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Mabry S, Bradshaw JL, Gardner JJ, Wilson EN, Cunningham RL. Sex-dependent effects of chronic intermittent hypoxia: implication for obstructive sleep apnea. Biol Sex Differ 2024; 15:38. [PMID: 38664845 PMCID: PMC11044342 DOI: 10.1186/s13293-024-00613-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) affects 10-26% of adults in the United States with known sex differences in prevalence and severity. OSA is characterized by elevated inflammation, oxidative stress (OS), and cognitive dysfunction. However, there is a paucity of data regarding the role of sex in the OSA phenotype. Prior findings suggest women exhibit different OSA phenotypes than men, which could result in under-reported OSA prevalence in women. To examine the relationship between OSA and sex, we used chronic intermittent hypoxia (CIH) to model OSA in rats. We hypothesized that CIH would produce sex-dependent phenotypes of inflammation, OS, and cognitive dysfunction, and these sex differences would be dependent on mitochondrial oxidative stress (mtOS). METHODS Adult male and female Sprague Dawley rats were exposed to CIH or normoxia for 14 days to examine the impact of sex on CIH-associated circulating inflammation (IL-1β, IL-6, IL-10, TNF-α), circulating steroid hormones, circulating OS, and behavior (recollective and spatial memory; gross and fine motor function; anxiety-like behaviors; and compulsive behaviors). Rats were implanted with osmotic minipumps containing either a mitochondria-targeting antioxidant (MitoTEMPOL) or saline vehicle 1 week prior to CIH initiation to examine how inhibiting mtOS would affect the CIH phenotype. RESULTS Sex-specific differences in CIH-induced inflammation, OS, motor function, and compulsive behavior were observed. In female rats, CIH increased inflammation (plasma IL-6 and IL-6/IL-10 ratio) and impaired fine motor function. Conversely, CIH elevated circulating OS and compulsivity in males. These sex-dependent effects of CIH were blocked by inhibiting mtOS. Interestingly, CIH impaired recollective memory in both sexes but these effects were not mediated by mtOS. No effects of CIH were observed on spatial memory, gross motor function, or anxiety-like behavior, regardless of sex. CONCLUSIONS Our results indicate that the impact of CIH is dependent on sex, such as an inflammatory response and OS response in females and males, respectively, that are mediated by mtOS. Interestingly, there was no effect of sex or mtOS in CIH-induced impairment of recollective memory. These results indicate that mtOS is involved in the sex differences observed in CIH, but a different mechanism underlies CIH-induced memory impairments.
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Affiliation(s)
- Steve Mabry
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA
| | - Jessica L Bradshaw
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA
| | - Jennifer J Gardner
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA
| | - E Nicole Wilson
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, System College of Pharmacy, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX, 76107-2699, USA.
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Fu X, Wan XJ, Liu JY, Sun Q, Shen Y, Li J, Mao CJ, Ma QH, Wang F, Liu CF. Effects of sleep fragmentation on white matter pathology in a rat model of cerebral small vessel disease. Sleep 2024; 47:zsad225. [PMID: 37638817 DOI: 10.1093/sleep/zsad225] [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: 06/02/2023] [Revised: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
STUDY OBJECTIVES Mounting evidence indicated the correlation between sleep and cerebral small vessel disease (CSVD). However, little is known about the exact causality between poor sleep and white matter injury, a typical signature of CSVD, as well as the underlying mechanisms. METHODS Spontaneously hypertensive rats (SHR) and control Wistar Kyoto rats were subjected to sleep fragmentation (SF) for 16 weeks. The effects of chronic sleep disruption on the deep white matter and cognitive performance were observed. RESULTS SHR were validated as a rat model for CSVD. Fragmented sleep induced strain-dependent white matter abnormalities, characterized by reduced myelin integrity, impaired oligodendrocytes precursor cells (OPC) maturation and pro-inflammatory microglial polarization. Partially reversible phenotypes of OPC and microglia were observed in parallel following sleep recovery. CONCLUSIONS Long-term SF-induced pathological effects on the deep white matter in a rat model of CSVD. The pro-inflammatory microglial activation and the block of OPC maturation may be involved in the mechanisms linking sleep to white matter injury.
