,p=0.019 respectively). Moreover, depressed OSA patients had lower socio-economic condition (p= 0.019), more coronary artery diseases (CAD) (p=0.019) and less cognitive disorder (p= 0.005). The HADS-D (r=0,095; p=0,404) and the HADS-A (r=0,212; p=0,059) were not correlated with the Apnea/Hyponea Index. The determinants of depressive and anxious mood were female-sex (p= 0.035, p=0.004 respectively) and libido disorder (p=0.040, p=0.02 respectively). Anhedonia (p=10-4) and CAD (p=0.010) were also identified as a predictive factors of depression. CONCLUSIONS In our study, the high prevalence of depression and axiety in apneic patients demonstrates the importance of the psychiatric component in the management of this disease. A collaboration between pneumologists and psychiatrists is necessary in order to improve the quality of life of these patients.
Collapse
Affiliation(s)
- Houda Gharsalli
- 1. Department of Pulmonology, A. Mami Hospital, Ariana, University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Chahida Harizi
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Rania Zaouche
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia,3. El Razi Hospital for psychiatric disorders , Manouba, Tunisia
| | - Imen Sahnoun
- 1. Department of Pulmonology, A. Mami Hospital, Ariana, University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Farah Saffar
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Sonia Maalej
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| | - Leila Douik El Gharbi
- 2. Epidemiology Department, A. Mami Hospital, Ariana, Tunisia / University Tunis El Manar, faculty of medicine of Tunis, Tunisia
| |
Collapse
|
11
|
Duan X, Zheng M, Zhao W, Huang J, Lao L, Li H, Lu J, Chen W, Liu X, Deng H. Associations of Depression, Anxiety, and Life Events With the Risk of Obstructive Sleep Apnea Evaluated by Berlin Questionnaire. Front Med (Lausanne) 2022; 9:799792. [PMID: 35463036 PMCID: PMC9021543 DOI: 10.3389/fmed.2022.799792] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Psychological problems are prevalent in the general population, and their impacts on sleep health deserve more attention. This study was to examine the associations of OSA risk with depression, anxiety, and life events in a Chinese population. Methods A total of 10,287 subjects were selected from the Guangzhou Heart Study. Berlin Questionnaire (BQ) was used to ascertain the OSA. The Center for Epidemiologic Studies Depression Scale (CES-D) and Zung's self-rating anxiety scale (SAS) were used to define depression and anxiety. A self-designed questionnaire was used to assess life events. Odds ratio (OR) with 95% confidence interval (95% CI) was calculated by using the logistic regression model. Results There were 1,366 subjects (13.28%) classified into the OSA group. After adjusting for potential confounders, subjects with anxiety (OR: 2.60, 95% CI: 1.63-4.04) and depression (OR: 1.91, 95% CI: 1.19-2.97) were more likely to have OSA. Subjects suffering from both anxiety and depression were associated with a 3.52-fold (95% CI: 1.88-6.31) risk of OSA. Every 1-unit increment of CES-D score and SAS index score was associated with 13% (95% CI: 1.11-1.15) and 4% (95% CI: 1.03-1.06) increased risk of OSA. Neither positive life events nor adverse life events were associated with OSA. Conclusions The results indicate that depression and anxiety, especially co-occurrence of both greatly, were associated with an increased risk of OSA. Neither adverse life events nor positive life events were associated with any risk of OSA. Screening for interventions to prevent and manage OSA should pay more attention to depression and anxiety.
Collapse
Affiliation(s)
- Xueru Duan
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Murui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Jun Huang
- Department of Geriatrics, Institute of Geriatrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Lixian Lao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Haiyi Li
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jiahai Lu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| |
Collapse
|
12
|
Song X, Roy B, Vacas S, Woo MA, Kang DW, Aysola RS, Kumar R. Brain regional homogeneity changes after short-term positive airway pressure treatment in patients with obstructive sleep apnea. Sleep Med 2022; 91:12-20. [PMID: 35245787 PMCID: PMC10498724 DOI: 10.1016/j.sleep.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 12/16/2022]
Abstract
Patients with obstructive sleep apnea (OSA) reveal functional changes in brain sites involved in autonomic, cognitive, and mood regulations. However, it is unclear whether these brain changes reverse with short-term positive airway pressure (PAP) treatment. Our aim was to examine brain functional changes in response to 3-months of PAP treatment using regional homogeneity (ReHo) measures, where increased and decreased ReHo value indicates hyper- and hypo-local neural activities, respectively, and considered as functional deficits. We collected brain magnetic resonance imaging data as well as mood, cognitive, and sleep variables from 17 treatment-naïve OSA at baseline and after 3-months of PAP treatment and 25 age- and gender-matched healthy controls. Whole-brain ReHo maps were calculated and compared between OSA and controls and OSA subjects before and after PAP treatment. At baseline, treatment-naïve OSA subjects showed higher ReHo in the bilateral thalamus, putamen, postcentral gyrus, paracentral lobule, supplementary motor area, and right insula, and lower ReHo in the frontal and parietal cortices, compared to controls. After 3-months of PAP treatment, abnormal sleep and mood scores decreased significantly to normal levels. ReHo decreased in the autonomic and somatosensory control areas, including the thalamus, putamen, postcentral gyrus, and insula, and increased in the cognitive and affective regulatory parietal regions. The normalized ReHo was correlated with improved sleep quality and reduced anxiety symptoms. These findings suggest that 3-months of PAP use can improve sleep, mood issues, and partly recover brain activities, however, longer PAP treatment may be required to fully and permanently reverse brain functional deficits.
Collapse
Affiliation(s)
- Xiaopeng Song
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Bhaswati Roy
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Susana Vacas
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Daniel W Kang
- Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ravi S Aysola
- Department of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA; Department of Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA.
| |
Collapse
|
13
|
Kong L, Li H, Shu Y, Liu X, Li P, Li K, Xie W, Zeng Y, Peng D. Aberrant Resting-State Functional Brain Connectivity of Insular Subregions in Obstructive Sleep Apnea. Front Neurosci 2022; 15:765775. [PMID: 35126035 PMCID: PMC8813041 DOI: 10.3389/fnins.2021.765775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
The insular cortex is a cortical regulatory area involved in dyspnea, cognition, emotion, and sensorimotor function. Previous studies reported that obstructive sleep apnea (OSA) shows insular tissue damage and abnormal functional connections for the whole insula. The insula can be divided into different subregions with distinct functional profiles, including the ventral anterior insula (vAI) participating in affective processing, dorsal anterior insula (dAI) involved in cognitive processing, and posterior insula (PI) involved in the processing of sensorimotor information. However, the functional connectivity (FC) of these insular subregions in OSA has yet to be established. Hence, the purpose of this study was to explore the resting-state FC of the insular subregions with other brain areas and its relationship with clinical symptoms of OSA. Resting-state functional magnetic resonance imaging data from 83 male OSA patients and 84 healthy controls were analyzed by whole-brain voxel-based FC using spherical seeds from six insular subregions, namely, the bilateral vAI, dAI, and PI, to identify abnormalities in the insular subregions network and related brain regions. Ultimately, the Pearson correlation analysis was carried out between the dysfunction results and the neuropsychological tests. Compared with the healthy control group, the OSA patients exhibited disturbed FC from the dAI to areas relevant to cognition, such as the bilateral cerebellum posterior lobe, superior frontal gyrus, right middle frontal gyrus and middle temporal gyrus; decreased FC from the vAI to areas linked with emotion, such as the bilateral fusiform gyrus, superior parietal lobule, precuneus and cerebellum posterior lobe; and abnormal FC from the PI to the brain regions involved in sensorimotor such as the bilateral precentral gyrus, right superior/middle temporal gyrus and left superior frontal gyrus. The linear regression result showed that the apnea-hypopnea index was positively correlated with the increased FC between the right PI and the right precuneus (after Bonferroni correlation, P < 0.001) In conclusion, the abnormal FC between insular subregions and other brain regions were related to cognitive, emotional and sensorimotor networks in OSA patients. These results may provide a new imaging perspective for further understanding of OSA-related cognitive and affective disorders.
Collapse
|
14
|
Ben Thabet J, Gassara I, Smaoui N, Msaad S, Maalej Bouali M, Yaich S, Omri S, Feki R, Zouari L, Charfi N, Maalej M. [Effects of continuous positive airway pressure on depression, anxiety and quality of life in obstructive sleep apnea hypopnea syndrome patients]. Encephale 2021; 48:397-403. [PMID: 34311963 DOI: 10.1016/j.encep.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The obstructive sleep apnea hypopnea syndrome (OSAHS) is a chronic stressor that may alter the emotional state and quality of life (QOL) of patients suffering from it. In this work, we proposed to estimate the prevalence of depression and anxiety, to assess the QOL in a Tunisian population of apneic patients, and to assess their evolution under continuous positive airway pressure (CPAP). METHODS We conducted a prospective study, involving 33 apneic patients followed for SAHOS with moderate or severe class disease in the pneumology department at Hedi Chaker university hospital in Sfax, Tunisia. They received CPAP treatment for three months. We used an epidemiological record. Two scales, the Hospital Anxiety and Depression Scale (HADS) and the 36-item Short-Form Health Survey (SF-36), were completed before and after treatment to evaluate the effect of three months of treatment with CPAP. RESULTS The prevalence of depression in the study's patients, according to the HADS, was 45.5% and that of anxiety was 21.2%. After 3months of CPAP, the prevalence of depression and anxiety had become 18.2% and 6.1%, respectively. QOL was impaired in 81.8% of cases before treatment, according to the SF-36. This figure had decreased to 69.7% after 3months of treatment with CPAP. Apart from the third dimension (physical pain), all other dimensions were significantly improved after 3months of CPAP treatment. The treatment with CPAP induced a significant improvement in the average scores of depression (P<0.001), anxiety (P=0.002) and QOL (P<0.001). CONCLUSIONS These results attest to the importance of the frequency of anxio-depressive disorders as well as an altered QOL in patients with OSAHS. CPAP treatment was shown to be effective in improving these parameters, but this efficacy was partial. Specialized care may be needed in cases of residual anxio-depressive symptoms.
