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Huang L, Shu Y, Liu X, Li L, Long T, Zeng L, Liu Y, Deng Y, Li H, Peng D. Abnormal dynamic functional connectivity in the hippocampal subregions of patients with untreated moderate-to-severe obstructive sleep apnea. Sleep Med 2023; 112:273-281. [PMID: 37939546 DOI: 10.1016/j.sleep.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To investigate the dynamic change characteristics of dynamic functional connectivity (dFC) between the hippocampal subregions (anterior and posterior) and other brain regions in obstructive sleep apnoea (OSA) and its relationship with cognitive function, and to explore whether these characteristics can be used to distinguish OSA from healthy controls (HCs). METHODS Eighty-five patients with newly diagnosed moderate-to-severe OSA and 85 HCs were enrolled. All participants underwent resting-state functional magnetic resonance imaging (fMRI). The difference between dFC values between the hippocampal subregions and other brain regions in OSA patients and HCs was compared using the two-sample t tests. Correlation analyses were used to assess the relationship between dFC, clinical data, and cognitive functions in OSA patients. dFC values from different brain regions were used as classification features to distinguish between the two groups using a support vector machine. RESULTS Compared with HCs, the dFC values between the left anterior hippocampus and right culmen of the cerebellum anterior lobe, right anterior hippocampus and left lingual gyrus, and left posterior hippocampus and left precentral gyrus were significantly lower, and the dFC values between the left posterior hippocampus and precuneus were significantly higher in OSA patients. The dFC values between the left posterior hippocampus and the precuneus of OSA patients were associated with sleep-related indicators and Montreal Cognitive Assessment scores. Support vector machine analysis results showed that dFC values in different brain regions could distinguish OSA patients from HCs. CONCLUSION dFC patterns between the hippocampal subregions and other brain regions were altered in patients with OSA, including the cerebellum, default mode networks, sensorimotor networks, and visual function networks, which is possibly associated with cognitive decline. In addition, the dFC values of different brain regions could effectively distinguish OSA patients from HCs. These findings provide new perspectives on neurocognition in these patients.
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Affiliation(s)
- Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lifeng Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yumeng Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yingke Deng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China; PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China; PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, China.
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Gao J, Cao J, Chen J, Wu D, Luo K, Shen G, Fang Y, Zhang W, Huang G, Su X, Zhao L. Brain morphology and functional connectivity alterations in patients with severe obstructive sleep apnea. Sleep Med 2023; 111:62-69. [PMID: 37722341 DOI: 10.1016/j.sleep.2023.08.032] [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: 05/29/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND It has been demonstrated that widespread structural and functional brain alterations influence the development of cognitive impairment in patients with obstructive sleep apnea (OSA). However, the literature has limited evidence regarding the neuropathophysiological mechanisms behind these impairments. This research aimed to investigate brain morphologic and functional connectivity (FC) abnormalities related to neurocognitive function in OSA. METHODS Fifty treatment-naïve males, newly diagnosed patients with severe OSA, and 50 well-matched healthy controls (HCs) were enrolled prospectively. All subjects underwent an MRI scan, cognitive psychological and sleep scale assessment. The differences of brain morphological and seed-based FC between the two groups were compared. The correlation analysis and receiver operating characteristic curve were performed for further analysis. RESULTS Compared with HCs, the right brainstem, left dorsal-lateral superior frontal gyrus (SFGdor), and superior temporal gyrus (STG) exhibited atrophy in the OSA group. In addition, FC between the left SFGdor and the right postcentral gyrus (PoCG) was increased, which was positively correlated with disease duration (r = 0.312, FDR-corrected P = 0.027). The Jacobian values of the brainstem were negatively correlated with MoCA and recall scores (r = -0.449, FDR-corrected P = 0.0025; r = -0.416, FDR-corrected P = 0.005). Furthermore, the Jacobian values of the left SFGdor demonstrated a relatively high diagnostic performance (sensitivity: 86%, specificity: 56%, AUC: 0.740, 95% CI: 0.643-0.836, P < 0.0001). CONCLUSIONS Structural atrophy in brainstem and frontotemporal lobe and altered FC may be the neurobiological hallmark of brain impairment in OSA. Notably, brainstem atrophy has been associated with cognitive impairment, which may provide new insights into understanding the neuropathophysiological mechanisms of cognitive impairment in OSA patients.
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Affiliation(s)
- Jing Gao
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Jiancang Cao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Jieyu Chen
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Dan Wu
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Ke Luo
- The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital), Lanzhou, 730000, China
| | - Guo Shen
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, 750004, China
| | - Yanyan Fang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Wenwen Zhang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Gang Huang
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Xiaoyan Su
- Sleep Medicine Center, Gansu Provincial Hospital, Lanzhou, 730000, China
| | - Lianping Zhao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730000, China.
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Martinez Villar G, Daneault V, Martineau-Dussault MÈ, Baril AA, Gagnon K, Lafond C, Gilbert D, Thompson C, Marchi NA, Lina JM, Montplaisir J, Carrier J, Gosselin N, André C. Altered resting-state functional connectivity patterns in late middle-aged and older adults with obstructive sleep apnea. Front Neurol 2023; 14:1215882. [PMID: 37470008 PMCID: PMC10353887 DOI: 10.3389/fneur.2023.1215882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/05/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is increasingly recognized as a risk factor for cognitive decline, and has been associated with structural brain alterations in regions relevant to memory processes and Alzheimer's disease. However, it is unclear whether OSA is associated with disrupted functional connectivity (FC) patterns between these regions in late middle-aged and older populations. Thus, we characterized the associations between OSA severity and resting-state FC between the default mode network (DMN) and medial temporal lobe (MTL) regions. Second, we explored whether significant FC changes differed depending on cognitive status and were associated with cognitive performance. Methods Ninety-four participants [24 women, 65.7 ± 6.9 years old, 41% with Mild Cognitive Impairment (MCI)] underwent a polysomnography, a comprehensive neuropsychological assessment and a resting-state functional magnetic resonance imaging (MRI). General linear models were conducted between OSA severity markers (i.e., the apnea-hypopnea, oxygen desaturation and microarousal indices) and FC values between DMN and MTL regions using CONN toolbox. Partial correlations were then performed between OSA-related FC patterns and (i) OSA severity markers in subgroups stratified by cognitive status (i.e., cognitively unimpaired versus MCI) and (ii) cognitive scores in the whole sample. All analyzes were controlled for age, sex and education, and considered significant at a p < 0.05 threshold corrected for false discovery rate. Results In the whole sample, a higher apnea-hypopnea index was significantly associated with lower FC between (i) the medial prefrontal cortex and bilateral hippocampi, and (ii) the left hippocampus and both the posterior cingulate cortex and precuneus. FC patterns were not associated with the oxygen desaturation index, or micro-arousal index. When stratifying the sample according to cognitive status, all associations remained significant in cognitively unimpaired individuals but not in the MCI group. No significant associations were observed between cognition and OSA severity or OSA-related FC patterns. Discussion OSA severity was associated with patterns of lower FC in regions relevant to memory processes and Alzheimer's disease. Since no associations were found with cognitive performance, these FC changes could precede detectable cognitive deficits. Whether these FC patterns predict future cognitive decline over the long-term needs to be investigated.