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Affiliation(s)
- Xiang Fu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Xiao-Jie Wan
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Jun-Yi Liu
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Qian Sun
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Shen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Li
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Cheng-Jie Mao
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Quan-Hong Ma
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Fen Wang
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
| | - Chun-Feng Liu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience, Soochow University, Suzhou, China
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3
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Mabry S, Bradshaw JL, Gardner JJ, Wilson EN, Cunningham R. Sex-dependent effects of chronic intermittent hypoxia: Implication for obstructive sleep apnea. RESEARCH SQUARE 2024:rs.3.rs-3898670. [PMID: 38352622 PMCID: PMC10862974 DOI: 10.21203/rs.3.rs-3898670/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Background Obstructive sleep apnea (OSA) affects 10-26% of adults in the United States with known sex differences in prevalence and severity. OSA is characterized by elevated inflammation, oxidative stress (OS), and cognitive dysfunction. However, there is a paucity of data regarding the role of sex in the OSA phenotype. Prior findings suggest women exhibit different OSA phenotypes than men, which could result in under-reported OSA prevalence in women. To examine the relationship between OSA and sex, we used chronic intermittent hypoxia (CIH) to model OSA in rats. We hypothesized that CIH would produce sex-dependent phenotypes of inflammation, OS, and cognitive dysfunction, and these sex differences would be dependent on mitochondrial oxidative stress (mtOS). Methods Adult male and female Sprague Dawley rats were exposed to CIH or normoxia for 14 days to examine the impact of sex on CIH-associated circulating inflammation (IL-1β, IL-4, IL-6, IL-10, TNF-α), circulating OS, and behavior (recollective and spatial memory; gross and fine motor function; anxiety-like behaviors; and compulsive behaviors). A subset of rats was implanted with osmotic minipumps containing either a mitochondria-targeting antioxidant (MitoTEMPOL) or saline vehicle 1 week prior to CIH initiation to examine how inhibiting mtOS would affect the CIH phenotype. Results Sex-specific differences in CIH-induced inflammation, OS, motor function, and compulsive behavior were observed. In female rats, CIH increased inflammation (plasma IL-6 and IL-6/IL-10 ratio) and impaired fine motor function. Conversely, CIH elevated circulating OS and compulsivity in males. These sex-dependent effects of CIH were blocked by inhibiting mtOS. Interestingly, CIH impaired recollective memory in both sexes but these effects were not mediated by mtOS. No effects of CIH were observed on spatial memory, gross motor function, or anxiety-like behavior, regardless of sex. Conclusions Our results indicate that the impact of CIH is dependent on sex, such as an inflammatory response and OS response in females and males, respectively, that are mediated by mtOS. Interestingly, there was no effect of sex or mtOS in CIH-induced impairment of recollective memory. These results indicate that mtOS is involved in the sex differences observed in CIH, but a different mechanism underlies CIH-induced memory impairments.
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Berisha DE, Rizvi B, Chappel-Farley MG, Tustison N, Taylor L, Dave A, Sattari NS, Chen IY, Lui KK, Janecek JC, Keator D, Neikrug AB, Benca RM, Yassa MA, Mander BA. Cerebrovascular pathology mediates associations between hypoxemia during rapid eye movement sleep and medial temporal lobe structure and function in older adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.28.577469. [PMID: 38328085 PMCID: PMC10849660 DOI: 10.1101/2024.01.28.577469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Obstructive sleep apnea (OSA) is common in older adults and is associated with medial temporal lobe (MTL) degeneration and memory decline in aging and Alzheimer's disease (AD). However, the underlying mechanisms linking OSA to MTL degeneration and impaired memory remains unclear. By combining magnetic resonance imaging (MRI) assessments of cerebrovascular pathology and MTL structure with clinical polysomnography and assessment of overnight emotional memory retention in older adults at risk for AD, cerebrovascular pathology in fronto-parietal brain regions was shown to statistically mediate the relationship between OSA-related hypoxemia, particularly during rapid eye movement (REM) sleep, and entorhinal cortical thickness. Reduced entorhinal cortical thickness was, in turn, associated with impaired overnight retention in mnemonic discrimination ability across emotional valences for high similarity lures. These findings identify cerebrovascular pathology as a contributing mechanism linking hypoxemia to MTL degeneration and impaired sleep-dependent memory in older adults.