Collapse
Affiliation(s)
- J Ben Thabet
- Service de psychiatrie « C », CHU Hédi Chaker, route Elain km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| | - I Gassara
- Service de psychiatrie légale, hôpital Razi, Mannouba, Tunis, Tunisie
| | - N Smaoui
- Service de psychiatrie « C », CHU Hédi Chaker, route Elain km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie.
| | - S Msaad
- Service de pneumologie, CHU Hédi Chaker, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| | - M Maalej Bouali
- Service de psychiatrie « C », CHU Hédi Chaker, route Elain km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| | - S Yaich
- Service de médecine préventive, CHU Hédi Chaker, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| | - S Omri
- Service de psychiatrie « C », CHU Hédi Chaker, route Elain km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| | - R Feki
- Service de psychiatrie « C », CHU Hédi Chaker, route Elain km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| | - L Zouari
- Service de psychiatrie « C », CHU Hédi Chaker, route Elain km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| | - N Charfi
- Service de psychiatrie « C », CHU Hédi Chaker, route Elain km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| | - M Maalej
- Service de psychiatrie « C », CHU Hédi Chaker, route Elain km 0,5, 3029 Sfax, Tunisie; Faculté de médecine de Sfax, université de Sfax, Sfax, Tunisie
| |
Collapse
|
15
|
Wong JL, Martinez F, Aguila AP, Pal A, Aysola RS, Henderson LA, Macey PM. Stress in obstructive sleep apnea. Sci Rep 2021; 11:12631. [PMID: 34135372 PMCID: PMC8209037 DOI: 10.1038/s41598-021-91996-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/03/2021] [Indexed: 12/03/2022] Open
Abstract
People with obstructive sleep apnea (OSA) often have psychological symptoms including depression and anxiety, which are commonly treated with anti-depression or anti-anxiety interventions. Psychological stress is a related symptom with different intervention targets that may also improve mental state, but this symptom is not well characterized in OSA. We therefore aimed to describe stress in relation to other psychological symptoms. We performed a prospective cross-sectional study of 103 people, 44 untreated OSA (mean ± s.d. age: 51.2 ± 13.9 years, female/male 13/31) and 57 healthy control participants (age: 46.3 ± 13.8 years, female/male 34/23). We measured stress (Perceived Stress Scale; PSS), excessive daytime sleepiness (Epworth Sleepiness Scale; ESS), depressive symptoms (Patient Health Questionnaire; PHQ-9), and anxiety symptoms (General Anxiety Disorder; GAD-7). We compared group means with independent samples t-tests and calculated correlations between variables. Mean symptom levels were higher in OSA than control, including PSS (mean ± s.d.: OSA = 15.3 ± 6.9, control = 11.4 ± 5.5; P = 0.002), GAD-7 (OSA = 4.8 ± 5.0, control = 2.1 ± 3.9; P = 0.02), PHQ-9 (OSA = 6.9 ± 6.1, control = 2.6 ± 3.8; P = 0.003) and ESS (OSA = 8.1 ± 5.3, control = 5.0 ± 3.3; P = 0.03). Similar OSA-vs-control differences appeared in males, but females only showed significant differences in PHQ-9 and ESS, not PSS or GAD-7. PSS correlated strongly with GAD-7 and PHQ-9 across groups (R = 0.62–0.89), and moderately with ESS. Perceived stress is high in OSA, and closely related to anxiety and depressive symptoms. The findings support testing stress reduction in OSA.
Collapse
Affiliation(s)
- Jasmine L Wong
- UCLA School of Nursing, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA
| | - Fernando Martinez
- UCLA School of Nursing, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA
| | - Andrea P Aguila
- UCLA School of Nursing, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA
| | - Amrita Pal
- UCLA School of Nursing, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA
| | - Ravi S Aysola
- Department of Medicine (Division of Pulmonary and Critical Care), David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, 90095, USA
| | - Luke A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA. .,Brain Research Institute, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, 90095, USA.
| |
Collapse
|
16
|
Madrid-Valero JJ, Barclay NL, Rowe R, Perach R, Buysse DJ, Ordoñana JR, Eley TC, Gregory AM. Association between symptoms of sleep apnea and problem behaviors in young adult twins and siblings. Psychol Med 2021; 51:1175-1182. [PMID: 32026794 DOI: 10.1017/s0033291719004070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Sleep apnea is one of the most common sleep disorders and it is related to multiple negative health consequences. Previous studies have shown that sleep apnea is influenced by genetic factors. However, studies have not investigated the genetic and environmental influences of symptoms of sleep apnea in young adults. Furthermore, the underpinnings of the relationship between apnea symptoms and internalizing/externalizing problems are unknown. The objectives of this study were to estimate the magnitude of: (1) genetic and environmental influences on self-reported apnea symptoms; (2) the relationship between self-reported apnea symptoms and internalizing/externalizing traits; (3) genetic and environmental influences on the associations between self-reported apnea symptoms, internalizing behaviors and externalizing behaviors. METHODS In a twin/sibling study, univariate and multivariate models were fitted to estimate both individual variance and sources of covariance between symptoms of sleep apnea and internalizing/externalizing behaviors. RESULTS Our results show that genetic influences account for 40% of the variance in sleep apnea symptoms. Moreover, there are modest associations between depression, anxiety and externalizing behaviors with apnea symptoms (ranging from r = 0.22-0.29). However, the origins of these associations differ. For example, whereas most of the covariation between symptoms of depression and sleep apnea can be explained by genes (95%), there was a larger role for the environment (53%) in the association between symptoms of anxiety and sleep apnea. CONCLUSIONS Genetic factors explain a significant proportion of variance in symptoms of apnea and most of the covariance with depression.
Collapse
Affiliation(s)
- Juan J Madrid-Valero
- Department of Human Anatomy and Psychobiology, University of Murcia, Murcia, Spain
- Murcia Institute of Biomedical Research, IMIB-Arrixaca, Murcia, Spain
| | - Nicola L Barclay
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Richard Rowe
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Rotem Perach
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Daniel J Buysse
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Juan R Ordoñana
- Department of Human Anatomy and Psychobiology, University of Murcia, Murcia, Spain
- Murcia Institute of Biomedical Research, IMIB-Arrixaca, Murcia, Spain
| | - Thalia C Eley
- King's College London, MRC Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| |
Collapse
|
17
|
Gulec Balbay E, Yildiz P, Elverisli MF, Cangur S, Erçelik M. The eating attitudes in patients with obstructive sleep apnea syndrome. Aging Male 2020; 23:1170-1175. [PMID: 32048528 DOI: 10.1080/13685538.2020.1718090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM Obstructive sleep apnea syndrome (OSAS) patients show multiple physiological deficits and several neuropsychological comorbidities. The aim of this study was to investigate the eating attitudes in OSAS patients. MATERIAL AND METHODS Polysomnography records of 157 were performed. Eating Attitudes Test (EAT), Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) were applied to all participants. RESULTS The mean age of the 157 individuals included in the study was 47.2 ± 11.4 (18-76) years and 36% (n = 56) of the individuals were female and 64% (n = 101) were male. When the patients were ranked according to the severity of OSAS, 38.2% (n = 60) were severe, 20.4% (n = 32) were moderate, 24.2% (n = 38) were mild, and 17.2% (n = 27) were OSAS negative. There was a significant difference in terms of the age-and-BMI-adjusted EAT score according to OSAS severity (p = .042). There was a significant difference in the age-and-BMI-adjusted value of the EAT according to the presence of OSAS (p = .011). After controlling age and BMI, no significant correlation was found between the EAT and the BDI (r = 0.012, p = .890) in patients with OSAS while there was a significant positive correlation EAT and the BAI (r = 0.177, p = .046). CONCLUSIONS Considering the association of OSAS with psychiatric disorders, the presence of eating disorders (EDs) becomes an important and special topic. Treatment of patients with OSAS should not only aim to improve the patient's sleep apnea, but also to improve the patient's quality of life by evaluating the patient's psychological and physical functions.