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Affiliation(s)
- Guillermo Martinez Villar
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Véronique Daneault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Marie-Ève Martineau-Dussault
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health Institute, McGill University, Montréal, QC, Canada
| | - Katia Gagnon
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Laboratory and Sleep Clinic, Hôpital en Santé Mentale Rivière-des-Prairies, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Chantal Lafond
- Department of Pulmonology, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Danielle Gilbert
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, QC, Canada
- Department of Radiology, Hopital du Sacré-Coeur de Montréal, CIUSSS du Nord-de-l'Ile-de, Montréal, QC, Canada
| | - Cynthia Thompson
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
| | - Nicola Andrea Marchi
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Center for Investigation and Research in Sleep, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Laboratory for Research in Neuroimaging, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Lina
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Département de Génie Electrique, École de Technologie Supérieure, Montréal, QC, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
| | - Claire André
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord de l'Île-de-Montréal, Montréal, QC, Canada
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
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Pal A, Martinez F, Wagman J, Aysola RS, Shechter A, Mysliwiec V, Martin J, Macey PM. A First Look at Childhood Abuse in Women with Obstructive Sleep Apnea. RESEARCH SQUARE 2023:rs.3.rs-2842895. [PMID: 37205583 PMCID: PMC10187378 DOI: 10.21203/rs.3.rs-2842895/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Study objectives. Women who experienced childhood sexual abuse have higher rates of obesity, a risk factor for obstructive sleep apnea (OSA). We assessed if prior childhood sexual abuse was more common in women with OSA vs. control, with possible mediation by obesity. Methods . We studied 21 women with OSA (age mean±s.d. 59±12 years, body mass index (BMI) 33±8 kg/m 2 , respiratory event index [REI] 25±16 events/hour, Epworth Sleepiness Scale [ESS] 8±5) and 21 women without OSA (age 53±9 years, BMI 25±5 kg/m 2 , REI (in 7/21 women) 1±1 events/hour, ESS 5±3). We evaluated four categories of trauma (general trauma, physical, emotional, and sexual abuse) with the early trauma inventory self-report-short form (ETISR-SF). We assessed group differences in trauma scores with independent samples t-tests and multiple regressions. Parametric Sobel tests were used to model BMI as a mediator for individual trauma scores predicting OSA in women. Results. Early childhood sexual abuse reported on the ETISR-SF was 2.4 times more common in women with vs. without OSA ( p =0.02 for group difference). Other trauma scores were not significantly different between women with and without OSA. However, BMI was a significant mediator ( p =0.02) in predicting OSA in women who experienced childhood physical abuse. Conclusions. Childhood sexual abuse was more common in a group of women with OSA than those without OSA. Additionally, BMI was a mediator for OSA of childhood physical but not sexual abuse. There may be physiological impacts of childhood trauma in women that predispose them to OSA.
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Long T, Li H, Shu Y, Li K, Xie W, Zeng Y, Huang L, Zeng L, Liu X, Peng D. Functional Connectivity Changes in the Insular Subregions of Patients with Obstructive Sleep Apnea after 6 Months of Continuous Positive Airway Pressure Treatment. Neural Plast 2023; 2023:5598047. [PMID: 36865671 PMCID: PMC9974286 DOI: 10.1155/2023/5598047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
This study was aimed at investigating the functional connectivity (FC) changes between the insular subregions and whole brain in patients with obstructive sleep apnea (OSA) after 6 months of continuous positive airway pressure (CPAP) treatment and at exploring the relationship between resting-state FC changes and cognitive impairment in OSA patients. Data from 15 patients with OSA before and after 6 months of CPAP treatment were included in this study. The FC between the insular subregions and whole brain was compared between baseline and after 6 months of CPAP treatment in OSA. After 6 months of treatment, OSA patients had increased FC from the right ventral anterior insula to the bilateral superior frontal gyrus and bilateral middle frontal gyrus and increased FC from the left posterior insula to the left middle temporal gyrus and left inferior temporal gyrus. Hyperconnectivity was found from the right posterior insula to the right middle temporal gyrus, bilateral precuneus, and bilateral posterior cingulate cortex, which mainly involved the default mode network. There are changes in functional connectivity patterns between the insular subregions and whole brain in OSA patients after 6 months of CPAP treatment. These changes provide a better understanding of the neuroimaging mechanisms underlying the improvement in cognitive function and emotional impairment in OSA patients and can be used as potential biomarkers for clinical CPAP treatment.
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Affiliation(s)
- Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
- PET Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Yaping Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
- PET Center, The First Affiliated Hospital of Nanchang University, Jiangxi Province, China
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Byun JI, Jahng GH, Ryu CW, Park S, Lee KH, Hong SO, Jung KY, Shin WC. Altered intrinsic brain functional network dynamics in moderate-to-severe obstructive sleep apnea. Sleep Med 2023; 101:550-557. [PMID: 36577226 DOI: 10.1016/j.sleep.2022.12.003] [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: 04/07/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) can affect temporal fluctuations in brain activity during rest. Dynamic functional connectivity (dFC) captures the fluctuations in FC during the resting state. This study aimed to investigate differences in dFC between moderate-to-severe OSA patients and healthy controls using resting-state functional magnetic resonance imaging (fMRI) and sliding-window analysis. METHODS Thirty-seven consecutive patients with moderate-to-severe OSA and 16 age- and sex-matched controls underwent resting-state fMRI in the morning following overnight polysomnography. The dynamics of aberrant FC between the groups and the correlation between the dynamics and clinical variables were evaluated. RESULTS dFC analysis revealed two distinct connectivity states: hypoconnected (State I) and hyperconnected (State II). In OSA patients, State I occurred 34% more often than in the controls and the occurrence of State II was proportionally reduced. The time in State I positively correlated with the Pittsburg Sleep Quality Index score in the OSA patients. CONCLUSIONS This study showed dFC alterations in moderate-to-severe OSA patients, which may serve as a novel physiological biomarker for OSA.
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Affiliation(s)
- Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Soonchan Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Kun Hee Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Ok Hong
- Department of Oral and Maxillofacial Surgery, Kyung Hee University College of Dentistry, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won Chul Shin
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea; Department of Medicine, AgeTech-service Convergence Major, Kyung Hee University, Seoul, Republic of Korea.
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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.
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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
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Shu Y, Liu X, Yu P, Li H, Duan W, Wei Z, Li K, Xie W, Zeng Y, Peng D. Inherent regional brain activity changes in male obstructive sleep apnea with mild cognitive impairment: A resting-state magnetic resonance study. Front Aging Neurosci 2022; 14:1022628. [DOI: 10.3389/fnagi.2022.1022628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is the most common sleep disorder worldwide. Previous studies have shown that OSA patients are often accompanied by cognitive function loss, and the underlying neurophysiological mechanism is still unclear. This study aimed to determine whether there are differences in regional homogeneity (Reho) and functional connectivity (FC) across the brain between OSA patients with MCI (OSA-MCI) and those without MCI (OSA-nMCI) and whether such differences can be used to distinguish the two groups. Resting state magnetic resonance data were collected from 48 OSA-MCI patients and 47 OSA-nMCI patients. The brain regions with significant differences in Reho and FC between the two groups were identified, and the Reho and FC features were combined with machine learning methods for classification. Compared with OSA-nMCI patients, OSA-MCI patients showed significantly lower Reho in bilateral lingual gyrus and left superior temporal gyrus. OSA-MCI patients also showed significantly lower FC between the bilateral lingual gyrus and bilateral cuneus, left superior temporal gyrus and left middle temporal gyrus, middle frontal gyrus, and bilateral posterior cingulate/calcarine/cerebellar anterior lobe. Based on Reho and FC features, logistic regression classification accuracy was 0.87; sensitivity, 0.70; specificity, 0.89; and area under the curve, 0.85. Correlation analysis showed that MoCA scale score in OSA patients was significant positive correlation sleep efficiency and negatively correlation with neck circumference. In conclusion, our results showed that the OSA-MCI group showed decreased Reho and FC in specific brain regions compared with the OSA-nMCI group, which may help to understand the underlying neuroimaging mechanism of OSA leading to cognitive dysfunction and may serve as a potential biomarker to distinguish whether OSA is accompanied by cognitive impairment.