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Affiliation(s)
- Destiny E. Berisha
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Batool Rizvi
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Miranda G. Chappel-Farley
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Nicholas Tustison
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Lisa Taylor
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Abhishek Dave
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
| | - Negin S. Sattari
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ivy Y. Chen
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Kitty K. Lui
- San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92093, USA
| | - John C. Janecek
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - David Keator
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ariel B. Neikrug
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ruth M. Benca
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, 53706, WI, USA
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, NC, 27109, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
| | - Michael A. Yassa
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
- Department of Neurology, University of California Irvine, Irvine CA, 92697, USA
| | - Bryce A. Mander
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine CA, 92697, USA
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Zhao L, Zhao Y, Su D, Lv Z, Xie F, Hu P, Porter KLA, Mazzei I, Chin JD, Wang Y, Fang Y. Cognitive Functions in Patients with Moderate-to-Severe Obstructive Sleep Apnea Syndrome with Emphasis on Executive Functions and Decision-Making. Brain Sci 2023; 13:1436. [PMID: 37891804 PMCID: PMC10605234 DOI: 10.3390/brainsci13101436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/16/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Patients with obstructive sleep apnea syndrome (OSAS) have cognitive dysfunction in many aspects, however, these patients' decision-making function remains unclear. In this study, the Game of Dice Task (GDT) was used to investigate the function of decision making in patients with OSAS. METHODS 30 participants with moderate to severe OSAS and 27 participants with no or mild OSAS diagnosed by sleep breathing monitor were selected from June 2021 to March 2022. Risky decision making was tested through the GDT with known risk probability. General demographic information and background cognitive functions, such as the overall cognitive functioning and executive functioning, were tested to establish baseline data. RESULTS There were no significant differences in gender, age, and years of education between the two groups. During the GDT, the moderate to severe OSAS group opted for the safety option at a statistically significant lower rate when compared to the no or mild OSAS group (7.53 ± 4.43 vs. 10.26 ± 4.26, p = 0.022). The moderate to severe OSAS group utilized the higher risk option than the group with no or mild OSAS (10.47 ± 4.43 vs. 7.74 ± 4.26, p = 0.022). The utilization rate of negative feedback in the moderate and severe OSAS group was lower than that in the no or mild OSAS group (7.50, 52.50 vs. 28.57, 100.00, p = 0.001). At the end of the GDT, the moderate and severe OSAS group was more likely to have negative total assets than the patients with no or mild OSAS (-1846.67 ± 2587.20 vs. 300.00 ± 1509.97, p < 0.001). Multiple linear regression analysis shows that there is a negative correlation between the selection of risk options and negative feedback utilization in the GDT. CONCLUSION Patients with moderate and severe OSAS displayed impaired decision-making throughout the study. Impaired decision-making is related to executive processes and may be caused by diminished prefrontal cortex functioning. However, the functions of memory, attention, language, abstraction, and orientation are relatively retained.
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Affiliation(s)
- Lei Zhao
- Department of Respiratory Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Heifei 230011, China; (L.Z.); (Y.Z.); (D.S.); (Z.L.)
| | - Yanyan Zhao
- Department of Respiratory Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Heifei 230011, China; (L.Z.); (Y.Z.); (D.S.); (Z.L.)
| | - Dongmei Su
- Department of Respiratory Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Heifei 230011, China; (L.Z.); (Y.Z.); (D.S.); (Z.L.)
| | - Zhi Lv
- Department of Respiratory Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Heifei 230011, China; (L.Z.); (Y.Z.); (D.S.); (Z.L.)
| | - Fei Xie
- Neurology Department of Neurology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Heifei 230011, China;
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Heifei 230022, China;
| | - Kierstin L. A. Porter
- Department of Microbiology, Immunology & Pathology, Des Moines University, Des Moines, IA 50312, USA; (K.L.A.P.); (I.M.); (J.D.C.)
| | - Isabella Mazzei
- Department of Microbiology, Immunology & Pathology, Des Moines University, Des Moines, IA 50312, USA; (K.L.A.P.); (I.M.); (J.D.C.)
| | - Jaeson D. Chin
- Department of Microbiology, Immunology & Pathology, Des Moines University, Des Moines, IA 50312, USA; (K.L.A.P.); (I.M.); (J.D.C.)
| | - Yongsheng Wang
- Department of Respiratory Medicine, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Heifei 230011, China; (L.Z.); (Y.Z.); (D.S.); (Z.L.)
| | - Yujiang Fang
- Department of Microbiology, Immunology & Pathology, Des Moines University, Des Moines, IA 50312, USA; (K.L.A.P.); (I.M.); (J.D.C.)
- Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA
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Loss of Blood-Brain Barrier Integrity in an In Vitro Model Subjected to Intermittent Hypoxia: Is Reversion Possible with a HIF-1α Pathway Inhibitor? Int J Mol Sci 2023; 24:ijms24055062. [PMID: 36902491 PMCID: PMC10003655 DOI: 10.3390/ijms24055062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/11/2023] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
Several sleep-related breathing disorders provoke repeated hypoxia stresses, which potentially lead to neurological diseases, such as cognitive impairment. Nevertheless, consequences of repeated intermittent hypoxia on the blood-brain barrier (BBB) are less recognized. This study compared two methods of intermittent hypoxia induction on the cerebral endothelium of the BBB: one using hydralazine and the other using a hypoxia chamber. These cycles were performed on an endothelial cell and astrocyte coculture model. Na-Fl permeability, tight junction protein, and ABC transporters (P-gp and MRP-1) content were evaluated with or without HIF-1 inhibitors YC-1. Our results demonstrated that hydralazine as well as intermittent physical hypoxia progressively altered BBB integrity, as shown by an increase in Na-Fl permeability. This alteration was accompanied by a decrease in concentration of tight junction proteins ZO-1 and claudin-5. In turn, microvascular endothelial cells up-regulated the expression of P-gp and MRP-1. An alteration was also found under hydralazine after the third cycle. On the other hand, the third intermittent hypoxia exposure showed a preservation of BBB characteristics. Furthermore, inhibition of HIF-1α with YC-1 prevented BBB dysfunction after hydralazine treatment. In the case of physical intermittent hypoxia, we observed an incomplete reversion suggesting that other biological mechanisms may be involved in BBB dysfunction. In conclusion, intermittent hypoxia led to an alteration of the BBB model with an adaptation observed after the third cycle.