Collapse
Affiliation(s)
- Ege Gulec Balbay
- Department of Chest Disease, Faculty of Medicine, Duzce University, Düzce, Turkey
| | - Pınar Yildiz
- Department of Chest Disease, Faculty of Medicine, Duzce University, Düzce, Turkey
| | | | - Sengul Cangur
- Department of Bioistatistics and Medical Informatics, Faculty of Medicine, Duzce University, Düzce, Turkey
| | - Merve Erçelik
- Department of Chest Disease, Faculty of Medicine, Duzce University, Düzce, Turkey
| |
Collapse
|
18
|
Rostampour M, Noori K, Heidari M, Fadaei R, Tahmasian M, Khazaie H, Zarei M. White matter alterations in patients with obstructive sleep apnea: a systematic review of diffusion MRI studies. Sleep Med 2020; 75:236-245. [DOI: 10.1016/j.sleep.2020.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/25/2022]
|
19
|
Tian J, Li L, Tao CL, Hao RY, Huang FH, Ge XH, Zhang SM. A glimpse into the psychological status of E.N.T inpatients in China: A cross-sectional survey of three hospitals in different regions. World J Otorhinolaryngol Head Neck Surg 2019; 5:95-104. [PMID: 31334488 PMCID: PMC6617534 DOI: 10.1016/j.wjorl.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 11/10/2018] [Accepted: 11/13/2018] [Indexed: 12/19/2022] Open
Abstract
Objective To determine whether E.N.T inpatients have a higher prevalence of mental illness than the general population and whether certain diseases are more likely to be associated with mental illness than other diseases. Methods This cross-sectional survey was conducted in the E.N.T departments of three hospitals in different cities in China. The psychological status of all consecutive adult inpatients was assessed within 1–2 days following hospital admission using the Symptom Checklist-90 (SCL-90), Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS). Inpatients from the general surgery and pneumology departments at the same hospital were enrolled and surveyed as control groups. Results The 439 patients enrolled in the final analysis accounted for 88.0% of all E.N.T inpatients during the study period. Of these patients, 16.4% were in an anxious state and 79.5% were in a depressive state. The overall anxiety (41.7 ± 9.7) and depression (55.9 ± 29.2) scores were much higher than Chinese norm (29.8 ± 10.0 and 33.5 ± 8.6, respectively), and significant differences were observed (t = 20.89, P < 0.01 and t = 13.12, P < 0.01, respectively). Although 18.7% of the E.N.T patients were psychiatric distress, these patients scored lower on the SCL-90 than the Chinese norm. Furthermore, the patients in the E.N.T department had a higher prevalence of anxiety and depression than those in the general surgery department but a similar prevalence to those in the respiratory department. Conclusion Psychological distress, particularly anxiety and depression, are widespread in patients with otolaryngological diseases. Therefore, the identification and treatment of co-occurring psychiatric disorders in this high risk and clinically challenging group of patients are urgent in China.
Collapse
Affiliation(s)
- Jun Tian
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Li Li
- Department of Otolaryngology Head and Neck Surgery, Hospital of Renmin University of China, Beijing, China
| | - Chun-Lei Tao
- Department of Otolaryngology Head and Neck Surgery, Heze Medical College, Shandong Province, China
| | - Rong-Ying Hao
- Department of Otolaryngology Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fu-Hui Huang
- Department of Otolaryngology Head and Neck Surgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xiao-Hui Ge
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - San-Mei Zhang
- Department of Medical Oncology, Shanxi Dayi Hospital, Shanxi Academy of Medical Science, Taiyuan, Shanxi Province, China
| |
Collapse
|
20
|
Chen YJ, Liu YC, Liu YW, Lee YB, Huang HC, Chen YY, Shih YH, Lee YC, Cheng CF, Meng TC. Nitrite Protects Neurons Against Hypoxic Damage Through S-nitrosylation of Caspase-6. Antioxid Redox Signal 2019; 31:109-126. [PMID: 30417658 DOI: 10.1089/ars.2018.7522] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aims: The coordination of neurons to execute brain functions requires plenty of oxygen. Thus, it is not surprising that the chronic hypoxia resulting from chronic obstructive pulmonary diseases (COPD) can cause neuronal damage. Injury in the cortex can give rise to anxiety and cognitive dysfunction. This study investigated what causes hypoxia-induced neuronal injury and what strategies might be used to protect neurons against such damage. Results: This study found that hypoxia in primary cortical neurons caused neurite retraction, a caspase-6-dependent process. The hypoxic stress activated caspase-6 within the neurite, leading to microtubule disassembly and neurite retraction. The effect of hypoxia on caspase-6 activation, microtubule disassembly, and neurite retraction was alleviated by nitrite treatment. The protective role of nitrite was further supported by the observation that the active-site Cys146 of caspase-6 was S-nitrosylated in hypoxic neuro-2a cells treated with nitrite. We further validated the beneficial effect of nitrite on neuronal function against hypoxic stress in vivo. Using the wild-type or Apo E-/- mice exposed to chronic hypoxia as a model, we demonstrated that supplementing drinking water with nitrite suppressed active caspase-6 in the cortex of the brain, concomitant with the prevention of hypoxia-induced anxiety in the animals. Innovation: These results are the first evidence of a new pathway for the activation of caspase-6 and the first to indicate that nitrite can protect neurons against chronic hypoxic insult. Conclusion: Our findings suggest that nitrite holds great potential for the treatment of diseases such as COPD associated with hypoxia-induced neuronal injury.
Collapse
Affiliation(s)
- Yen-Jung Chen
- 1 Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan.,2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yun-Chung Liu
- 1 Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan.,2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yu-Wen Liu
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yu-Bin Lee
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Hsin-Chieh Huang
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Yi-Yun Chen
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | | | - Ying-Chu Lee
- 2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| | - Ching-Feng Cheng
- 4 Department of Medical Research, Tzu Chi University, Hualien, Taiwan.,5 Department of Pediatrics, Tzu Chi General Hospital, Hualien, Taiwan.,6 Institutes of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Tzu-Ching Meng
- 1 Institute of Biochemical Sciences, National Taiwan University, Taipei, Taiwan.,2 Institutes of Biological Chemistry, Academia Sinica, Taipei, Taiwan
| |
Collapse
|
21
|
Cross-sectional examination of gender differences in depression and anxiety symptoms in patients with obstructive sleep apnea. Sleep Biol Rhythms 2019. [DOI: 10.1007/s41105-019-00225-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
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: 25] [Impact Index Per Article: 5.0] [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
|
23
|
Intermittent Hypoxia Disrupts Adult Neurogenesis and Synaptic Plasticity in the Dentate Gyrus. J Neurosci 2018; 39:1320-1331. [PMID: 30587544 DOI: 10.1523/jneurosci.1359-18.2018] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/03/2018] [Accepted: 09/27/2018] [Indexed: 01/06/2023] Open
Abstract
Individuals with sleep apnea often exhibit changes in cognitive behaviors consistent with alterations in the hippocampus. It is hypothesized that adult neurogenesis in the dentate gyrus is an ongoing process that maintains normal hippocampal function in many mammalian species, including humans. However, the impact of chronic intermittent hypoxia (IH), a principal consequence of sleep apnea, on hippocampal adult neurogenesis remains unclear. Using a murine model, we examined the impact of 30 d of IH (IH30) on adult neurogenesis and synaptic plasticity in the dentate gyrus. Although IH30 did not affect paired-pulse facilitation, IH30 suppressed long-term potentiation (LTP). Immunohistochemical experiments also indicate that IH perturbs multiple aspects of adult neurogenesis. IH30 increased the number of proliferating Sox2+ neural progenitor cells in the subgranular zone yet reduced the number of doublecortin-positive neurons. Consistent with these findings, cell lineage tracing revealed that IH30 increased the proportion of radial glial cells in the subgranular zone, yet decreased the proportion of adult-born neurons in the dentate gyrus. While administration of a superoxide anion scavenger during IH did not prevent neural progenitor cell proliferation, it mitigated the IH-dependent suppression of LTP and prevented adult-born neuron loss. These data demonstrate that IH causes both reactive oxygen species-dependent and reactive oxygen species-independent effects on adult neurogenesis and synaptic plasticity in the dentate gyrus. Our findings identify cellular and neurophysiological changes in the hippocampus that may contribute to cognitive and behavioral deficits occurring in sleep apnea.SIGNIFICANCE STATEMENT Individuals with sleep apnea experience periods of intermittent hypoxia (IH) that can negatively impact many aspects of brain function. Neurons are continually generated throughout adulthood to support hippocampal physiology and behavior. This study demonstrates that IH exposure attenuates hippocampal long-term potentiation and reduces adult neurogenesis. Antioxidant treatment mitigates these effects indicating that oxidative signaling caused by IH is a significant factor that impairs synaptic plasticity and reduces adult neurogenesis in the hippocampus.
Collapse
|
24
|
Nair D, Ramesh V, Gozal D. Cognitive Deficits Are Attenuated in Neuroglobin Overexpressing Mice Exposed to a Model of Obstructive Sleep Apnea. Front Neurol 2018; 9:426. [PMID: 29922222 PMCID: PMC5996123 DOI: 10.3389/fneur.2018.00426] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/22/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Obstructive sleep apnea (OSA) is a highly prevalent disease manifesting as intermittent hypoxia during sleep (IH) and is increasingly recognized as being independently associated with neurobehavioral deficits. These deficits may be due to increased apoptosis in the hippocampus and cerebral cortex, as well as increased oxidative stress and inflammation. It has been reported that neuroglobin (Ngb) is upregulated in response to hypoxia-ischemia insults and exhibits a protective role in ischemia-reperfusion brain injury. We hypothesized that transgenic overexpression of Ngb would attenuate spatial learning deficits in a murine model of OSA. Methods:Wild-type mice and Ngb overexpressing male mice (Ngb-TG) were randomly assigned to either IH or room air (RA) exposures. The effects of IH during the light period on performance in a water maze spatial task were assessed, as well as anxiety and depressive-like behaviors using elevated plus maze (EPM) and forced swim tests. Cortical tissues from all the mice were extracted for biochemical studies for lipid peroxidation. Results:Ngb TG mice exhibited increased Ngb immunoreactivity in brain tissues and IH did not elicit significant changes in Ngb expression in either Ngb-TG mice or WT mice. On a standard place training task in the water maze, Ngb-TG mice displayed preserved spatial learning, and were protected from the reduced spatial learning performances observed in WT mice exposed to IH. Furthermore, anxiety and depression levels were enhanced in WT mice exposed to IH as compared to RA controls, while alterations emerged in Ngb-TG mice exposed to IH. Furthermore, WT mice, but not Ngb-TG mice had significantly elevated levels of malondialdehyde in cortical lysates following IH exposures. Conclusions:In a murine model of OSA, oxidative stress responses and neurocognitive and behavioral impairments induced by IH during sleep are attenuated by the neuroprotective effects of Ngb.