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Seok D, Beer J, Jaskir M, Smyk N, Jaganjac A, Makhoul W, Cook P, Elliott M, Shinohara R, Sheline YI. Differential Impact of Anxious Misery Psychopathology on Multiple Representations of the Functional Connectome. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 2:489-499. [PMID: 36324648 PMCID: PMC9616351 DOI: 10.1016/j.bpsgos.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background One aim of characterizing dimensional psychopathology is associating different domains of affective dysfunction with brain circuitry. The functional connectome, as measured by functional magnetic resonance imaging, can be modeled and associated with psychopathology through multiple methods; some methods assess univariate relationships while others summarize broad patterns of activity. It remains unclear whether different dimensions of psychopathology require different representations of the connectome to generate reproducible associations. Methods Patients experiencing anxious misery symptomology (depression, anxiety, and trauma; n = 192) received resting-state functional magnetic resonance imaging scans. Three modeling approaches (seed-based correlation analysis, edgewise regression, and brain basis set modeling), each relying on increasingly broader representations of the functional connectome, were used to associate connectivity patterns with six data-driven dimensions of psychopathology: anxiety sensitivity, anxious arousal, rumination, anhedonia, insomnia, and negative affect. To protect against overfitting, 50 participants were held out in a testing dataset, leaving 142 participants as training data. Results Different modeling approaches varied in the extent to which they could model different symptom dimensions: seed-based correlation analysis failed to reproducibly model any symptoms, subsets of the connectome (edgewise regression) were sufficient to model insomnia and anxious arousal, and broad representations of the entire connectome (brain basis set modeling) were necessary to model negative affect and ruminative thought. Conclusions These results indicate that different methods of representing the functional connectome differ in the degree that they can model different symptom dimensions, highlighting the potential sufficiency of subsets of connections for some dimensions and the necessity of connectome-wide approaches in others.
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Affiliation(s)
- Darsol Seok
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanne Beer
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc Jaskir
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nathan Smyk
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adna Jaganjac
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Walid Makhoul
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philip Cook
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark Elliott
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Russell Shinohara
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yvette I. Sheline
- Center for Neuromodulation in Depression and Stress, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Zeng Y, Shu Y, Liu X, Li P, Kong L, Li K, Xie W, Zeng L, Long T, Huang L, Li H, Peng D. Frequency-specific alterations in intrinsic low-frequency oscillations in newly diagnosed male patients with obstructive sleep apnea. Front Neurosci 2022; 16:987015. [PMID: 36248662 PMCID: PMC9561418 DOI: 10.3389/fnins.2022.987015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Previous studies found abnormal low-frequency spontaneous brain activity related to cognitive impairment in patients with obstructive sleep apnea (OSA). However, it is unclear if low-frequency spontaneous brain activity is related to specific frequency bands in OSA patients. In this study, we used the amplitude of low-frequency fluctuation (ALFF) method in patients with OSA to explore characteristics of spontaneous brain activity in the classical (0.01–0.1 Hz) and five sub-frequency bands (slow-2 to slow-6) and analyzed the relationship between spontaneous brain activity and clinical evaluation was analyzed. Patients and methods Resting-state magnetic resonance imaging data and clinical assessments were collected from 52 newly-diagnosed OSA patients and 62 healthy controls (HCs). We calculated the individual group ALFF values in the classical and five different sub-frequency bands. A two-sample t-test compared ALFF differences, and one-way analysis of variance explored interactions in frequency bands between the two groups. Results ALFF values in the OSA group were lower than those in the HC group in the bilateral precuneus/posterior cingulate cortex, bilateral angular gyrus, left inferior parietal lobule, brainstem, and right fusiform gyrus. In contrast, ALFF values in the OSA group were higher than those in the HC group in the bilateral cerebellum posterior lobe, bilateral superior frontal gyrus, bilateral middle frontal gyrus, left inferior frontal gyrus, left inferior temporal gyrus, and left fusiform gyrus. Some ALFF values in altered brain regions were associated with body mass index, apnea-hypopnea index, neck circumference, snoring history, minimum SaO2, average SaO2, arousal index, oxygen reduction index, deep sleep period naming, abstraction, and delayed recall in specific frequency bands. Conclusion Our results indicated the existence of frequency-specific differences in spontaneous brain activity in OSA patients, which were related to cognitive and other clinical symptoms. This study identified frequency-band characteristics related to brain damage, expanded the cognitive neuroimaging mechanism, and provided additional OSA neuroimaging markers.
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Affiliation(s)
- Yaping Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yongqiang Shu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiang Liu
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Panmei Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linghong Kong
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kunyao Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Xie
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li Zeng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Long
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ling Huang
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haijun Li
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Haijun Li,
| | - Dechang Peng
- Medical Imaging Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- PET Center, The First Affiliated Hospital of Nanchang University, Nanchang, China
- Dechang Peng,
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11
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Pal A, Martinez F, Chatterjee R, Aysola RS, Harper RM, Macefield VG, Henderson LA, Macey PM. Baroreflex sensitivity during rest and pressor challenges in obstructive sleep apnea patients with and without CPAP. Sleep Med 2022; 97:73-81. [PMID: 35728308 DOI: 10.1016/j.sleep.2022.05.846] [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: 11/10/2021] [Revised: 05/09/2022] [Accepted: 05/29/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) increases sympathetic vasoconstrictor drive and reduces baroreflex sensitivity (BRS), the degree to which blood pressure changes modify cardiac output. Whether nighttime continuous positive airway pressure (CPAP) corrects BRS in the awake state in OSA remains unclear. We assessed spontaneous BRS using non-invasive continuous BP and ECG recordings at rest and during handgrip and Valsalva challenges, maneuvers that increase vasoconstrictor drive with progressively higher BP, in untreated OSA (unOSA), CPAP-treated OSA (cpOSA) and healthy (CON) participants. METHODS In a cross-sectional study of 104 participants, 34 unOSA (age mean±std, 50.6±14.1years; Respiratory Event Index [REI] 21.0±15.3 events/hour; 22male), 31 cpOSA (49.6±14.5years; REI 23.0±14.2 events/hour; 22male; self-report 4+hours/night,5+days/week,6months), and 39 CON (42.2±15.0years; 17male), we calculated BRS at rest and during handgrip and Valsalva. Additionally, we correlated BP variability (BPV) with BRS during these protocols. RESULTS BRS in unOSA, cpOSA and CON was, respectively (mean±sdv in ms/mmHg), at rest: 14.8±11.8, 15.8±17.0, 16.1±11.3; during handgrip 13.3±7.6, 12.7±8.4, 16.4±8.7; and during Valsalva 12.7±8.0, 11.5±6.6, 15.1±8.9. BRS was lower in cpOSA than CON for handgrip (p=0.04) and Valsalva (p=0.03). BRS was negatively correlated with BPV in unOSA during Valsalva and handgrip for cpOSA, both R=-0.4 (p=0.02). BRS was negatively correlated with OSA severity (levels: none, mild, moderate, severe) at R=-0.2 (p=0.04,n=104). CONCLUSIONS As expected, BRS was lower and BPV higher in OSA during the pressor challenges, and disease severity negatively correlated with BRS. In this cross-sectional study, both CPAP-treated (self-reported) and untreated OSA showed reduced BRS, leaving open whether within-person CPAP improves BRS.