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Xie W, Shu Y, Liu X, Li K, Li P, Kong L, Yu P, Huang L, Long T, Zeng L, Li H, Peng D. Abnormal Spontaneous Brain Activity and Cognitive Impairment in Obstructive Sleep Apnea. Nat Sci Sleep 2022; 14:1575-1587. [PMID: 36090000 PMCID: PMC9462436 DOI: 10.2147/nss.s376638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to explore the alterations in spontaneous brain activity in obstructive sleep apnea (OSA) using percent amplitude of fluctuation (PerAF) and investigate the relationship between abnormal spontaneous brain activity and cognitive impairment in OSA. PATIENTS AND METHODS Overall, 52 patients with moderate to severe OSA and 61 healthy controls (HCs) were eventually enrolled in this study. All participants underwent resting-state functional magnetic resonance (rs-fMRI) and T1-weighted imaging. The PerAF was calculated and compared between patients with OSA and HCs, with voxel level P < 0.001 and cluster level P < 0.05 corrected with Gaussian Random Field was be considered statistically different. A partial correlation analysis was used to assess the relationship between altered PerAF and clinical assessments in patients with OSA. RESULTS Compared to HCs, patients with OSA had significantly lower PerAF values in the right rectal gyrus and left superior frontal gyrus, but higher PerAF values in the right cerebellum posterior lobe and left middle frontal gyrus. The PerAF values of some specific regions in patients with OSA correlated with sleep efficiency and Montreal Cognitive Assessment scores. Additionally, support vector machine analysis showed that PerAF values in all differential brain regions could differentiate patients with OSA from HCs with good accuracy. CONCLUSION Specific brain areas in OSA patients may exhibit aberrant neuronal activity, and these anomalies may be linked to decreased cognitive performance. This discovery offers fresh perspectives on these patients' neurocognition.
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Affiliation(s)
- Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Panmei Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Linghong Kong
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Pengfei Yu
- Big Data Research Center, The Second Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China.,PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
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Tiara T, Fidiana F. Obstructive sleep apnea and chronic pain as risk factors of cognitive impairment in elderly population: A study from Indonesia. NARRA J 2021; 1:e62. [PMID: 38450216 PMCID: PMC10914088 DOI: 10.52225/narra.v1i3.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 03/08/2024]
Abstract
Obstructive sleep apnea (OSA), one of the most prevalent sleep-related breathing disorders in the elderly, seems to be underdiagnosed. Meanwhile, the resulting complication on cognitive function could impact on patient's quality of life. Association between OSA and cognitive function in the elderly varies highly, depending on study type, setting, and possibly by demographic differences. Therefore, this study sought to determine the risk of OSA among elderly and to assess the association of OSA risk and other plausible factors with cognitive function. In this cross-sectional study, patients aged 60 years and above who visited the outpatient clinic at two main hospitals in Surabaya of Indonesia were examined. A total of 178 participants were interviewed to evaluate the OSA risk using STOP-Bang questionnaire, the cognitive dysfunction using Montreal Cognitive Assessment Indonesian version (MoCA-Ina), depressive symptoms using Geriatric Depression Scale-15 (GDS-15), and sleep disorder using Insomnia Screening Questionnaire (ISQ). The Mann-Whitney and Chi-square tests were used to assess factors associated with cognitive impairment. In addition, logistic regression analyses were performed to evaluate the role of high risk of OSA on cognitive impairment. A total of 120 patients were considered having high risk of OSA (STOP- Bang score ≥3), and 129 had mild cognitive impairment (MCI) (MoCA-Ina <26). Among the elderly who had high risk of OSA, 94 were diagnosed with MCI (78.3%). Multivariate logistic regression analysis showed that high risk of OSA (OR: 2.99; 95%CI: 1.39, 6.46, p=0.005), chronic pain (OR: 5.53; 95%CI: 1.19, 25.64, p=0.029), and low education level (OR: 4.57; 95%CI: 1.79, 11.63) were associated with MCI. In conclusion, our data suggests a high prevalence of MCI among high risk OSA elderly. Screening and comprehensive management might be beneficial to improve or to preserve cognitive function in elderly group.