Collapse
Affiliation(s)
- Deepti Nair
- Section of Sleep Medicine, Biological Sciences Division, Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States.,Atlantic Health System, Morristown, NJ, United States.,Biomedical Research Institute of New Jersey, Cedar Knolls, NJ, United States
| | - Vijay Ramesh
- Section of Sleep Medicine, Biological Sciences Division, Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States
| | - David Gozal
- Section of Sleep Medicine, Biological Sciences Division, Department of Pediatrics, Pritzker School of Medicine, The University of Chicago, Chicago, IL, United States
| |
Collapse
|
25
|
Song X, Roy B, Kang DW, Aysola RS, Macey PM, Woo MA, Yan-Go FL, Harper RM, Kumar R. Altered resting-state hippocampal and caudate functional networks in patients with obstructive sleep apnea. Brain Behav 2018; 8:e00994. [PMID: 29749715 PMCID: PMC5991585 DOI: 10.1002/brb3.994] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 03/29/2018] [Accepted: 04/06/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Brain structural injury and metabolic deficits in the hippocampus and caudate nuclei may contribute to cognitive and emotional deficits found in obstructive sleep apnea (OSA) patients. If such contributions exist, resting-state interactions of these subcortical sites with cortical areas mediating affective symptoms and cognition should be disturbed. Our aim was to examine resting-state functional connectivity (FC) of the hippocampus and caudate to other brain areas in OSA relative to control subjects, and to relate these changes to mood and neuropsychological scores. METHODS We acquired resting-state functional magnetic resonance imaging (fMRI) data from 70 OSA and 89 healthy controls using a 3.0-Tesla magnetic resonance imaging scanner, and assessed psychological and behavioral functions, as well as sleep issues. After standard fMRI data preprocessing, FC maps were generated for bilateral hippocampi and caudate nuclei, and compared between groups (ANCOVA; covariates, age and gender). RESULTS Obstructive sleep apnea subjects showed significantly higher levels of anxiety and depressive symptoms over healthy controls. In OSA subjects, the hippocampus showed disrupted FC with the thalamus, para-hippocampal gyrus, medial and superior temporal gyrus, insula, and posterior cingulate cortex. Left and right caudate nuclei showed impaired FC with the bilateral inferior frontal gyrus and right angular gyrus. In addition, altered limbic-striatal-cortical FC in OSA showed relationships with behavioral and neuropsychological variables. CONCLUSIONS The compromised hippocampal-cortical FC in OSA may underlie depression and anxious mood levels in OSA, while impaired caudate-cortical FC may indicate deficits in reward processing and cognition. These findings provide insights into the neural mechanisms underlying the comorbidity of mood and cognitive deficits in OSA.
Collapse
Affiliation(s)
- Xiaopeng Song
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Bhaswati Roy
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Daniel W Kang
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Ravi S Aysola
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Frisca L Yan-Go
- Department of Neurology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Ronald M Harper
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA, USA.,Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA, USA.,Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA, USA.,Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW To summarize recent research investigating the interaction between obstructive sleep apnea (OSA) and anxiety, and contextualize their bidirectional relationship. RECENT FINDINGS Recent investigations corroborate the bidirectional relationship between sleep-disordered breathing (SDB) and anxiety, evaluate the etiological and clinical manifestations through different mechanisms, and provide insight into clinical implications of this interaction. Much of the literature about anxiety as it relates to SDB is from small samples, using different tools of symptom measurement that are often subjectively quantified. The objective severity of OSA does not appear to be associated with subjectively reported sleepiness and fatigue, whereas physiological manifestations of anxiety are associated with the severity of subjective symptoms reported. Recent findings support that women are more likely to have comorbid SDB and anxiety than men. SDB may precipitate and perpetuate anxiety, whereas anxiety in OSA negatively impacts quality-of-life. Treating SDB may improve anxiety symptoms, whereas anxiety symptoms can be an obstacle and deterrent to appropriate treatment. SUMMARY The interaction between anxiety and SDB is still poorly elucidated. Being aware of the clinical associations, risk factors, and treatment implications for SDB as related to anxiety disorders in different populations can help clinicians with the diagnosis and management of both SDB and anxiety.
Collapse
|
27
|
Non-Gaussian Diffusion Imaging Shows Brain Myelin and Axonal Changes in Obstructive Sleep Apnea. J Comput Assist Tomogr 2017; 41:181-189. [PMID: 27801694 DOI: 10.1097/rct.0000000000000537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is accompanied by brain changes in areas that regulate autonomic, cognitive, and mood functions, which were initially examined by Gaussian-based diffusion tensor imaging measures, but can be better assessed with non-Gaussian measures. We aimed to evaluate axonal and myelin changes in OSA using axial (AK) and radial kurtosis (RK) measures. MATERIALS AND METHODS We acquired diffusion kurtosis imaging data from 22 OSA and 26 controls; AK and RK maps were calculated, normalized, smoothed, and compared between groups using analysis of covariance. RESULTS Increased AK, indicating axonal changes, emerged in the insula, hippocampus, amygdala, dorsolateral pons, and cerebellar peduncles and showed more axonal injury over previously identified damage. Higher RK, showing myelin changes, appeared in the hippocampus, amygdala, temporal and frontal lobes, insula, midline pons, and cerebellar peduncles and showed more widespread myelin damage over previously identified injury. CONCLUSIONS Axial kurtosis and RK measures showed widespread changes over Gaussian-based techniques, suggesting a more sensitive nature of kurtoses to injury.
Collapse
|
28
|
Soliz J, Tam R, Kinkead R. Neonatal Maternal Separation Augments Carotid Body Response to Hypoxia in Adult Males but Not Female Rats. Front Physiol 2016; 7:432. [PMID: 27729873 PMCID: PMC5037225 DOI: 10.3389/fphys.2016.00432] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/12/2016] [Indexed: 12/20/2022] Open
Abstract
Perinatal exposure to adverse experiences disrupts brain development, including the brainstem network that regulates breathing. At adulthood, rats previously subjected to stress (in the form of neonatal maternal separation; NMS) display features reported in patients suffering from sleep disordered breathing, including an increased hypoxic ventilatory response and hypertension. This effect is also sex-specific (males only). Based on these observations, we hypothesized that NMS augments the carotid body's O2-chemosensitivity. Using an isolated and perfused ex vivo carotid body preparation from adult rats we compared carotid sinus nerve (CSN) responses to hypoxia and hypercapnia in carotid bodies harvested from adult rats that either experienced control conditions (no experimental manipulation) or were subjected to NMS (3 h/day from postnatal days 3 to 12). In males, the CSN response to hypoxia measured in preparations from NMS males was 1.5 fold higher than controls. In control rats, the female's response was similar to that of males; however, the increase in CSN activity measured in NMS females was 3.0 times lower than controls. The CSN response to hypercapnia was not influenced by stress or sex. We conclude that NMS is sufficient to have persistent and sex-specific effects on the carotid body's response to hypoxia. Because NMS also has sex-specific effects on the neuroendocrine response to stress, we propose that carotid body function is influenced by stress hormones. This, in turn, leads to a predisposition toward cardio-respiratory disorders.
Collapse
Affiliation(s)
| | | | - Richard Kinkead
- Department of Pediatrics, Centre de Recherche du CHU de Québec, Hôpital St-François d'Assise, Université LavalQuébec, QC, Canada
| |
Collapse
|
29
|
Li YY, Mazarakis T, Shen YC, Yang MC, Chang ET, Wang HM. Anxiety and depression are improved by continuous positive airway pressure treatments in obstructive sleep apnea. Int J Psychiatry Med 2016. [PMID: 28629298 DOI: 10.1177/0091217417696737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Obstructive sleep apnea involves repeated nocturnal desaturation and sleep fragmentation that leads to poor sleep quality, anxiety, and depression. This study aimed to investigate short- and long-term improvements in the anxiety and depression of patients with different obstructive sleep apnea treatments. Methods This is a prospective, non-randomized hospital-based study evaluated 55 patients (46 male, 9 female) with obstructive sleep apnea. The patients were divided into three groups based on different treatment: uvulopalatopharyngoplasty group, continuous positive airway pressure group, and no treatment group (by their own decision). They completed the Beck Depression Inventory II, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index before treatment and at one and six months after treatment. Results Compared to the no treatment group, the surgery and continuous positive airway pressure groups had higher body mass index, AHI, and Epworth sleepiness scale, but no difference in Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory. The continuous positive airway pressure and surgery groups still had no improvements in Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory scores one month after treatment. At six months after treatment, the continuous positive airway pressure group had significantly decreased Pittsburgh Sleep Quality Index, Chinese Health Questionnaire-12, Beck Depression Inventory II, and Beck Anxiety Inventory, whereas the surgery group had significant difference in Beck Anxiety Inventory only and the no treatment group still had no significant difference in any of the parameters. Conclusions Continuous positive airway pressure can improve the sleep quality, quality of life, depression, and anxiety of obstructive sleep apnea patients after six months of treatment. However, surgery can significantly improve anxiety only in the same period.
