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Lee G, Dharmakulaseelan L, Muir RT, Iskander C, Kendzerska T, Boulos MI. Obstructive sleep apnea is associated with markers of cerebral small vessel disease in a dose-response manner: A systematic review and meta-analysis. Sleep Med Rev 2023; 68:101763. [PMID: 36805589 DOI: 10.1016/j.smrv.2023.101763] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023]
Abstract
Cerebral small vessel disease manifests on neuroimaging as white matter hyperintensities, lacunes, cerebral microbleeds, perivascular spaces or subcortical infarcts and is a major contributor to dementia, stroke and incident death. We aimed to determine whether obstructive sleep apnea severity is associated cerebral small vessel disease. A systematic search was conducted for studies examining the association between obstructive sleep apnea and cerebral small vessel disease markers. A random-effects model was used to meta-analyze unadjusted odds ratios derived from event rates. The neuroimaging-derived measures of white matter hyperintensities, lacunes, and cerebral microbleeds were compared against increasing obstructive sleep apnea severity, as measured by apnea-hypopnea indices of <5, 5-15, ≥15 and ≥ 30. Thirty-two observational studies were included: ten reported effect sizes for white matter hyperintensities, nine for lacunes and three for cerebral microbleeds. Compared to patients without obstructive sleep apnea, the odds of possessing white matter hyperintensities were 1.7 [95% confidence interval 0.9-3.6] in mild, 3.9 [2.7-5.5] in moderate-severe and 4.3 [1.9-9.6] in severe obstructive sleep apnea. Moderate-severe obstructive sleep apnea was associated with a higher risk of lacunar infarcts. Obstructive sleep apnea had no association with cerebral microbleeds and an indeterminate association with perivascular spaces and subcortical infarcts due to insufficient data.
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Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laavanya Dharmakulaseelan
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ryan T Muir
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Carol Iskander
- Faculty of Medicine, The National University of Ireland, Galway, Ireland
| | - Tetyana Kendzerska
- Department of Medicine, Division of Respirology, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | - Mark I Boulos
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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2
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Baril AA, Gagnon K, Descoteaux M, Bedetti C, Chami S, Sanchez E, Montplaisir J, De Beaumont L, Gilbert D, Poirier J, Pelleieux S, Osorio RS, Carrier J, Gosselin N. Cerebral white matter diffusion properties and free-water with obstructive sleep apnea severity in older adults. Hum Brain Mapp 2020; 41:2686-2701. [PMID: 32166865 PMCID: PMC7294053 DOI: 10.1002/hbm.24971] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/25/2020] [Accepted: 02/16/2020] [Indexed: 12/13/2022] Open
Abstract
Characterizing the effects of obstructive sleep apnea (OSA) on the aging brain could be key in our understanding of neurodegeneration in this population. Our objective was to assess white matter properties in newly diagnosed and untreated adults with mild to severe OSA. Sixty‐five adults aged 55 to 85 were recruited and divided into three groups: control (apnea‐hypopnea index ≤5/hr; n = 18; 65.2 ± 7.2 years old), mild (>5 to ≤15 hr; n = 27; 64.2 ± 5.3 years old) and moderate to severe OSA (>15/hr; n = 20; 65.2 ± 5.5 years old). Diffusion tensor imaging metrics (fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity, and mean diffusivity) were compared between groups with Tract‐Based Spatial Statistics within the white matter skeleton created by the technique. Groups were also compared for white matter hyperintensities volume and the free‐water (FW) fraction. Compared with controls, mild OSA participants showed widespread areas of lower diffusivity (p < .05 corrected) and lower FW fraction (p < .05). Participants with moderate to severe OSA showed lower AD in the corpus callosum compared with controls (p < .05 corrected). No between‐group differences were observed for FA or white matter hyperintensities. Lower white matter diffusivity metrics is especially marked in mild OSA, suggesting that even the milder form may lead to detrimental outcomes. In moderate to severe OSA, competing pathological responses might have led to partial normalization of diffusion metrics.
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Affiliation(s)
- Andrée-Ann Baril
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.,The Framingham Heart Study, Boston University School of Medicine, Boston, Massachussetts
| | - Katia Gagnon
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada.,Research Centre, Hôpital Rivière-des-Prairies, Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Maxime Descoteaux
- Research Centre, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.,Computer Science Department, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Christophe Bedetti
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Sirin Chami
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Erlan Sanchez
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Jacques Montplaisir
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Louis De Beaumont
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Danielle Gilbert
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Judes Poirier
- Centre for Studies on Prevention of Alzheimer's disease, Douglas Institute, Verdun, Québec, Canada.,Department of Psychiatry and Medicine, McGill University, Montréal, Québec, Canada
| | - Sandra Pelleieux
- Centre for Studies on Prevention of Alzheimer's disease, Douglas Institute, Verdun, Québec, Canada.,Department of Psychiatry and Medicine, McGill University, Montréal, Québec, Canada
| | - Ricardo S Osorio
- Department of Psychiatry, Center for Brain Health, NYU Langone Medical Center, New York, New York, USA
| | - Julie Carrier
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Nadia Gosselin
- Research Centre, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.,Department of Psychology, Université de Montréal, Montréal, Québec, Canada
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Chokesuwattanaskul A, Lertjitbanjong P, Thongprayoon C, Bathini T, Sharma K, Mao MA, Cheungpasitporn W, Chokesuwattanaskul R. Impact of obstructive sleep apnea on silent cerebral small vessel disease: a systematic review and meta-analysis. Sleep Med 2019; 68:80-88. [PMID: 32028230 DOI: 10.1016/j.sleep.2019.11.1262] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/28/2019] [Accepted: 11/27/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is a well-known cause of vascular dementia, a leading medical morbidity in the aging population. Obstructive sleep apnea (OSA) has been validated as a cardiovascular risk factor. However, the relationship between these two clinical syndromes is not well established. We aimed to assess the association between OSA and CSVD. METHODS Databases were searched from inception through May 2019. Studies that reported incidence or odd ratios of CSVD in patients with OSA were included. Effect estimates from the individual studies were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS A total of 14 observational studies comprising of 4335 patients were included into the analysis. Compared to patients without OSA, patients with OSA were significantly associated with CSVD magnetic resonance imaging (MRI) findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) with a pooled OR of 2.31 (95% confidence interval [CI], 1.46-3.66, I2 = 79%) and 1.78 (95% CI, 1.06-3.01, I2 = 41%), respectively. However, there was no significant association between OSA and findings of cerebral microbleeds (CMBs), with a pooled odds ratio (OR) of 2.15 (95% CI, 0.64-7.29, I2 = 55%). CONCLUSIONS Our study demonstrated the association between OSA and CSVD MRI findings of white matter hyperintensity (WMH) and asymptomatic lacunar infarction (ALI) when compared to patients without OSA. The absence of an association of CMBs findings with OSA could be due either by a lower sensitivity of neuroimaging techniques utilized to detect CMBs or a potentially different pathogenesis of CMBs.
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Affiliation(s)
- Anthipa Chokesuwattanaskul
- Division of Neurology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
| | | | | | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | - Konika Sharma
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA
| | - Michael A Mao
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, 32224, USA
| | | | - Ronpichai Chokesuwattanaskul
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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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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