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Affiliation(s)
- Tiara Tiara
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Fidiana Fidiana
- Department of Neurology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Neurology, Dr. Soetomo General Hospital, Surabaya, Indonesia
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9
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Kiernan EA, Ewald AC, Ouellette JN, Wang T, Agbeh A, Knutson AO, Roopra AS, Watters JJ. Prior Hypoxia Exposure Enhances Murine Microglial Inflammatory Gene Expression in vitro Without Concomitant H3K4me3 Enrichment. Front Cell Neurosci 2020; 14:535549. [PMID: 33132843 PMCID: PMC7575929 DOI: 10.3389/fncel.2020.535549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/09/2020] [Indexed: 12/19/2022] Open
Abstract
Hypoxia (Hx) is a component of multiple disorders, including stroke and sleep-disordered breathing, which often precede or are comorbid with neurodegenerative diseases. However, little is known about how hypoxia affects the ability of microglia, resident CNS macrophages, to respond to subsequent inflammatory challenges that are often present during neurodegenerative processes. We, therefore, tested the hypothesis that hypoxia would enhance or "prime" microglial pro-inflammatory gene expression in response to a later inflammatory challenge without programmatically increasing basal levels of pro-inflammatory cytokine expression. To test this, we pre-exposed immortalized N9 and primary microglia to hypoxia (1% O2) for 16 h and then challenged them with pro-inflammatory lipopolysaccharide (LPS) either immediately or 3-6 days following hypoxic exposure. We used RNA sequencing coupled with chromatin immunoprecipitation sequencing to analyze primed microglial inflammatory gene expression and modifications to histone H3 lysine 4 trimethylation (H3K4me3) at the promoters of primed genes. We found that microglia exhibited enhanced responses to LPS 3 days and 6 days post-hypoxia. Surprisingly, however, the majority of primed genes were not enriched for H3K4me3 acutely following hypoxia exposure. Using the bioinformatics tool MAGICTRICKS and reversible pharmacological inhibition, we found that primed genes required the transcriptional activities of NF-κB. These findings provide evidence that hypoxia pre-exposure could lead to persistent and aberrant inflammatory responses in the context of CNS disorders.
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Affiliation(s)
- Elizabeth A. Kiernan
- Department of Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrea C. Ewald
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Jonathan N. Ouellette
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Tao Wang
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Abiye Agbeh
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew O. Knutson
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
- Molecular and Environmental Toxicology Training Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Avtar S. Roopra
- Department of Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
- Department of Neuroscience, University of Wisconsin-Madison, Madison, WI, United States
| | - Jyoti J. Watters
- Department of Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, United States
- Molecular and Environmental Toxicology Training Program, University of Wisconsin-Madison, Madison, WI, United States
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10
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Liu X, Ma Y, Ouyang R, Zeng Z, Zhan Z, Lu H, Cui Y, Dai Z, Luo L, He C, Li H, Zong D, Chen Y. The relationship between inflammation and neurocognitive dysfunction in obstructive sleep apnea syndrome. J Neuroinflammation 2020; 17:229. [PMID: 32738920 PMCID: PMC7395983 DOI: 10.1186/s12974-020-01905-2] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS), a state of sleep disorder, is characterized by repetitive apnea, chronic hypoxia, oxygen desaturation, and hypercapnia. Previous studies have revealed that intermittent hypoxia (IH) conditions in OSAS patients elicited neuron injury (especially in the hippocampus and cortex), leading to cognitive dysfunction, a significant and extraordinary complication of OSAS patients. The repeated courses of airway collapse and obstruction in OSAS patients resulted in apnea and arousal during sleep, leading to IH and excessive daytime sleepiness (EDS) and subsequently contributing to the development of inflammation. IH-mediated inflammation could further trigger various types of cognitive dysfunction. Many researchers have found that, besides continuous positive airway pressure (CPAP) treatment and surgery, anti-inflammatory substances might alleviate IH-induced neurocognitive dysfunction. Clarifying the role of inflammation in IH-mediated cognitive impairment is crucial for potentially valuable therapies and future research in the related domain. The objective of this article was to critically review the relationship between inflammation and cognitive deficits in OSAS.
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Affiliation(s)
- Xiangming Liu
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Yiming Ma
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Ruoyun Ouyang
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zihang Zeng
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zijie Zhan
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Huanhuan Lu
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Yanan Cui
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Zhongshang Dai
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Lijuan Luo
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Chenjie He
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Herui Li
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
| | - Dandan Zong
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
| | - Yan Chen
- Department of Respiratory and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China. .,Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
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11
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Abstract
PURPOSE OF REVIEW This review provides a contemporary review of sleep apnea with emphasis on definitions, epidemiology, and consequences. RECENT FINDINGS Amyloid β-42 is one of the main peptides forming amyloid plaques in the brains of Alzheimer patients. Poorer sleep quality and shorter sleep duration have been associated with a higher amyloid burden. Decreased sleep time in the elderly is a precipitating factor in amyloid retention. Studies have shown that the dysregulation of the homeostatic balance of the major inhibitory and excitatory amino acid neurotransmitter systems of gamma-aminobutyric acid (GABA) and glutamate play a role in sleep disordered breathing (SDB). SUMMARY Untreated sleep disordered breathing (obstructive sleep apnea and/or central sleep apnea) are an important cause of medical mortality and morbidity. OSA is characterized by recurrent episodes of partial or complete collapse of the upper airway during sleep followed by hypoxia and sympathetic activation. Apneic events are terminated by arousal, followed by increases in pulse and blood pressure, and re-oxygenation and the release of inflammatory factors. Individuals with OSA have an increased risk of developing atrial fibrillation. Hypoxemia and poor sleep quality because of OSA increase the risk of cognitive decline in the elderly.