Collapse
Affiliation(s)
- Yu-Ying Li
- 1 Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
| | - Thodoris Mazarakis
- 1 Department of Counseling and Clinical Psychology, National Dong Hwa University, Hualien, Taiwan
| | - Yu-Chih Shen
- 2 Department of Psychiatry, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,3 School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Miao-Chun Yang
- 4 Department of Otolaryngology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - En-Ting Chang
- 3 School of Medicine, Tzu Chi University, Hualien, Taiwan.,5 Division of Chest Medicine, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Hsiu-Mei Wang
- 5 Division of Chest Medicine, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| |
Collapse
|
30
|
Kesavan K, Frank P, Cordero DM, Benharash P, Harper RM. Neuromodulation of Limb Proprioceptive Afferents Decreases Apnea of Prematurity and Accompanying Intermittent Hypoxia and Bradycardia. PLoS One 2016; 11:e0157349. [PMID: 27304988 PMCID: PMC4909267 DOI: 10.1371/journal.pone.0157349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 05/28/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Apnea of Prematurity (AOP) is common, affecting the majority of infants born at <34 weeks gestational age. Apnea and periodic breathing are accompanied by intermittent hypoxia (IH). Animal and human studies demonstrate that IH exposure contributes to multiple pathologies, including retinopathy of prematurity (ROP), injury to sympathetic ganglia regulating cardiovascular action, impaired pancreatic islet cell and bone development, cerebellar injury, and neurodevelopmental disabilities. Current standard of care for AOP/IH includes prone positioning, positive pressure ventilation, and methylxanthine therapy; these interventions are inadequate, and not optimal for early development. OBJECTIVE The objective is to support breathing in premature infants by using a simple, non-invasive vibratory device placed over limb proprioceptor fibers, an intervention using the principle that limb movements trigger reflexive facilitation of breathing. METHODS Premature infants (23-34 wks gestational age), with clinical evidence of AOP/IH episodes were enrolled 1 week after birth. Caffeine treatment was not a reason for exclusion. Small vibration devices were placed on one hand and one foot and activated in 6 hour ON/OFF sequences for a total of 24 hours. Heart rate, respiratory rate, oxygen saturation (SpO2), and breathing pauses were continuously collected. RESULTS Fewer respiratory pauses occurred during vibration periods, relative to baseline (p<0.005). Significantly fewer SpO2 declines occurred with vibration (p<0.05), relative to control periods. Significantly fewer bradycardic events occurred during vibration periods, relative to no vibration periods (p<0.05). CONCLUSIONS In premature neonates, limb proprioceptive stimulation, simulating limb movement, reduces breathing pauses and IH episodes, and lowers the number of bradycardic events that accompany aberrant breathing episodes. This low-cost neuromodulatory procedure has the potential to provide a non-invasive intervention to reduce apnea, bradycardia and intermittent hypoxia in premature neonates. TRIAL REGISTRATION ClinicalTrials.gov NCT02641249.
Collapse
Affiliation(s)
- Kalpashri Kesavan
- Pediatrics, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Paul Frank
- Cardiothoracic Surgery, University of California Los Angeles, Los Angeles, California, United States of America
| | - Daniella M. Cordero
- Pediatrics, University of California Los Angeles, Los Angeles, California, United States of America
| | - Peyman Benharash
- Surgery, Harbor-UCLA, Los Angeles, California, United States of America
| | - Ronald M. Harper
- Neurobiology, University of California Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
31
|
Macey PM, Rieken NS, Kumar R, Ogren JA, Middlekauff HR, Wu P, Woo MA, Harper RM. Sex Differences in Insular Cortex Gyri Responses to the Valsalva Maneuver. Front Neurol 2016; 7:87. [PMID: 27375549 PMCID: PMC4899449 DOI: 10.3389/fneur.2016.00087] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/27/2016] [Indexed: 12/26/2022] Open
Abstract
Sex differences in autonomic regulation may underlie cardiovascular disease variations between females and males. One key autonomic brain region is the insular cortex, which typically consists of five main gyri in each hemisphere, and shows a topographical organization of autonomic function across those gyri. The present study aims to identify possible sex differences in organization of autonomic function in the insula. We studied brain functional magnetic resonance imaging (fMRI) responses to a series of four 18-s Valsalva maneuvers in 22 healthy females (age ± SD: 50.0 ± 7.9 years) and 36 healthy males (45.3 ± 9.2 years). Comparisons of heart rate (HR) and fMRI signals were performed with repeated measures ANOVA (threshold P < 0.05 for all findings). All subjects achieved the target 30 mmHg expiratory pressure for all challenges. Typical HR responses were elicited by the maneuver, including HR increases from ~4 s into the strain period (Phase II) and rapid declines to below baseline 5–10 s, following strain release (Phase IV). Small, but significant, sex differences in HR percent change occurred during the sympathetic-dominant Phase II (female < male) and parasympathetic-dominant Phase IV (female > male, i.e., greater undershoot in males). The insular cortices showed similar patterns in all gyri, with greater signal decreases in males than females. Both sexes exhibited an anterior–posterior topographical organization of insular responses during Phase II, with anterior gyri showing higher responses than more posterior gyri. The exception was the right anterior-most gyrus in females, which had lower responses than the four other right gyri. Responses were lateralized, with right-sided dominance during Phase II in both sexes, except the right anterior-most gyrus in females, which showed lower responses than the left. The findings confirm the anterior and right-sided sympathetic dominance of the insula. Although sex differences were prominent in response magnitude, organization differences between males and females were limited to the right anterior-most gyrus, which showed a lower fMRI response in females vs. males (and vs. other gyri in females). The sex differences suggest a possible differing baseline state of brain physiology or tonic functional activity between females and males, especially in the right anterior-most gyrus.
Collapse
Affiliation(s)
- Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Nicholas S Rieken
- UCLA School of Nursing, University of California at Los Angeles , Los Angeles, CA , USA
| | - Rajesh Kumar
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA; Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jennifer A Ogren
- Department of Neurobiology, University of California at Los Angeles , Los Angeles, CA , USA
| | - Holly R Middlekauff
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine, University of California at Los Angeles , Los Angeles, CA , USA
| | - Paula Wu
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA, USA; Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles , Los Angeles, CA , USA
| | - Ronald M Harper
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
32
|
Lee VV, Trinder J, Jackson ML. Autobiographical memory impairment in obstructive sleep apnea patients with and without depressive symptoms. J Sleep Res 2016; 25:605-611. [DOI: 10.1111/jsr.12418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/21/2016] [Indexed: 01/21/2023]
Affiliation(s)
- V Vien Lee
- School of Health and Biomedical Sciences; RMIT University; Victoria Australia
- Institute for Breathing and Sleep; Austin Health; Victoria Australia
| | - John Trinder
- Melbourne School of Psychological Sciences; The University of Melbourne; Victoria Australia
| | - Melinda L. Jackson
- School of Health and Biomedical Sciences; RMIT University; Victoria Australia
- Institute for Breathing and Sleep; Austin Health; Victoria Australia
- Melbourne School of Psychological Sciences; The University of Melbourne; Victoria Australia
| |
Collapse
|
33
|
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: 37] [Impact Index Per Article: 4.6] [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
|
34
|
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: 5.5] [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
|
35
|
Tummala S, Palomares J, Kang DW, Park B, Woo MA, Harper RM, Kumar R. Global and Regional Brain Non-Gaussian Diffusion Changes in Newly Diagnosed Patients with Obstructive Sleep Apnea. Sleep 2016; 39:51-7. [PMID: 26285005 DOI: 10.5665/sleep.5316] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/18/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) patients show brain structural injury and functional deficits in autonomic, affective, and cognitive regulatory sites, as revealed by mean diffusivity (MD) and other imaging procedures. The time course and nature of gray and white matter injury can be revealed in more detail with mean kurtosis (MK) procedures, which can differentiate acute from chronic injury, and better show extent of damage over MD procedures. Our objective was to examine global and regional MK changes in newly diagnosed OSA, relative to control subjects. METHODS Two diffusion kurtosis image series were collected from 22 recently-diagnosed, treatment-naïve OSA and 26 control subjects using a 3.0-Tesla MRI scanner. MK maps were generated, normalized to a common space, smoothed, and compared voxel-by-voxel between groups using analysis of covariance (covariates; age, sex). RESULTS No age or sex differences appeared, but body mass index, sleep, neuropsychologic, and cognitive scores significantly differed between groups. MK values were significantly increased globally in OSA over controls, and in multiple localized sites, including the basal forebrain, extending to the hypothalamus, hippocampus, thalamus, insular cortices, basal ganglia, limbic regions, cerebellar areas, parietal cortices, ventral temporal lobe, ventrolateral medulla, and midline pons. Multiple sites, including the insular cortices, ventrolateral medulla, and midline pons showed more injury over previously identified damage with MD procedures, with damage often lateralized. CONCLUSIONS Global mean kurtosis values are significantly increased in obstructive sleep apnea (OSA), suggesting acute tissue injury, and these changes are principally localized in critical sites mediating deficient functions in the condition. The mechanisms for injury likely include altered perfusion and hypoxemia-induced processes, leading to acute tissue changes in recently diagnosed OSA.