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Affiliation(s)
- Amrita Pal
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Fernando Martinez
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Roopsha Chatterjee
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Ravi S Aysola
- Division of Pulmonary and Critical Care, Department of Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Ronald M Harper
- Neurobiology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, CA, USA
| | - Vaughan G Macefield
- Baker Heart and Diabetes Institute, Melbourne, and Department of Anatomy and Physiology, School of Biomedical Sciences, The University of Melbourne, 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 Los Angeles, Los Angeles, CA, USA.
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12
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Sun Y, Yang SX, Xie M, Zou K, Tang X. Aberrant amplitude of low-frequency fluctuations in different frequency bands and changes after one-night positive airway pressure treatment in severe obstructive sleep apnea. Front Neurol 2022; 13:985321. [PMID: 36071907 PMCID: PMC9441702 DOI: 10.3389/fneur.2022.985321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study was aimed to investigate the characteristics of the amplitude of low-frequency fluctuation (ALFF) at specific frequencies in severe obstructive sleep apnea (OSA) patients. A comparison was made between pre-CPAP treatment and one night after continuous positive airway pressure (CPAP) treatment.Methods30 severe OSA patients and 19 healthy controls (HC) were recruited. The ALFF method was used to assess the local features of spontaneous brain activity and calculated at different bands (slow-5 and slow-4). A correlation analysis was performed to evaluate the relationship between the changes of the ALFF and polysomnography data.ResultsCompared with HC, in slow-5 frequency band, OSA patients showed significantly decreased ALFF in the left inferior temporal gyrus, and significantly increased ALFF in the left middle frontal gyrus, left inferior frontal gyrus, triangular part, right superior frontal gyrus, dorsolateral and right middle temporal gyrus. In slow-4 frequency, there was significantly decreased ALFF in the right inferior temporal gyrus, and significantly increased ALFF in the left precuneus, right posterior cingulate gyrus and right median cingulate besides the slow-5 difference band showed. Compared with pre-CPAP, we found that after CPAP treatment, ALFF signals in the left insula in slow-5 and left caudate in slow-4 increased, but the calcarine in slow-4 significantly reduced. Correlation analysis showed that the left angular slow-4 band change was positively correlated with the slow wave sleep change (r = 0.4933, p = 0.0056). The left cerebellum 6 slow-5 band change was positively correlated with the duration of the REM sleep change (r = 0.4563, p = 0.0113), and the left cerebellum 6 slow-4 band change was also positively correlated with the mean blood oxygen change in the REM (r = 0.4591, p = 0.0107) and NREM sleep (r = 0.4492, p = 0.0128).ConclusionWe found that the use of slow-4 was more specific in OSA studies. These results suggested that the severe OSA patients have frequency-related abnormal spontaneous neural activity, which may contribute to a better understanding of the pathological basis of OSA-related diseases and provide a potential therapeutic target for OSA patients.
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Affiliation(s)
- Yuanfeng Sun
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Sophine Xin Yang
- Business Administration of Business School, Sichuan University, Chengdu, China
| | - Min Xie
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ke Zou
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ke Zou
| | - Xiangdong Tang
- Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Xiangdong Tang
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13
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Hou A, Pang X, Zhang X, Peng Y, Li D, Wang H, Zhang Q, Liang M, Gao F. Widespread aberrant functional connectivity throughout the whole brain in obstructive sleep apnea. Front Neurosci 2022; 16:920765. [PMID: 35979339 PMCID: PMC9377518 DOI: 10.3389/fnins.2022.920765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Obstructive sleep apnea (OSA) is a sleep-related breathing disorder with high prevalence and is associated with cognitive impairment. Previous neuroimaging studies have reported abnormal brain functional connectivity (FC) in patients with OSA that might contribute to their neurocognitive impairments. However, it is unclear whether patients with OSA have a characteristic pattern of FC changes that can serve as a neuroimaging biomarker for identifying OSA. Methods A total of 21 patients with OSA and 21 healthy controls (HCs) were included in this study and scanned using resting-state functional magnetic resonance imaging (fMRI). The automated anatomical labeling (AAL) atlas was used to divide the cerebrum into 90 regions, and FC between each pair of regions was calculated. Univariate analyses were then performed to detect abnormal FCs in patients with OSA compared with controls, and multivariate pattern analyses (MVPAs) were applied to classify between patients with OSA and controls. Results The univariate comparisons did not detect any significantly altered FC. However, the MVPA showed a successful classification between patients with OSA and controls with an accuracy of 83.33% (p = 0.0001). Furthermore, the selected FCs were associated with nearly all brain regions and widely distributed in the whole brain, both within and between, many resting-state functional networks. Among these selected FCs, 3 were significantly correlated with the apnea-hypopnea index (AHI) and 2 were significantly correlated with the percentage of time with the saturation of oxygen (SaO2) below 90% of the total sleep time (%TST < 90%). Conclusion There existed widespread abnormal FCs in the whole brain in patients with OSA. This aberrant FC pattern has the potential to serve as a neurological biomarker of OSA, highlighting its importance for understanding the complex neural mechanism underlying OSA and its cognitive impairment.
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Affiliation(s)
- Ailin Hou
- College of Precision Instrument and Optoelectronics Engineering, Tianjin University, Tianjin, China
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Xueming Pang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Xi Zhang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Yanmin Peng
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Dongyue Li
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - He Wang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
| | - Quan Zhang
- Department of Radiology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
- *Correspondence: Quan Zhang,
| | - Meng Liang
- School of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, China
- Meng Liang,
| | - Feng Gao
- College of Precision Instrument and Optoelectronics Engineering, Tianjin University, Tianjin, China
- Tianjin Key Laboratory of Biomedical Detecting Techniques and Instruments, Tianjin University, Tianjin, China
- Feng Gao,
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14
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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.
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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.
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15
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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.
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16
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Armendariz JR, Han SD, Fung CH. A Scoping Review and Conceptual Framework Examining the Role of Sleep Disturbance in Financial Exploitation in Older Adults. Gerontol Geriatr Med 2022; 8:23337214221116233. [PMID: 35958036 PMCID: PMC9358199 DOI: 10.1177/23337214221116233] [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] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
Sleep disturbances and financial exploitation have both been linked to impaired cognitive ability, loneliness, and depressed mood in older adults, suggesting a potential role of sleep disturbances in increasing vulnerability to financial exploitation. We sought to identify evidence linking sleep disturbances to financial exploitation. We conducted a systematic search of MEDLINE, PubMed Central, and National Center for Biotechnology Information Bookshelf for relevant published articles on sleep and financial exploitation. Three studies examining both sleep and financial exploitation were identified. None of the studies explored sleep disturbances as a cause of financial exploitation. More work needs to be done to examine the role of sleep disturbances in financial exploitation. We propose a conceptual framework for identifying possible associations among sleep disturbance, biopsychosocial, and decision-related situational factors to guide further exploration of relationships between sleep and financial exploitation.
