Dysfunction in Automatic Processing of Emotional Facial Expressions in Patients with Obstructive Sleep Apnea Syndrome: An Event-Related Potential Study

GLP-1 analogue liraglutide attenuates CIH-induced cognitive deficits by inhibiting oxidative stress, neuroinflammation, and apoptosis via the Nrf2/HO-1 and MAPK/NF-κB signaling pathways

Obstructive sleep apnea (OSA) is a common clinical condition linked to cognitive impairment, mainly characterized by chronic intermittent hypoxia (CIH). GLP-1 receptor agonist, known for promoting insulin secretion and reducing glucose levels, has demonstrated neuroprotective effects in various experimental models such as stroke, Alzheimer's disease, and Parkinson's disease. This study aims to investigate the potential role and mechanisms of the GLP-1 receptor agonist liraglutide in ameliorating OSA-induced cognitive deficits. CIH exposure, a well-established and mature OSA pathological model, was used both in vitro and in vivo. In vitro, CIH significantly activated oxidative stress, inflammation, and apoptosis in SH-SY5Y cells. Liraglutide enhanced the nuclear translocation of Nrf2, activating its downstream pathways, thereby mitigating CIH-induced injury in SH-SY5Y cells. Additionally, liraglutide modulated the MAPK/NF-κB signaling pathway, reducing the expression of inflammatory factors and proteins. In vivo, we subjected mice to an intermittent hypoxia incubator to mimic the pathogenesis of human OSA. The Morris water maze test revealed that CIH exposure substantially impaired spatial memory. Subsequent western blot analyses and histopathological examinations indicated that liraglutide could activate the Nrf2/HO-1 axis and inhibit the MAPK/NF-κB signaling pathway, thereby alleviating OSA-associated cognitive dysfunction in mice. These findings suggest that GLP-1 receptor agonists may offer a promising preventive strategy for OSA-associated cognitive impairment. By refining these findings, we provide new insights into GLP-1's protective mechanisms in combating cognitive deficits associated with CIH, underscoring its potential as a therapeutic agent for conditions linked to OSA.

Implications of depressive mood in OSAHS patients: insights from event-related potential

BACKGROUND

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic breathing disorder characterized by recurrent upper airway obstruction during sleep. Although previous studies have shown a link between OSAHS and depressive mood, the neurobiological mechanisms underlying mood disorders in OSAHS patients remain poorly understood. This study aims to investigate the emotion processing mechanism in OSAHS patients with depressive mood using event-related potentials (ERPs).

METHODS

Seventy-four OSAHS patients were divided into the depressive mood and non-depressive mood groups according to their Self-rating Depression Scale (SDS) scores. Patients underwent overnight polysomnography and completed various cognitive and emotional questionnaires. The patients were shown facial images displaying positive, neutral, and negative emotions and tasked to identify the emotion category, while their visual evoked potential was simultaneously recorded.

RESULTS

The two groups did not differ significantly in age, BMI, and years of education, but showed significant differences in their slow wave sleep ratio (P = 0.039), ESS (P = 0.006), MMSE (P < 0.001), and MOCA scores (P = 0.043). No significant difference was found in accuracy and response time on emotional face recognition between the two groups. N170 latency in the depressive group was significantly longer than the non-depressive group (P = 0.014 and 0.007) at the bilateral parieto-occipital lobe, while no significant difference in N170 amplitude was found. No significant difference in P300 amplitude or latency between the two groups. Furthermore, N170 amplitude at PO7 was positively correlated with the arousal index and negatively with MOCA scores (both P < 0.01).

CONCLUSION

OSAHS patients with depressive mood exhibit increased N170 latency and impaired facial emotion recognition ability. Special attention towards the depressive mood among OSAHS patients is warranted for its implications for patient care.