Collapse
Affiliation(s)
- Sudhakar Tummala
- Department of Anesthesiology, University of California at Los Angeles. Los Angeles, CA
| | - Jose Palomares
- Department of Anesthesiology, University of California at Los Angeles. Los Angeles, CA
| | - Daniel W Kang
- Department of Medicine, University of California at Los Angeles. Los Angeles, CA
| | - Bumhee Park
- 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
| | - Ronald M Harper
- Department of Neurobiology, University of California at Los Angeles. Los Angeles, CA.,The Brain Research Institute, 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
|
36
|
Harper RM, Kumar R, Macey PM, Harper RK, Ogren JA. Impaired neural structure and function contributing to autonomic symptoms in congenital central hypoventilation syndrome. Front Neurosci 2015; 9:415. [PMID: 26578872 PMCID: PMC4626648 DOI: 10.3389/fnins.2015.00415] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 10/15/2015] [Indexed: 12/30/2022] Open
Abstract
Congenital central hypoventilation syndrome (CCHS) patients show major autonomic alterations in addition to their better-known breathing deficiencies. The processes underlying CCHS, mutations in the PHOX2B gene, target autonomic neuronal development, with frame shift extent contributing to symptom severity. Many autonomic characteristics, such as impaired pupillary constriction and poor temperature regulation, reflect parasympathetic alterations, and can include disturbed alimentary processes, with malabsorption and intestinal motility dyscontrol. The sympathetic nervous system changes can exert life-threatening outcomes, with dysregulation of sympathetic outflow leading to high blood pressure, time-altered and dampened heart rate and breathing responses to challenges, cardiac arrhythmia, profuse sweating, and poor fluid regulation. The central mechanisms contributing to failed autonomic processes are readily apparent from structural and functional magnetic resonance imaging studies, which reveal substantial cortical thinning, tissue injury, and disrupted functional responses in hypothalamic, hippocampal, posterior thalamic, and basal ganglia sites and their descending projections, as well as insular, cingulate, and medial frontal cortices, which influence subcortical autonomic structures. Midbrain structures are also compromised, including the raphe system and its projections to cerebellar and medullary sites, the locus coeruleus, and medullary reflex integrating sites, including the dorsal and ventrolateral medullary nuclei. The damage to rostral autonomic sites overlaps metabolic, affective and cognitive regulatory regions, leading to hormonal disruption, anxiety, depression, behavioral control, and sudden death concerns. The injuries suggest that interventions for mitigating hypoxic exposure and nutrient loss may provide cellular protection, in the same fashion as interventions in other conditions with similar malabsorption, fluid turnover, or hypoxic exposure.
Collapse
Affiliation(s)
- Ronald M Harper
- Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA ; Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Rajesh Kumar
- Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA ; Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA ; Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA ; Department of Bioengineering, University of California, Los Angeles Los Angeles, CA, USA
| | - Paul M Macey
- Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA ; UCLA School of Nursing, University of California, Los Angeles Los Angeles, CA, USA
| | - Rebecca K Harper
- Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| | - Jennifer A Ogren
- Department of Neurobiology, David Geffen School of Medicine, University of California, Los Angeles Los Angeles, CA, USA
| |
Collapse
|
37
|
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: 4.2] [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]
|
38
|
Lee SA, Han SH, Ryu HU. Anxiety and its relationship to quality of life independent of depression in patients with obstructive sleep apnea. J Psychosom Res 2015; 79:32-6. [PMID: 25661543 DOI: 10.1016/j.jpsychores.2015.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/22/2015] [Accepted: 01/22/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The relationship between anxiety and obstructive sleep apnea (OSA) has not been well studied. We evaluated the factors associated with anxiety and whether anxiety is related to quality of life (QoL) independently of depression in OSA patients. METHODS Data were collected from adults with newly diagnosed, untreated OSA. The State-Trait Anxiety Inventory-State Scale (STAI-S), the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and the Short Form 36 Health survey (SF-36) were used. Anxiety and depression were defined as high levels of anxiety symptoms (STAI-S score≥40) and depressive symptoms (BDI≥10), respectively. Associations between anxiety and OSA were analyzed using multiple linear regression analysis. RESULTS Of 655 OSA subjects included, the prevalence of anxiety and depression was 48.4% and 46.4%, respectively. The scores of STAI-S had strong correlations with BDI (r=0.676, p<0.001). Female sex (p<0.05), excessive daytime sleepiness (ESS≥10) (p<0.05), and a lower educational level (p<0.05) were identified as independent factors for predicting the presence of anxiety in OSA patients. The severity of OSA measured by the apnea-hypopnea index or respiratory distress index was not related to comorbid anxiety. In linear regression analysis, both anxiety (ß=-10.196, p<0.001) and depression (ß=-16.317, p<0.001) were independently associated with lower SF-36 scores in OSA patients. CONCLUSIONS The presence of anxiety can be predicted by female sex, daytime sleepiness, and a lower educational level. Both anxiety and depression were independently associated with a lower QoL in OSA patients.
Collapse
Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Su-Hyun Han
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Uk Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
39
|
Ceïde ME, Williams NJ, Seixas A, Longman-Mills SK, Jean-Louis G. Obstructive sleep apnea risk and psychological health among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) cohort study. Ann Med 2015; 47:687-93. [PMID: 26593384 PMCID: PMC4805365 DOI: 10.3109/07853890.2015.1107186] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION This study assessed associations of depression and anxiety with risk of obstructive sleep apnea (OSA) among non-Hispanic blacks in the Metabolic Syndrome Outcome (MetSO) study. METHOD A total of 1,035 patients participated. ARES™ score ≥6 defined high OSA risk. Moderate depression was defined by a CES-D score ≥16. Moderate anxiety was measured by a BAI score ≥16. RESULTS The mean age was 62 ± 14 years; 70% were female. A total of 93% were diagnosed with hypertension; 61%, diabetes; and 72%, dyslipidemia; 90% were overweight/obese; 33% had a history of heart disease; and 10% had a stroke. Logistic regression analysis, adjusting for age and gender, showed that patients with depression had nearly two-fold increased odds of being at risk for OSA (OR 1.75, 95% CI 1.02-2.98, p < 0.05). Patients with anxiety had three-fold increased odds of being at risk for OSA (OR 3.30, 95% CI 2.11-5.15, p < 0.01). After adjusting for marital status and income, patients with anxiety had a 6% increase in OSA risk (OR 1.06, 95% CI 1.04-1.09, p < 0.05), but depression was no longer significant. CONCLUSION Our results suggest that non-Hispanic blacks with metabolic syndrome who experience anxiety and/or depression should be screened for OSA.
Collapse
Affiliation(s)
- Mirnova E Ceïde
- a Montefiore Medical Center , Department of Psychiatry and Behavioral Science , Bronx , NY 10467 , USA
| | - Natasha J Williams
- b Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health , New York University Medical Center , New York , NY 10016 , USA
| | - Azizi Seixas
- b Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health , New York University Medical Center , New York , NY 10016 , USA
| | - Samantha K Longman-Mills
- c Department of Community Health and Psychiatry , The University of the West Indies , Mona , Jamaica
| | - Girardin Jean-Louis
- b Center for Healthful Behavior Change (CHBC), Division of Health and Behavior, Department of Population Health , New York University Medical Center , New York , NY 10016 , USA
| |
Collapse
|
40
|
Kacar E, Sarinc Ulasli S, Günay E, Güngör G, Ünlü E, Beker Acay M, Koyuncu T, Ünlü M, Haktanir A. Assessment of neural alterations in obstructive sleep apnoea syndrome: can apparent diffusion coefficient measurements be useful? CLINICAL RESPIRATORY JOURNAL 2014; 10:189-97. [PMID: 25103635 DOI: 10.1111/crj.12201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/24/2014] [Accepted: 08/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Our aim was to investigate whether neurological alteration in patients with obstructive sleep apnoea syndrome (OSAS) with apparently normal cerebral and cerebellar structures can be assessed by means of apparent diffusion coefficient (ADC) measurement and to investigate the association between OSAS severity and ADC values. METHODS Following the acquisition of diffusion-weighted cranial magnetic resonance imaging, ADC measurements were performed in 24 different apparently normal cerebral and cerebellar structures, including the bilateral frontal and parietal cortices, insulae, cingulate gyri, hippocampi, frontal and parieto-occipital periventricular white matter (PWM), caudate nuclei, putamen, thalami, cerebellar hemispheres, pons and mesencephalon in 47 OSAS patients and 20 control subjects. The ADC values of the patients and the control group were compared. The association between the apnoea-hypopnoea index (AHI) and the ADC values of the patients were investigated. RESULTS The ADC values in the bilateral frontal PWM were lower in the patient group than those in the control subjects (P < 0.05). The measurements in the right cingulate gyri of the OSAS patients exhibited significantly higher ADC values than those of the control group (P = 0.002). Bilateral thalamic ADC values in severe OSAS patients were significantly higher than those in mild and moderate OSAS patients (P < 0.05). CONCLUSION The ADC measurement is a simple and effective technique to evaluate neural alteration of the brain in patients with OSAS. ADC measurements can also be useful in the evaluation of the association between the AHI and the degree of neural alteration in the central nervous system.