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12
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Rubin BR, Milner TA, Pickel VM, Coleman CG, Marques-Lopes J, Van Kempen TA, Kazim SF, McEwen BS, Gray JD, Pereira AC. Sex and age differentially affect GABAergic neurons in the mouse prefrontal cortex and hippocampus following chronic intermittent hypoxia. Exp Neurol 2019; 325:113075. [PMID: 31837319 DOI: 10.1016/j.expneurol.2019.113075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA), a chronic sleep disorder characterized by repetitive reduction or cessation of airflow during sleep, is widely prevalent and is associated with adverse neurocognitive sequelae including increased risk of Alzheimer's disease (AD). In humans, OSA is more common in elderly males. OSA is characterized by sleep fragmentation and chronic intermittent hypoxia (CIH), and recent epidemiological studies point to CIH as the best predictor of neurocognitive sequelae associated with OSA. The sex- and age- specific effects of OSA-associated CIH on specific cell populations such as γ-aminobutyric acid (GABA)-ergic neurons in the hippocampus and the medial prefrontal cortex (mPFC), regions important for cognitive function, remain largely unknown. The present study examined the effect of 35 days of either moderate (10% oxygen) or severe (5% oxygen) CIH on GABAergic neurons in the mPFC and hippocampus of young and aged male and female mice as well as post-accelerated ovarian failure (AOF) female mice. In the mPFC and hippocampus, the number of GABA-labeled neurons increased in aged and young severe CIH males compared to controls but not in young moderate CIH males. This change was not representative of the individual GABAergic cell subpopulations, as the number of parvalbumin-labeled neurons decreased while the number of somatostatin-labeled neurons increased in the hippocampus of severe CIH young males only. In all female groups, the number of GABA-labeled cells was not different between CIH and controls. However, in the mPFC, CIH increased the number of parvalbumin-labeled neurons in young females and the number of somatostatin-labeled cells in AOF females but decreased the number of somatostatin-labeled cells in aged females. In the hippocampus, CIH decreased the number of somatostatin-labeled neurons in young females. CIH decreased the density of vesicular GABA transporter in the mPFC of AOF females only. These findings suggest sex-specific changes in GABAergic neurons in the hippocampus and mPFC with males showing an increase of this cell population as compared to their female counterparts following CIH. Age at exposure and severity of CIH also differentially affect the GABAergic cell population in mice.
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Affiliation(s)
- Batsheva R Rubin
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America.
| | - Teresa A Milner
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America.
| | - Virginia M Pickel
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America
| | - Christal G Coleman
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America
| | - Jose Marques-Lopes
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America
| | - Tracey A Van Kempen
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY 10065, United States of America
| | - Syed Faraz Kazim
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America; Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY 10029, United States of America; Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America
| | - Bruce S McEwen
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America
| | - Jason D Gray
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America
| | - Ana C Pereira
- Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology, The Rockefeller University, New York, NY 10065, United States of America; Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY 10029, United States of America; Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States of America.
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13
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Late-onset unexplained epilepsy: What are we missing? Epilepsy Behav 2019; 99:106478. [PMID: 31481308 DOI: 10.1016/j.yebeh.2019.106478] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 01/22/2023]
Abstract
With the aging of the US population, the incidence of epilepsy will increase, with 25 to 50% of new cases with no identifiable etiology diagnosed as late-onset unexplained epilepsy (LOUE). In the current targeted review, we discuss the possible role of cerebral small vessel ischemic disease, accumulation of amyloidβ and hyperphosphorylated tau, and sleep apnea as potential pathophysiologic mechanisms explaining LOUE. We highlight the impact of these processes on cognition and avenues for diagnosis and treatment.
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14
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Qassamali SR, Lagoo-Deenadayalan S, McDonald S, Morgan B, Goode V. The importance of the STOP- BANG questionnaire as a preoperative assessment tool for the elderly population. Geriatr Nurs 2019; 40:536-539. [PMID: 31481260 DOI: 10.1016/j.gerinurse.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Undiagnosed obstructive sleep apnea (OSA) may adversely impact surgical patients and can lead to increased morbidity and mortality during the perioperative period, especially among the geriatric patient population (Chung et al. 2008, 2012, 2014; McDonald et al., 2018; Zietlow et al., 2018; Singh et al., 2012). The setting of this quality improvement project was a preoperative anesthesia and geriatric evaluation clinic housed within a 957-bed tertiary academic affiliated hospital. The sample included 45 patients who met the criteria established for surgery and OSA screening preoperatively. Nine patients (20.0%) were assessed as low risk (Stop-bang [SB] score </=2) for OSA, and 36 patients (80.0%) had a prior diagnosis from an ICD-9/10 code or a SB score >/= 3 indicative of high-risk for OSA. The retrospective utilization of a modified SB screening on charts that did not receive a clinical OSA evaluation (n = 52) detected 23 (44.2%) patients who were considered high-risk for OSA but were not identified prior to surgery. The SB questionnaire is underutilized, and patients' OSA is often unidentified prior to surgery.