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Affiliation(s)
- Jessica R. Armendariz
- University of Southern California, Los Angeles, USA
- VA Greater Los Angeles Healthcare System, North Hills, CA, USA
| | - S. Duke Han
- University of Southern California, Alhambra, USA
| | - Constance H. Fung
- VA Greater Los Angeles Healthcare System, North Hills, CA, USA
- David Geffen School of Medicine at UCLA, USA
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17
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Zhang T, Xie X, Li Q, Zhang L, Chen Y, Ji GJ, Hou Q, Li T, Zhu C, Tian Y, Wang K. Hypogyrification in Generalized Anxiety Disorder and Associated with Insomnia Symptoms. Nat Sci Sleep 2022; 14:1009-1019. [PMID: 35642211 PMCID: PMC9148579 DOI: 10.2147/nss.s358763] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Insomnia is a recognized feature of generalized anxiety disorder (GAD). The underlying neural substrate of insomnia in GAD is still unclear. Cortical folding is a reliable index and possibly an endophenotype of psychiatric disease. The aim of this study was to explore whether the aberrant cortical morphology was associated with insomnia in GAD. PATIENTS AND METHODS We enrolled 73 patients with GAD and 74 matched healthy controls (HCs) to undergo neuropsychiatric assessment and 3.0 T magnetic resonance imaging scanning. Neuropsychiatric batteries included the 14-item Hamilton Anxiety Rating Scale (HAMA) and the Insomnia Severity Index (ISI). Using FreeSurfer7.1.1, we calculated local gyrification index, cortical thickness and surface area and identified group differences in these parameters. Then, we calculated the functional connectivity of these identified regions and determined functional alterations. The relationship between these neuroimaging indicators and clinical measurement was explored. RESULTS Compared with HCs, the LGI in the bilateral orbitofrontal cortex (OFC), bilateral insula, left middle frontal gyrus, left temporal pole, and left fusiform area was significantly decreased in GAD. GAD patients had concurrent decreased surface area in the left OFC and thicker right OFC. GAD patients also exhibited increased functional connectivity between the left insula and frontoparietal control network. In addition, a negative relationship was observed between decreased LGI in these limbic regions and ISI score. CONCLUSION GAD patients presented aberrant cortical folding in limbic network. Cortical morphology is a potential endophenotype in GAD, corresponding to an insomnia phenotype.
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Affiliation(s)
- Ting Zhang
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China
| | - Xiaohui Xie
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Qianqian Li
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China
| | - Lei Zhang
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Department of Psychiatry, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Yue Chen
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Gong-Jun Ji
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Qiangqiang Hou
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Tianxia Li
- Anhui Mental Health Center, Hefei, Anhui Province, People's Republic of China
| | - Chunyan Zhu
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Department of Psychiatry, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, People's Republic of China
| | - Kai Wang
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, People's Republic of China
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18
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Park HR, Cha J, Joo EY, Kim H. Altered cerebrocerebellar functional connectivity in patients with obstructive sleep apnea and its association with cognitive function. Sleep 2021; 45:6357664. [PMID: 34432059 DOI: 10.1093/sleep/zsab209] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/19/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Previous functional MRI studies have reported altered brain networks in patients with obstructive sleep apnea (OSA). However, the extent and pattern of abnormal connectivity were inconsistent across studies, and cerebrocerebellar connections have been rarely assessed. We investigated functional network changes in cerebral and cerebellar cortices of OSA patients. METHODS Resting-state functional MRI, polysomnography and neuropsychological (NP) test data were acquired from 74 OSA patients (age: 45.8±10.7 years) and 33 healthy subjects (39.6±9.3 years). Connectivity matrices were extracted by computing correlation coefficients from various ROIs, and Fisher r-to-z transformations. In the functional connections that showed significant group differences, linear regression was conducted to examine the association between connectivity and clinical characteristics. RESULTS Patients with OSA showed reduced functional connectivity (FC) in cerebrocerebellar connections linking different functional networks, and greater FC in cortical between-network connections in prefrontal regions involving the default mode network and the control network. For OSA group, we found no correlation between FC and sleep parameters including lowest SaO2 and arousal index in the connections where significant associations were observed in healthy subjects. FC changes in default mode network (DMN) areas were related to reduced verbal fluency in OSA. Lower local efficiency and lower clustering coefficient of the salience network in the left cerebellum were also observed in OSA. CONCLUSIONS OSA affects mainly the cerebrocerebellar pathway. The disruption of function in these connections are related to sleep fragmentation and hypoxia during sleep. These abnormal network functions, especially DMN, are suggested to participate in cognitive decline of OSA.
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Affiliation(s)
- Hea Ree Park
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Jungho Cha
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hosung Kim
- USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
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19
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Pal A, Ogren JA, Aguila AP, Aysola R, Kumar R, Henderson LA, Harper RM, Macey PM. Functional organization of the insula in men and women with obstructive sleep apnea during Valsalva. Sleep 2021; 44:5864015. [PMID: 32592491 DOI: 10.1093/sleep/zsaa124] [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: 02/24/2020] [Revised: 05/11/2020] [Indexed: 12/26/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) patients show impaired autonomic regulation, perhaps related to functional reorganization of the insula, which in healthy individuals shows sex-specific anterior and right dominance during sympathetic activation. We examined insular organization of responses to a Valsalva maneuver in OSA with functional magnetic resonance imaging (fMRI). METHODS We studied 43 newly diagnosed OSA (age mean ± SD: 46.8 ± 8.7 years; apnea-hypopnea index (AHI) ± SD: 32.1 ± 20.1 events/hour; 34 males) and 63 healthy (47.2 ± 8.8 years; 40 males) participants. Participants performed four 18-second Valsalva maneuvers (1-minute intervals, pressure ≥ 30 mmHg) during scanning. fMRI time trends from five insular gyri-anterior short (ASG); mid short (MSG); posterior short (PSG); anterior long (ALG); and posterior long (PLG)-were assessed for within-group responses and between-group differences with repeated measures ANOVA (p < 0.05); age and resting heart rate (HR) influences were also assessed. RESULTS Right and anterior fMRI signal dominance appeared in OSA and controls, with no between-group differences. Separation by sex revealed group differences. Left ASG anterior signal dominance was lower in OSA versus control males. Left ASG and ALG anterior dominance was higher in OSA versus control females. In all right gyri, only OSA females showed greater anterior dominance than controls. Right dominance was apparent in PSG and ALG in all groups; females showed right dominance in MSG and PLG. OSA males did not show PLG right dominance. Responses were influenced substantially by HR but modestly by age. CONCLUSIONS Anterior and right insular fMRI dominance appears similar in OSA versus control participants during the sympathetic phase of the Valsalva maneuver. OSA and control similarities were present in just males, but not necessarily females, which may reflect sex-specific neural injury.