Collapse
Affiliation(s)
- Emre Kacar
- Department of Radiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Sevinc Sarinc Ulasli
- Department of Pulmonary Medicine, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Ersin Günay
- Department of Pulmonary Medicine, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Gülay Güngör
- Department of Radiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Ebru Ünlü
- Department of Radiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Mehtap Beker Acay
- Department of Radiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Tülay Koyuncu
- Department of Pulmonary Medicine, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Mehmet Ünlü
- Department of Pulmonary Medicine, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Alpay Haktanir
- Department of Radiology, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| |
Collapse
|
41
|
Castronovo V, Scifo P, Castellano A, Aloia MS, Iadanza A, Marelli S, Cappa SF, Strambi LF, Falini A. White matter integrity in obstructive sleep apnea before and after treatment. Sleep 2014; 37:1465-75. [PMID: 25142557 DOI: 10.5665/sleep.3994] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is commonly associated with cognitive and functional deficits, some of which are resolved after continuous positive airway pressure (CPAP) treatment. The investigation of brain structural changes before and after treatment could provide deep insights into the pathogenesis and the reversibility of this disorder. We hypothesized that severe OSA patients would have altered white matter (WM) integrity and cognition and that treatment would improve both the structural damage and the cognitive impairment. DESIGN Prospective clinical study. SETTING The Sleep Disorders Center and the Center of Excellence in High-Field Magnetic Resonance Imaging at Vita-Salute San Raffaele University, Milan, Italy. PARTICIPANTS Seventeen never-treated consecutive OSA patients were evaluated before and after treatment (after 3 and 12 months) and compared to 15 matched healthy controls. INTERVENTION CPAP. MEASUREMENTS WM integrity measured by diffusion tensor imaging (DTI) and cognitive performance (measured with neuropsychological testing) before and after 3 and 12 months of CPAP. RESULTS Results in pre-treatment OSA patients showed impairments in most cognitive areas, mood and sleepiness that were associated with diffuse reduction of WM fiber integrity reflected by diminished fractional anisotropy (FA) and mean diffusivity (MD) in multiple brain areas. After 3 months of CPAP, only limited changes of WM were found. However, over the course of 12 months CPAP treatment, an almost complete reversal of WM abnormalities in all the affected regions was observed in patients who were compliant with treatment. Significant improvements involving memory, attention, and executive-functioning paralleled WM changes after treatment. CONCLUSIONS Changes of WM DTI "signatures" of brain pathology in OSA patients are appreciable over the course of 12-month treatment with CPAP in most of the regions involved. Recovery of cognitive deficits after treatment is consistent with the presence of a reversible structural neural injury in OSA in patients who were compliant with treatment.
Collapse
|
42
|
Risk assessment for obstructive sleep apnea and anxiety in a Pakistani population with coronary artery disease. Sleep Breath 2014; 19:291-6. [PMID: 24925822 DOI: 10.1007/s11325-014-1018-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/19/2014] [Accepted: 06/02/2014] [Indexed: 01/10/2023]
Abstract
PURPOSE Previous studies in the western world have reported the possible association of obstructive sleep apnea (OSA) with anxiety and cardiovascular diseases. However, the data from developing countries such as Pakistan remains scarce in this regard. The main aim of this study was to investigate the prevalence of coronary artery disease (CAD) patients who are at high risk of OSA and to determine the association between the risk of OSA and levels of anxiety. METHODS The sample population consisted of 400 participants including 200 patients, who had been previously diagnosed with CAD, and 200 healthy controls. The 200 CAD patients were approached for inclusion in the study on their follow-ups after their acute symptoms had subsided. The patients were interviewed after a mean time period of 13 weeks post event. All patients with lung disease or respiratory infection were excluded from the study. The risk of OSA was determined using Berlin questionnaire, while the levels of anxiety were measured by Beck anxiety inventory scale (BAI). RESULTS More than half (n = 104) of the CAD patients were at high risk of OSA while majority (n = 168) of the healthy controls were at low risk. The high risk of OSA was significantly (P < 0.0001) more prevalent in CAD patients compared with controls. It was also observed that the patients who were at high risk of OSA, among both cases and controls, had significantly (P values <0.001) higher levels of anxiety. CONCLUSION A significant proportion of CAD patients are at high risk of OSA in our region. Moreover, OSA is also associated with greater levels of anxiety in both healthy people and CAD patients.
Collapse
|
43
|
Shapiro AL, Culp S, Azulay Chertok IR. OSA symptoms associated with and predictive of anxiety in middle-aged men: secondary analysis of NHANES data. Arch Psychiatr Nurs 2014; 28:200-5. [PMID: 24856274 DOI: 10.1016/j.apnu.2014.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/11/2014] [Accepted: 02/15/2014] [Indexed: 11/19/2022]
Abstract
OBJECT This population-based study examined obstructive sleep apnea (OSA) symptoms predictive of anxiety in middle-aged men. METHOD Secondary analyses were conducted on the National Health and Nutrition Examination Survey (NHANES) 2007-2008 data using weighted samples and complex sample analysis techniques (unweighted N=1,217). FINDINGS Nonrefreshing sleep (χ(2)=69.333, p<0.001), excessive daytime sleepiness (χ(2)=47.766, p<0.001), and sleep fragmentation (χ(2)=30.692, p<0.001) were significantly associated with anxiety. Nonrefreshing sleep (OR 3.582, p<0.001) and awakenings due to apneic episodes (OR 2.047, p=0.001) were predictive of anxiety. CONCLUSION Comorbid anxiety and OSA symptoms are common and have implications for activities of daily living, social responsibilities, and quality of life. Screening for anxiety among men with OSA symptoms is recommended.
Collapse
Affiliation(s)
- April L Shapiro
- School of Nursing, West Virginia University, 600 Harley O. Staggers Sr. Drive, Keyser, WV.
| | - Stacey Culp
- School of Nursing, West Virginia University, 6404 Health Sciences South Morgantown, WV.
| | - Ilana R Azulay Chertok
- School of Nursing, West Virginia University, 6504 Health Sciences South, Morgantown, WV.
| |
Collapse
|
44
|
Yadav SK, Kumar R, Macey PM, Woo MA, Yan-Go FL, Harper RM. Insular cortex metabolite changes in obstructive sleep apnea. Sleep 2014; 37:951-8. [PMID: 24790274 DOI: 10.5665/sleep.3668] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVE Adults with obstructive sleep apnea (OSA) show significant autonomic and neuropsychologic deficits, which may derive from damage to insular regions that serve those functions. The aim was to assess glial and neuronal status from anterior insular metabolites in OSA versus controls, using proton magnetic resonance spectroscopy (PMRS), and thus to provide insights for neuroprotection against tissue changes, and to reduce injury consequences. DESIGN Cross-sectional study. SETTING University-based medical center. PARTICIPANTS Thirty-six patients with OSA, 53 controls. INTERVENTIONS None. MEASUREMENTS AND RESULTS We performed PMRS in bilateral anterior insulae using a 3.0-Tesla magnetic resonance imaging scanner, calculated N-acetylaspartate/creatine (NAA/Cr), choline/creatine (Cho/Cr), myo-inositol/creatine (MI/Cr), and MI/NAA metabolite ratios, and examined daytime sleepiness (Epworth Sleepiness Scale, ESS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), and neuropsychologic status (Beck Depression Inventory II [BDI-II] and Beck Anxiety Inventory [BAI]). Body mass index, BAI, BDI-II, PSQI, and ESS significantly differed between groups. NAA/ Cr ratios were significantly reduced bilaterally, and left-sided MI/Cr and MI/NAA ratios were increased in OSA over controls. Significant positive correlations emerged between left insular MI/Cr ratios and apnea-hypopnea index values, right insular Cho/Cr ratios and BDI-II and BAI scores, and negative correlations appeared between left insular NAA/Cr ratios and PSQI scores and between right-side MI/Cr ratios and baseline and nadir change in O2 saturation. CONCLUSIONS Adults with obstructive sleep apnea showed bilaterally reduced N-acetylaspartate and left-side increased myo-inositol anterior insular metabolites, indicating neuronal damage and increased glial activation, respectively, which may contribute to abnormal autonomic and neuropsychologic functions in the condition. The activated glial status likely indicates increased inflammatory action that may induce more neuronal injury, and suggests separate approaches for glial and neuronal protection.
Collapse
Affiliation(s)
- Santosh K Yadav
- Department of Anesthesiology, David Geffen School of Medicine at UCLA
| | - Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine at UCLA ; Department of Radiological Sciences, David Geffen School of Medicine at UCLA ; the Brain Research Institute, 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
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA
| | - Frisca L Yan-Go
- Department of Neurology, David Geffen School of Medicine at UCLA
| | - Ronald M Harper
- the Brain Research Institute, University of California at Los Angeles, Los Angeles, CA ; Department of Neurobiology, David Geffen School of Medicine at UCLA
| |
Collapse
|
45
|
|
46
|
Kumar R, Pham TT, Macey PM, Woo MA, Yan-Go FL, Harper RM. Abnormal myelin and axonal integrity in recently diagnosed patients with obstructive sleep apnea. Sleep 2014; 37:723-32. [PMID: 24899761 DOI: 10.5665/sleep.3578] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Patients with obstructive sleep apnea (OSA) show significant white matter injury; whether that injury represents myelin or axonal damage is unclear. The objective was to examine myelin and axonal changes in patients with newly diagnosed OSA over control subjects. DESIGN Cross-sectional study. SETTING University-based medical center. PARTICIPANTS Twenty-three newly-diagnosed, treatment-naïve OSA and 23 age- and sex-matched control subjects. INTERVENTIONS None. MEASUREMENTS AND RESULTS Radial and axial diffusivity maps, calculated from diffusion tensor imaging data (3.0 Tesla MRI scanner), indicating diffusion perpendicular (myelin status) or parallel (axonal status) to fibers, respectively, were normalized, smoothed, and compared between groups (analysis of covariance; covariate: age). Global brain radial and axial diffusivity values, and global brain volume with myelin and axonal changes were determined, and region-of-interest analyses performed in areas of significant differences between groups based on voxel-based procedures. Global radial and axial diffusivity values were significantly reduced in OSA versus control subjects (radial, P = 0.004; axial, P = 0.019), with radial (myelin) diffusivity reduced more than axial (axonal), and more left-sided reduction for both measures. Localized declines for myelin and axonal measures appeared in the dorsal and ventral medulla, cerebellar cortex and deep nuclei, basal ganglia, hippocampus, amygdala, corpus callosum, insula, cingulate and medial frontal cortices, and other cortical areas (P < 0.005), all regions mediating functions affected in OSA. CONCLUSIONS Fiber injury appears in critical medullary respiratory regulatory sites, as well as cognitive and autonomic control areas. Myelin is more affected in newly diagnosed OSA than axons, and primarily on the left side, possibly from the increased myelin sensitivity to hypoxia and asymmetric perfusion.