Facial feedback manipulation influences the automatic detection of unexpected emotional body expressions

Unexpected or changing facial expressions are known to be able to engage more automatic processing than frequently occurring facial expressions, thereby inducing a neural differential wave response known as expression mismatch negativity (EMMN). Recent studies have shown that EMMN can be modulated by the observer's facial feedback (i.e., feedback from their own facial movements). A similar EMMN activity has been discovered for body expressions, but thus far only a few emotion types have been investigated. It is unknown whether the EMMNs evoked by body expressions can be influenced by facial feedback. To explore this question, we recorded EEG activity of 29 participants in the reverse oddball paradigm. Here two unexamined categories of body expressions were presented, happy and sad, placed in two paired stimulus sequences: in one the happy body was presented with a probability of 80% (standards) while the sad body was presented with a probability of 20% (deviants), and in the other the probabilities were reversed. The facial feedback was manipulated by different pen holding conditions (i.e., participants holding the pen with the teeth, lips, or nondominant hand). The nonparametric cluster permutation test revealed significant happy and sad body-related EMMN (bEMMN) activities. The happy-bEMMN were more negative than sad-bEMMN within the range of 100-150 ms. Additionally, the bEMMN amplitude of both emotions is modulated by the facial feedback conditions. These results expand the range of emotional types applicable to bEMMN and provide evidence for the validity of the facial feedback hypothesis across emotional carriers.

Obstructive sleep apnea hypopnea syndrome in ancient traditional Chinese medicine

In western medicine, obstructive sleep apnea hypopnea syndrome (OSAHS) is an increasingly serious public health hazard, which is exacerbated by the obesity epidemic and an aging population. Ancient medical literature of traditional Chinese medicine (TCM) also recorded OSAHS-like symptoms but described the disease from a completely distinct theoretical perspective. The earliest records of snoring in ancient China can be traced back 2500 years. In TCM, the pathogenesis of OSAHS can be attributed mainly to turbid phlegm and blood stasis. Various TCM prescriptions, herbal medicines, and external therapy have also been proposed for the prevention and therapy of OSAHS. Some of these strategies are still used in current clinical practice. This review highlights historical characterizations of OSAHS and the theory of TCM and also explores its therapy in TCM, which may shed light on future OSAHS research. This is the first systematic English review of the role of TCM in the treatment of OSAHS.

Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in sleep in which the airways narrow or collapse during sleep, causing obstructive sleep apnea. The prevalence of OSAS continues to rise worldwide, particularly in middle-aged and elderly individuals. The mechanism of upper airway collapse is incompletely understood but is associated with several factors, including obesity, craniofacial changes, altered muscle function in the upper airway, pharyngeal neuropathy, and fluid shifts to the neck. The main characteristics of OSAS are recurrent pauses in respiration, which lead to intermittent hypoxia (IH) and hypercapnia, accompanied by blood oxygen desaturation and arousal during sleep, which sharply increases the risk of several diseases. This paper first briefly describes the epidemiology, incidence, and pathophysiological mechanisms of OSAS. Next, the alterations in relevant signaling pathways induced by IH are systematically reviewed and discussed. For example, IH can induce gut microbiota (GM) dysbiosis, impair the intestinal barrier, and alter intestinal metabolites. These mechanisms ultimately lead to secondary oxidative stress, systemic inflammation, and sympathetic activation. We then summarize the effects of IH on disease pathogenesis, including cardiocerebrovascular disorders, neurological disorders, metabolic diseases, cancer, reproductive disorders, and COVID-19. Finally, different therapeutic strategies for OSAS caused by different causes are proposed. Multidisciplinary approaches and shared decision-making are necessary for the successful treatment of OSAS in the future, but more randomized controlled trials are needed for further evaluation to define what treatments are best for specific OSAS patients.

The automatic detection of unexpected emotion and neutral body postures: A visual mismatch negativity study

The ability to automatically detect emotional changes in the environment is crucial for social interaction. In the visual system, expression-related mismatch negativity (EMMN) reflects the automatic processing of emotional changes in facial expression. However, body postures also carry visual emotional information that can be recognized effectively and processed automatically, although their processing mechanism remains unknown. In this study, the reverse oddball paradigm was used to investigate the mismatch responses of unexpected fear and neutral body postures. The nonparametric cluster permutation test revealed significant fear and neutral visual mismatch negativity (vMMN) activities, and the fear-related vMMN was enhanced prior (130-230 ms) to the neutral vMMN (180-230 ms). The body-sensitive N190 component may partially account for the vMMN obtained in this study. The fearful body posture evoked a greater N190 response over the neutral body, and amplitudes of N190 were more negative in the deviant condition than the standard condition. Additionally, the body-related visual mismatch oscillatory responses were associated with enhancement of the alpha band oscillation, especially for the fearful body posture. These results expanded the applicable scope of body posture cues corresponding to mismatch signals, objectively defined the electrophysiological activities evoked, and revealed the processing bias toward negative emotion.