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Affiliation(s)
- Amrita Pal
- UCLA School of Nursing, University of California, Los Angeles, CA
| | - Jennifer A Ogren
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Andrea P Aguila
- UCLA School of Nursing, University of California, Los Angeles, CA
| | - Ravi Aysola
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Rajesh Kumar
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Luke A Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ronald M Harper
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA
| | - Paul M Macey
- UCLA School of Nursing, University of California, Los Angeles, CA
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20
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Wu H, Zheng Y, Zhan Q, Dong J, Peng H, Zhai J, Zhao J, She S, Wu C. Covariation between spontaneous neural activity in the insula and affective temperaments is related to sleep disturbance in individuals with major depressive disorder. Psychol Med 2021; 51:731-740. [PMID: 31839025 DOI: 10.1017/s0033291719003647] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Affective temperaments have been considered antecedents of major depressive disorder (MDD). However, little is known about how the covariation between alterations in brain activity and distinct affective temperaments work collaboratively to contribute to MDD. Here, we focus on the insular cortex, a critical hub for the integration of subjective feelings, emotions, and motivations, to examine the neural correlates of affective temperaments and their relationship to depressive symptom dimensions. METHODS Twenty-nine medication-free patients with MDD and 58 healthy controls underwent magnetic resonance imaging scanning and completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Patients also received assessments of the Hamilton Depression Rating Scale (HDRS). We used multivariate analyses of partial least squares regression and partial correlation analyses to explore the associations among the insular activity, affective temperaments, and depressive symptom dimensions. RESULTS A profile (linear combination) of increased fractional amplitude of low-frequency fluctuations (fALFF) of the anterior insular subregions (left dorsal agranular-dysgranular insula and right ventral agranuar insula) was positively associated with an affective-temperament (depressive, irritable, anxious, and less hyperthymic) profile. The covariation between the insula-fALFF profile and the affective-temperament profile was significantly correlated with the sleep disturbance dimension (especially the middle and late insomnia scores) in the medication-free MDD patients. CONCLUSIONS The resting-state spontaneous activity of the anterior insula and affective temperaments collaboratively contribute to sleep disturbances in medication-free MDD patients. The approach used in this study provides a practical way to explore the relationship of multivariate measures in investigating the etiology of mental disorders.
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Affiliation(s)
- Huawang Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Yingjun Zheng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Qianqian Zhan
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Jie Dong
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Hongjun Peng
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Jinguo Zhai
- School of Mental Health, Jining Medical University, Jining272067, China
| | - Jingping Zhao
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Shenglin She
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou510370, China
| | - Chao Wu
- School of Nursing, Peking University Health Science Center, Beijing100191, China
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21
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Ferini-Strambi L, Hensley M, Salsone M. Decoding Causal Links Between Sleep Apnea and Alzheimer’s Disease. J Alzheimers Dis 2021; 80:29-40. [DOI: 10.3233/jad-201066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Obstructive sleep apnea (OSA) and Alzheimer’s disease (AD) are two common chronic diseases with a well-documented association. Whether the association is causal has been highlighted by recent evidence reporting a neurobiological link between these disorders. This narrative review discusses the brain regions and networks involved in OSA as potential vulnerable areas for the development of AD neuropathology with a particular focus on gender-related implications. Using a neuroimaging perspective supported by neuropathological investigations, we provide a new model of neurodegeneration common to OSA and AD, that we have called OSA-AD neurodegeneration in order to decode the causal links between these two chronic conditions.
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Affiliation(s)
| | - Michael Hensley
- John Hunter Hospital and The University of Newcastle, Newcastle, Australia
| | - Maria Salsone
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology-Sleep Disorder Center, Milan, Italy
- Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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22
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Pal A, Ogren JA, Aysola RS, Kumar R, Henderson LA, Harper RM, Macey PM. Insular functional organization during handgrip in females and males with obstructive sleep apnea. PLoS One 2021; 16:e0246368. [PMID: 33600443 PMCID: PMC7891756 DOI: 10.1371/journal.pone.0246368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/18/2021] [Indexed: 11/18/2022] Open
Abstract
STUDY OBJECTIVES Brain regulation of autonomic function in obstructive sleep apnea (OSA) is disrupted in a sex-specific manner, including in the insula, which may contribute to several comorbidities. The insular gyri have anatomically distinct functions with respect to autonomic nervous system regulation; yet, OSA exerts little effect on the organization of insular gyral responses to sympathetic components of an autonomic challenge, the Valsalva. We further assessed neural responses of insular gyri in people with OSA to a static handgrip task, which principally involves parasympathetic withdrawal. METHODS We measured insular function with blood oxygen level dependent functional MRI. We studied 48 newly-diagnosed OSA (age mean±std:46.5±9 years; AHI±std:32.6±21.1 events/hour; 36 male) and 63 healthy (47.2±8.8 years;40 male) participants. Subjects performed four 16s handgrips (1 min intervals, 80% subjective maximum strength) during scanning. fMRI time trends from five insular gyri-anterior short (ASG); mid short (MSG); posterior short (PSG); anterior long (ALG); and posterior long (PLG)-were assessed for within-group responses and between-group differences with repeated measures ANOVA (p<0.05) in combined and separate female-male models; age and resting heart-rate (HR) influences were also assessed. RESULTS Females showed greater right anterior dominance at the ASG, but no differences emerged between OSA and controls in relation to functional organization of the insula in response to handgrip. Males showed greater left anterior dominance at the ASG, but there were also no differences between OSA and controls. The males showed a group difference between OSA and controls only in the ALG. OSA males had lower left activation at the ALG compared to control males. Responses were mostly influenced by HR and age; however, age did not impact the response for right anterior dominance in females. CONCLUSIONS Insular gyri functional responses to handgrip differ in OSA vs controls in a sex-based manner, but only in laterality of one gyrus, suggesting anterior and right-side insular dominance during sympathetic activation but parasympathetic withdrawal is largely intact, despite morphologic injury to the overall structure.
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Affiliation(s)
- Amrita Pal
- UCLA School of Nursing, University of California, Los Angeles, California, United States of America
| | - Jennifer A. Ogren
- Department of Neurobiology, University of California, Los Angeles, California, United States of America
| | - Ravi S. Aysola
- Division of Pulmonary and Critical Care, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, United States of America
| | - Rajesh Kumar
- Department of Anesthesiology, University of California, Los Angeles, California, United States of America
- Department of Radiological Sciences, University of California, Los Angeles, California, United States of America
| | - Luke A. Henderson
- Department of Anatomy and Histology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ronald M. Harper
- Department of Neurobiology, University of California, Los Angeles, California, United States of America
| | - Paul M. Macey
- UCLA School of Nursing, University of California, Los Angeles, California, United States of America
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23
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Li H, Xin H, Yu J, Yu H, Zhang J, Wang W, Peng D. Abnormal intrinsic functional hubs and connectivity in stable patients with COPD: a resting-state MRI study. Brain Imaging Behav 2021; 14:573-585. [PMID: 31187474 PMCID: PMC7160072 DOI: 10.1007/s11682-019-00130-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) affects a large population and is closely associated with cognitive impairment. However, the mechanisms of cognitive impairment in COPD patients have not been unraveled. This study investigated the change in patterns of intrinsic functional hubs using a degree centrality (DC) analysis. The connectivity between these abnormal hubs with the remaining brain was also investigated using functional connectivity (FC). Nineteen stable patients with COPD and 20 normal controls(NC) underwent functional magnetic resonance imaging (MRI) examinations and clinical and neuropsychologic assessments. We measured the voxel-wise DC across the whole brain gray matter and the seed-based FC between these abnormal hubs in the remaining brain matter; the group difference was calculated. A partial correlation analysis was performed to assess the relationship between the abnormal DC and clinical variables in COPD patients. Compared to NC, the patients with COPD exhibited significantly decreased DC in the right lingual gyrus (LG), bilateral supplementary motor area (SMA), and right paracentral lobule (PCL). A further seed-based FC analysis found that COPD patients demonstrated significantly decreased FC between these abnormal hubs in several brain areas, including the left cerebellum anterior lobe, left lingual gyrus, left fusiform gyrus, right insula, right inferior frontal gyrus, limbic lobe, cingulate gyrus, left putamen, lentiform nucleus, right precuneus, and right paracentral lobule. A partial correlation analysis showed that the decreased DC in the right PCL was positively correlated with the FEV1 and FEV1/FVC, and the decreased DC in the SMA was positively correlated with naming and pH in COPD patients. This study demonstrates that there are intrinsic functional hubs and connectivity alterations that may reflect the aberrant information communication in the brain of COPD patients. These findings may help provide new insight for understanding the mechanisms of COPD-related cognitive impairment from whole brain functional connections.