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Affiliation(s)
- Sonia R Qassamali
- Duke University School of Nursing, Nurse Anesthesia Program 307 Trent Dr, Durham, NC 27710
| | | | - Shelley McDonald
- Duke University Medical Center, 2301 Erwin Road Durham, NC 27710
| | - Brett Morgan
- Duke University School of Nursing, Nurse Anesthesia Program 307 Trent Dr, Durham, NC 27710
| | - Victoria Goode
- Duke University School of Nursing, Nurse Anesthesia Program 307 Trent Dr, Durham, NC 27710.
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15
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Abstract
Sleep is a behavioral phenomenon conserved among mammals and some invertebrates, yet the biological functions of sleep are still being elucidated. In humans, sleep time becomes shorter, more fragmented, and of poorer quality with advancing age. Epidemiologically, the development of age-related neurodegenerative diseases such as Alzheimer's and Parkinson's disease is associated with pronounced sleep disruption, whereas emerging mechanistic studies suggest that sleep disruption may be causally linked to neurodegenerative pathology, suggesting that sleep may represent a key therapeutic target in the prevention of these conditions. In this review, we discuss the physiology of sleep, the pathophysiology of neurodegenerative disease, and the current literature supporting the relationship between sleep, aging, and neurodegenerative disease.
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Affiliation(s)
- Thierno M Bah
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - James Goodman
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey J Iliff
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA.
- Veterans Integrated Service Network 20 Mental Illness Research, Education and Clinical Center, Puget Sound Health Care System, Mail Stop 116-MIRECC, 1660 South Columbian Way, Seattle, Washington, 98108, USA.
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA.
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16
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Patrician A, Tymko MM, Caldwell HG, Howe CA, Coombs GB, Stone R, Hamilton A, Hoiland RL, Ainslie PN. The Effect of an Expiratory Resistance Mask with Dead Space on Sleep, Acute Mountain Sickness, Cognition, and Ventilatory Acclimatization in Normobaric Hypoxia. High Alt Med Biol 2019; 20:61-70. [PMID: 30720346 DOI: 10.1089/ham.2018.0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
We examined the hypothesis that an expiratory resistance mask containing a small amount of dead space (ER/DS) would reduce the apnea-hypopnea index (AHI) during sleep, attenuate the severity of acute mountain sickness (AMS), and offset decrements in cognitive function compared with a sham mask. In a double-blinded, randomized, sham-controlled, crossover design, 19 volunteers were exposed to two nights of normobaric hypoxia (FIO2 = 0.125), using a ER/DS mask (3.5 mm restrictive expiratory orifice; 125 mL DS volume) and sham mask (zero-flow resistance; 50 mL DS volume). Cognitive function, AMS, and ventilatory acclimatization were assessed before and after the 12-hour normobaric hypoxia exposure. Polysomnography was conducted during sleep. AHI was reduced using the ER/DS sleep mask compared with the sham (30.1 ± 23.9 events·hr-1 vs. 58.9 ± 34.4 events·hr-1, respectively; p = 0.01). Likewise, oxygen desaturation index and headache severity were reduced (both p < 0.05). There were also benefits on limiting the hypoxia-induced reductions in select measures of reaction speed and attention (p < 0.05). Our study indicates that a simple noninvasive and portable ER/DS mask resulted in reductions (49%) in AHI, and reduced headache severity and aspects of cognitive decline. The field applications of this ER/DS mask should be investigated before recommendations can be made to support its benefit for travel to high altitude.