Collapse
Affiliation(s)
- Rajesh Kumar
- Department of Anesthesiology ; Department of Radiological Sciences ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA
| | - Tiffany T Pham
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Paul M Macey
- UCLA School of Nursing, Los Angeles, CA ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA
| | | | - Frisca L Yan-Go
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA
| |
Collapse
|
47
|
Kumar R, Farahvar S, Ogren JA, Macey PM, Thompson PM, Woo MA, Yan-Go FL, Harper RM. Brain putamen volume changes in newly-diagnosed patients with obstructive sleep apnea. NEUROIMAGE-CLINICAL 2014; 4:383-91. [PMID: 24567910 PMCID: PMC3930100 DOI: 10.1016/j.nicl.2014.01.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 01/17/2014] [Accepted: 01/21/2014] [Indexed: 11/24/2022]
Abstract
Obstructive sleep apnea (OSA) is accompanied by cognitive, motor, autonomic, learning, and affective abnormalities. The putamen serves several of these functions, especially motor and autonomic behaviors, but whether global and specific sub-regions of that structure are damaged is unclear. We assessed global and regional putamen volumes in 43 recently-diagnosed, treatment-naïve OSA (age, 46.4 ± 8.8 years; 31 male) and 61 control subjects (47.6 ± 8.8 years; 39 male) using high-resolution T1-weighted images collected with a 3.0-Tesla MRI scanner. Global putamen volumes were calculated, and group differences evaluated with independent samples t-tests, as well as with analysis of covariance (covariates; age, gender, and total intracranial volume). Regional differences between groups were visualized with 3D surface morphometry-based group ratio maps. OSA subjects showed significantly higher global putamen volumes, relative to controls. Regional analyses showed putamen areas with increased and decreased tissue volumes in OSA relative to control subjects, including increases in caudal, mid-dorsal, mid-ventral portions, and ventral regions, while areas with decreased volumes appeared in rostral, mid-dorsal, medial-caudal, and mid-ventral sites. Global putamen volumes were significantly higher in the OSA subjects, but local sites showed both higher and lower volumes. The appearance of localized volume alterations points to differential hypoxic or perfusion action on glia and other tissues within the structure, and may reflect a stage in progression of injury in these newly-diagnosed patients toward the overall volume loss found in patients with chronic OSA. The regional changes may underlie some of the specific deficits in motor, autonomic, and neuropsychologic functions in OSA. Global and regional putamen volumes were examined in newly-diagnosed OSA. Global volumes are higher, but subareas showed increases and decreases. The volume increases suggest transient tissue swelling from hypoxic action. Altered sites likely contribute to motor and other functional deficits in OSA.
Collapse
Key Words
- 3D surface morphometry
- 3D, Three dimensional
- AHI, Apnea–hypopnea index
- Autonomic
- BAI, Beck Anxiety Inventory
- BDI-II, Beck Depression Inventory II
- Basal ganglia
- CSF, Cerebrospinal fluid
- Cognition
- ESS, Epworth Sleepiness Scale
- FA, Flip angle
- FOV, Field of view
- GRAPPA, Generalized autocalibrating partially parallel acquisition
- Intermittent hypoxia
- MNI, Montreal Neurological Institute
- MPRAGE, Magnetization prepared rapid acquisition gradient-echo
- MRI, Magnetic resonance imaging
- Magnetic resonance imaging
- Motor
- OSA, Obstructive sleep apnea
- PD, Proton density
- PSQI, Pittsburgh Sleep Quality Index
- TE, Echo time
- TIV, Total intracranial volume
- TR, Repetition time
Collapse
Affiliation(s)
- Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA ; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Salar Farahvar
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Jennifer A Ogren
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M Thompson
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA ; Department of Psychiatry, David Geffen School of Medicine at UCLA, 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
| | - Frisca L Yan-Go
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, USA ; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
| |
Collapse
|
48
|
Harper RM, Kumar R, Macey PM, Woo MA, Ogren JA. Affective brain areas and sleep-disordered breathing. PROGRESS IN BRAIN RESEARCH 2014; 209:275-93. [PMID: 24746053 DOI: 10.1016/b978-0-444-63274-6.00014-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The neural damage accompanying the hypoxia, reduced perfusion, and other consequences of sleep-disordered breathing, found in obstructive sleep apnea, heart failure, and congenital central hypoventilation syndrome (CCHS), appears in areas that serve multiple functions, including emotional drives to breathe, and involve systems that serve affective, cardiovascular, and breathing roles. The damage, assessed with structural magnetic resonance imaging (MRI) procedures, shows tissue loss or water content and diffusion changes indicative of injury, and impaired axonal integrity between structures; damage is preferentially unilateral. Functional MRI responses in affected areas also are time- or amplitude-distorted to ventilatory or autonomic challenges. Among the structures injured are the insular, cingulate, and ventral medial prefrontal cortices, as well as cerebellar deep nuclei and cortex, anterior hypothalamus, caudal raphé, ventrolateral medulla, portions of the basal ganglia and, in CCHS, the locus coeruleus. Caudal raphé and locus coeruleus injury have the potential to modify serotonergic and adrenergic modulation of upper airway and arousal characteristics, as well as affective drive to breathe. Since both axons and gray matter show injury, the consequences to function, especially to autonomic, cognitive, and mood regulation, are major. Several of the affected rostral sites mediate aspects of dyspnea, especially in CCHS, while others participate in initiation of inspiration after central breathing pauses, and the medullary injury can impair baroreflex and breathing control. The ancillary injury associated with sleep-disordered breathing to central structures can elicit multiple other distortions in cardiovascular, cognitive, and emotional functions in addition to effects on breathing regulation.
Collapse
Affiliation(s)
- Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Rajesh Kumar
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA
| | - Paul M Macey
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA; UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| | - Jennifer A Ogren
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
49
|
Zhang SXL, Wang Y, Gozal D. Pathological consequences of intermittent hypoxia in the central nervous system. Compr Physiol 2013; 2:1767-77. [PMID: 23723023 DOI: 10.1002/cphy.c100060] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intermittent hypoxia (IH) is a frequent occurrence in clinical settings. In the last decades, evidence has emerged implicating the gas exchange alterations and sleep disruption associated with those disorders in the high prevalence of cognitive and behavioral deficits afflicting these patients. In an effort to better characterize the role of IH, and to identify potential mechanisms of IH-induced central nervous system (CNS) dysfunction, a large number of rodent models have been recently developed. The cumulative evidence confirms that IH indeed induces a heterotopic pattern of injury in the brain, particularly affecting cortical, subcortical, and hippocampal regions, ultimately leading to neuronal apoptosis and activation of microglia. These IH-induced deleterious processes exhibit substantial variability across the lifespan, are under substantial modulatory influences of diet, physical or intellectual activity, and genetic factors, and preferentially recruit oxidative stress and inflammatory pathways.
Collapse
Affiliation(s)
- Shelley X L Zhang
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | | | | |
Collapse
|
50
|
Heart rate responses to autonomic challenges in obstructive sleep apnea. PLoS One 2013; 8:e76631. [PMID: 24194842 PMCID: PMC3806804 DOI: 10.1371/journal.pone.0076631] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 08/23/2013] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is accompanied by structural alterations and dysfunction in central autonomic regulatory regions, which may impair dynamic and static cardiovascular regulation, and contribute to other syndrome pathologies. Characterizing cardiovascular responses to autonomic challenges may provide insights into central nervous system impairments, including contributions by sex, since structural alterations are enhanced in OSA females over males. The objective was to assess heart rate responses in OSA versus healthy control subjects to autonomic challenges, and, separately, characterize female and male patterns. We studied 94 subjects, including 37 newly-diagnosed, untreated OSA patients (6 female, age mean ± std: 52.1 ± 8.1 years; 31 male aged 54.3 ± 8.4 years), and 57 healthy control subjects (20 female, 50.5 ± 8.1 years; 37 male, 45.6 ± 9.2 years). We measured instantaneous heart rate with pulse oximetry during cold pressor, hand grip, and Valsalva maneuver challenges. All challenges elicited significant heart rate differences between OSA and control groups during and after challenges (repeated measures ANOVA, p<0.05). In post-hoc analyses, OSA females showed greater impairments than OSA males, which included: for cold pressor, lower initial increase (OSA vs. control: 9.5 vs. 7.3 bpm in females, 7.6 vs. 3.7 bpm in males), OSA delay to initial peak (2.5 s females/0.9 s males), slower mid-challenge rate-of-increase (OSA vs. control: -0.11 vs. 0.09 bpm/s in females, 0.03 vs. 0.06 bpm/s in males); for hand grip, lower initial peak (OSA vs. control: 2.6 vs. 4.6 bpm in females, 5.3 vs. 6.0 bpm in males); for Valsalva maneuver, lower Valsalva ratio (OSA vs. control: 1.14 vs. 1.30 in females, 1.29 vs. 1.34 in males), and OSA delay during phase II (0.68 s females/1.31 s males). Heart rate responses showed lower amplitude, delayed onset, and slower rate changes in OSA patients over healthy controls, and impairments may be more pronounced in females. The dysfunctions may reflect central injury in the syndrome, and suggest autonomic deficiencies that may contribute to further tissue and functional pathologies.
Collapse
|