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Affiliation(s)
- Haijun Li
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No.17, Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Huizhen Xin
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No.17, Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Jingjing Yu
- Department of Respiratory, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Honghui Yu
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No.17, Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Juan Zhang
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No.17, Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China
| | - Wenjing Wang
- Department of Respiratory, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dechang Peng
- Department of Radiology, the First Affiliated Hospital of Nanchang University, No.17, Yongwai Zheng Street, Donghu District, Nanchang, 330006, Jiangxi Province, People's Republic of China.
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24
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Zhou L, Liu G, Luo H, Li H, Peng Y, Zong D, Ouyang R. Aberrant Hippocampal Network Connectivity Is Associated With Neurocognitive Dysfunction in Patients With Moderate and Severe Obstructive Sleep Apnea. Front Neurol 2020; 11:580408. [PMID: 33362692 PMCID: PMC7759642 DOI: 10.3389/fneur.2020.580408] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/11/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives: This work aims to explore the changes of functional connectivity (FC) within the hippocampus network in patients with moderate and severe obstructive sleep apnea (OSA) and its correlation with neurocognitive dysfunction to explore the potential neurophysiological mechanism. Methods: A total of 32 treatment-naïve patients with moderate or severe OSA and 26 healthy controls (HCs), matched in age, gender, and education, underwent the evaluations of Epworth Sleep Scale, neurocognitive function, full-night polysomnography, and resting-state functional magnetic resonance imaging. The FC map of the hippocampus to other brain areas was compared among 15 OSA patients and 15 HCs with little head motion. Finally, the correlation between hippocampus FC strength and respiratory sleep parameters and neurocognitive assessments was analyzed. Results: Compared with HCs, the right hippocampus showed a significantly decreased FC with the bilateral insular lobe, right thalamus, and right anterior cingulate gyrus (ACG) and an increased FC with the right superior and middle temporal gyrus, left posterior cingulate gyrus, and left angular gyrus in the patients with OSA. The left hippocampus presented a significantly decreased FC with the left anterior cerebellum in patients with OSA. In addition, the aberrant right hippocampal FC with the right ACG was significantly correlated with disease severity and disrupted sleep architecture in the OSA group. Furthermore, after adjusting the related confounding factors, the FC strength between the right hippocampus, right insular lobe, and right thalamus was positively associated with the scores of Stroop Color-Word Test (SCWT) or Hopkins Verbal Learning Test-Revised (HVLT-R), while the FC between the right hippocampus and the right middle temporal gyrus was negatively correlated with the scores of HVLT-R. The right hippocampus FC with right superior temporal gyrus, left angular gyrus, and ACG were all negatively related to the scores of the symbol coding test (r = -0.642, p = 0.045; r = -0.638, p = 0.047; r = -0.753, p = 0.012), respectively. The FC between the left hippocampal and the left anterior cerebellar lobe showed a positive relationship with the scores of HVLT-R (r = 0.757, p = 0.011) and CPT-3D (r = -0.801, p = 0.005). Conclusion: The hippocampus presented abnormal FC with the cerebral and cerebellar regions extensively in OSA, and the correlation between abnormal hippocampal network FC and neurocognitive dysfunction in OSA suggests a promising insight to explore the potential biomarker and pathophysiologic mechanism of neurocognitive dysfunction of OSA.
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Affiliation(s)
- Li Zhou
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Guiqian Liu
- Hunan Province Prevention and Treatment Institute for Occupational Diseases, Changsha, China
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yating Peng
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Dandan Zong
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
| | - Ruoyun Ouyang
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- Research Unit of Respiratory Disease, Central South University, Changsha, China
- Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, China
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25
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Naismith SL, Duffy SL, Cross N, Grunstein R, Terpening Z, Hoyos C, D'Rozario A, Lagopoulos J, Osorio RS, Shine JM, McKinnon AC. Nocturnal Hypoxemia Is Associated with Altered Parahippocampal Functional Brain Connectivity in Older Adults at Risk for Dementia. J Alzheimers Dis 2020; 73:571-584. [PMID: 31815696 DOI: 10.3233/jad-190747] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obstructive sleep apnea is associated with an increased risk of developing mild cognitive impairment and dementia. Intermittent nocturnal hypoxemia in obstructive sleep apnea is associated with brain changes in key regions that underpin memory. OBJECTIVE To determine whether older adults with severe nocturnal hypoxemia would exhibit reduced functional connectivity within these regions, with associated deficits in memory. METHODS Seventy-two participants 51 years and over underwent polysomnography with continuous blood oxygen saturation recorded via oximetry. The oxygen desaturation index (ODI, 3% dips in oxygen levels per hour) was the primary outcome measure. ODI was split into tertiles, with analyses comparing the lowest and highest tertiles (N = 48). Thirty-five of the 48 participants from these two tertiles had mild cognitive impairment. Participants also underwent resting-state fMRI and comprehensive neuropsychological, medical, and psychiatric assessment. RESULTS The highest ODI tertile group demonstrated significantly reduced connectivity between the left and right parahippocampal cortex, relative to the lowest ODI tertile group (t(42) = -3.26, p = 0.041, beta = -1.99).The highest ODI tertile group also had poorer working memory performance. In the highest ODI tertile group only, higher left-right parahippocampal functional connectivity was associated with poorer visual memory recall (between-groups z = -2.93, p = 0.0034). CONCLUSIONS Older adults with severe nocturnal hypoxemia demonstrate impaired functional connectivity in medial temporal structures, key regions involved in sleep memory processing and implicated in dementia pathophysiology. Oxygen desaturation and functional connectivity in these individuals each relate to cognitive performance. Research is now required to further elucidate these findings.