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Affiliation(s)
- Alexander Patrician
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Michael M Tymko
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Hannah G Caldwell
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Connor A Howe
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Geoff B Coombs
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Rachel Stone
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Allison Hamilton
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Ryan L Hoiland
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
| | - Philip N Ainslie
- Center for Heart, Lung and Vascular Health, University of British Columbia, Okanagan, Kelowna, Canada
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17
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Macey PM, Prasad JP, Ogren JA, Moiyadi AS, Aysola RS, Kumar R, Yan-Go FL, Woo MA, Albert Thomas M, Harper RM. Sex-specific hippocampus volume changes in obstructive sleep apnea. NEUROIMAGE-CLINICAL 2018; 20:305-317. [PMID: 30101062 PMCID: PMC6083433 DOI: 10.1016/j.nicl.2018.07.027] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 07/05/2018] [Accepted: 07/25/2018] [Indexed: 01/24/2023]
Abstract
Introduction Obstructive sleep apnea (OSA) patients show hippocampal-related autonomic and neurological symptoms, including impaired memory and depression, which differ by sex, and are mediated in distinct hippocampal subfields. Determining sites and extent of hippocampal sub-regional injury in OSA could reveal localized structural damage linked with OSA symptoms. Methods High-resolution T1-weighted images were collected from 66 newly-diagnosed, untreated OSA (mean age ± SD: 46.3 ± 8.8 years; mean AHI ± SD: 34.1 ± 21.5 events/h;50 male) and 59 healthy age-matched control (46.8 ± 9.0 years;38 male) participants. We added age-matched controls with T1-weighted scans from two datasets (IXI, OASIS-MRI), for 979 controls total (426 male/46.5 ± 9.9 years). We segmented the hippocampus and analyzed surface structure with “FSL FIRST” software, scaling volumes for brain size, and evaluated group differences with ANCOVA (covariates: total-intracranial-volume, sex; P < .05, corrected). Results In OSA relative to controls, the hippocampus showed small areas larger volume bilaterally in CA1 (surface displacement ≤0.56 mm), subiculum, and uncus, and smaller volume in right posterior CA3/dentate (≥ − 0.23 mm). OSA vs. control males showed higher bilateral volume (≤0.61 mm) throughout CA1 and subiculum, extending to head and tail, with greater right-sided increases; lower bilateral volumes (≥ − 0.45 mm) appeared in mid- and posterior-CA3/dentate. OSA vs control females showed only right-sided effects, with increased CA1 and subiculum/uncus volumes (≤0.67 mm), and decreased posterior CA3/dentate volumes (≥ − 0.52 mm). Unlike males, OSA females showed volume decreases in the right hippocampus head and tail. Conclusions The hippocampus shows lateralized and sex-specific, OSA-related regional volume differences, which may contribute to sex-related expression of symptoms in the sleep disorder. Volume increases suggest inflammation and glial activation, whereas volume decreases suggest long-lasting neuronal injury; both processes may contribute to dysfunction in OSA. The hippocampus in OSA shows areas of increased and decreased volume. The injury is sex-specific, in subregions related to symptoms in females and males. Injury may be inflammation (volume increases) or cell death (volume decreases).
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Affiliation(s)
- Paul M Macey
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, United States; Brain Research Institute, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States.
| | - Janani P Prasad
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Jennifer A Ogren
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Ammar S Moiyadi
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Ravi S Aysola
- Medicine-Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Rajesh Kumar
- Brain Research Institute, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States; Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States; Radiological Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Frisca L Yan-Go
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Mary A Woo
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - M Albert Thomas
- Radiological Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States
| | - Ronald M Harper
- Brain Research Institute, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States; Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA 90095, United States
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18
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Gozal D. The ageing brain in sleep apnoea: paradoxical resilience, survival of the fittest, or simply comparing apples and oranges? Eur Respir J 2018; 51:51/6/1800802. [PMID: 29903830 DOI: 10.1183/13993003.00802-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 04/30/2018] [Indexed: 12/21/2022]
Affiliation(s)
- David Gozal
- Dept of Pediatrics, Section of Sleep Medicine, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA
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19
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Obstructive sleep apnea and cerebral white matter change: a systematic review and meta-analysis. J Neurol 2018; 265:1643-1653. [PMID: 29766271 DOI: 10.1007/s00415-018-8895-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 01/23/2023]
Abstract
Obstructive sleep apnea (OSA) can cause sleep fragmentation and intermittent hypoxemia, which are linked to oxidative stress. White matter changes (WMCs) representing cerebrovascular burden and are at risk factor for oxidative ischemic injury. The current study explores the mutual relationships between OSA and WMCs. We performed a systematic review of electronic databases for clinical studies investigating OSA and WMCs. Random-effects models were used for pooled estimates calculation. A total of 22 studies were included in the meta-analysis. The results revealed a significantly higher prevalence rate of WMCs [odds ratio (OR) 2.06, 95% confidence interval (CI) 1.52-2.80, p < 0.001] and significantly higher severity of WMCs (Hedges' g = 0.23, 95% CI 0.06-0.40, p = 0.009) in the patients with OSA than in controls. Furthermore, the results revealed a significantly higher apnea-hypopnea index (Hedges' g = 0.54, 95% CI 0.31-0.78, p < 0.001) and significantly higher prevalence rate of moderate-to-severe OSA (OR 2.86, 95% CI 1.44-5.66, p = 0.003) in the patients with WMCs than in controls, however there was no significant difference in the prevalence rate of mild OSA between the patients with WMCs and controls (OR 0.71, 95% CI 0.20-2.54, p = 0.603). OSA was associated with a higher prevalence and more severe WMCs, and the patients with WMCs had an increased association with moderate-to-severe OSA. Future large-scale randomized controlled trials with a longitudinal design are essential to further evaluate treatment in patients with OSA.
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