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Affiliation(s)
- Sharon L Naismith
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,Brain & Mind Centre, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep), Australia
| | - Shantel L Duffy
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia.,Brain & Mind Centre, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep), Australia
| | - Nathan Cross
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, Australia.,Brain & Mind Centre, University of Sydney, Sydney, Australia.,Sleep and Circadian Group, Woolcock Institute of Medical Research, Sydney Health Partners, Sydney, Australia
| | - Ron Grunstein
- Sleep and Circadian Group, Woolcock Institute of Medical Research, Sydney Health Partners, Sydney, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep), Australia
| | - Zoe Terpening
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Camilla Hoyos
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, Australia.,Brain & Mind Centre, University of Sydney, Sydney, Australia.,Sleep and Circadian Group, Woolcock Institute of Medical Research, Sydney Health Partners, Sydney, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep), Australia
| | - Angela D'Rozario
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, Australia.,Brain & Mind Centre, University of Sydney, Sydney, Australia.,Sleep and Circadian Group, Woolcock Institute of Medical Research, Sydney Health Partners, Sydney, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep), Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience Thompson Institute University of Sunshine Coast, Queensland, Australia
| | - Ricardo S Osorio
- Department of Psychiatry, Sleep Aging and Memory Lab, NYU School of Medicine, New York, NY, USA.,Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - James M Shine
- Brain & Mind Centre, University of Sydney, Sydney, Australia
| | - Andrew C McKinnon
- Healthy Brain Ageing Program, School of Psychology, University of Sydney, Sydney, Australia.,Brain & Mind Centre, University of Sydney, Sydney, Australia.,NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep), Australia
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26
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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]
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Resting-state functional magnetic resonance imaging of high altitude patients with obstructive sleep apnoea hypopnoea syndrome. Sci Rep 2020; 10:15546. [PMID: 32968086 PMCID: PMC7511410 DOI: 10.1038/s41598-020-72339-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
The objective of the study was to observe brain function changes in Obstructive Sleep Apnoea Hypopnoea Syndrome (OSAHS) patients at high altitude. Resting-state functional magnetic resonance imaging (rs-fMRI) in patients with OSAHS was assessed using regional homogeneity (ReHo), amplitude of low frequency fluctuation (ALFF) and functional connectivity (FC). In this study, 36 male patients with OSAHS and 38 healthy male subjects were recruited from high-altitude areas, specifically, altitudes of 2,000–3,000 m. OSAHS was diagnosed by polysomnography (PSG). The blood oxygen level-dependent (BOLD) signals of OSAHS patients and healthy controls in the resting state were obtained and compared using ReHo, ALFF and FC methods. The posterior cingulate cortex (PCC) was selected as the seed region in the comparison of FC between the two groups. Compared with the healthy control group, multiple brain functions in the OSAHS patient group were different. There were correlations between the brain function values of some brain regions and demographic data. We also found that in contrast to earlier findings with individuals in plains areas, the brain function at the frontal lobe and the precuneus were higher in OSAHS patients, and the PCC showed higher FC with the left caudate, which may be due to the high-altitude hypoxic environment.
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Wu Y, Zhao W, Chen X, Wan X, Lei X. Aberrant Awake Spontaneous Brain Activity in Obstructive Sleep Apnea: A Review Focused on Resting-State EEG and Resting-State fMRI. Front Neurol 2020; 11:768. [PMID: 32849223 PMCID: PMC7431882 DOI: 10.3389/fneur.2020.00768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022] Open
Abstract
As one of the most common sleep-related respiratory disorders, obstructive sleep apnea (OSA) is characterized by excessive snoring, repetitive apnea, arousal, sleep fragmentation, and intermittent nocturnal hypoxemia. Focused on the resting-state brain imaging techniques, we reviewed the OSA-related resting-state electroencephalogram and resting-state functional magnetic resonance imaging (rsfMRI) studies. Compared with the healthy control group, patients with OSA presented increased frontal and central δ/θ powers during resting-state wakefulness, and their slow-wave activity showed a positive correlation with apnea–hypopnea index. For rsfMRI, the prefrontal cortex and insula may be the vital regions for OSA and are strongly related to the severity of the disease. Meanwhile, some large-scale brain networks, such as the default-mode network, salience network, and central executive network, play pivotal roles in the pathology of OSA. We then discussed the contribution of resting-state brain imaging as an evaluation approach for disease interventions. Finally, we briefly introduced the effects of OSA-related physiological and mental diseases and discussed some future research directions from the perspective of resting-state brain imaging.
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Affiliation(s)
- Yue Wu
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Wenrui Zhao
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Xinyuan Chen
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Xiaoyong Wan
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China
| | - Xu Lei
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing, China.,Key Laboratory of Cognition and Personality of Ministry of Education, Chongqing, China.,Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
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A capital role for the brain's insula in the diverse fibromyalgia-associated symptoms. Med Hypotheses 2020; 143:110077. [PMID: 32721793 DOI: 10.1016/j.mehy.2020.110077] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/04/2023]
Abstract
Unexplained yet persisting general and widespread non-articular musculoskeletal pain and the associated complaints, known as fibromyalgia (FM), is a common disorder with major social and economic impact. We postulate that in FM disturbance of neurotransmitter balances at the brain's insula not only leads to aberrant pain processing but could also govern other associated symptoms. Symptoms might arise from central nervous system dysregulation mediated through an imbalance between the excitatory neurotransmitter glutamate and the inhibitory transmitter gamma-amino butyric acid. The insula could also have a leading role in the dysregulation of heart rate and blood pressure, bladder and bowel symptoms, and anxiety and sleep disturbances which are experienced by many FM patients. The presented hypothesis explains how the diverse FM-associated symptoms could be linked, and puts the brain's insula forward as a possible therapeutic target to be further explored for FM.
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Yeung AWK. Morphometric and functional connectivity changes in the brain of patients with obstructive sleep apnea: A meta‐analysis. J Sleep Res 2019; 28:e12857. [DOI: 10.1111/jsr.12857] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Andy W. K. Yeung
- Oral and Maxillofacial Radiology Applied Oral Sciences Faculty of Dentistry University of Hong Kong Hong Kong SAR China
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Abstract
The aim of this study was to investigate the changes in insular cortex metabolites and the correlation with clinical manifestations in patients with obstructive sleep apnea syndrome (OSA). Lateral insular metabolite levels were measured and relevant ratios were calculated in OSA patients and healthy individuals, including N-acetyl aspartate/creatine (NAA/Cr), choline/creatine (Cho/Cr), inositol/creatine (Ins/Cr), glutamate compound/creatine (Glx/Cr), N-acetyl aspartate/choline (NAA/Cho), and lactic acid (Lac). Participants' scores on the Hamilton Anxiety Scale (HAMA), the Hamilton Depression Scale (HAMD), the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS) were also evaluated. Apnea-Hypopnea Index, the lowest arterial oxygen saturation, and the mean arterial oxygen saturation (MSaO2) values were monitored by polysomnography. NAA/Cr, Glx/Cr, and NAA/Cho values in the insular cortex were significantly decreased, whereas HAMA, HAMD, PSQI, and ESS scores were significantly higher in OSA patients compared with the control participants. HAMA and HAMD scores showed a significant negative correlation with the NAA/Cho value in the insular cortex and a positive correlation with PSQI and ESS scores. PSQI scores were correlated positively with the Cho/Cr and Ins/Cr ratios in the left insular cortex, but correlated negatively with the NAA/Cho ratio. The symptoms of anxiety and depression in OSA patients may be associated with insular neuron damage or dysfunction; proton magnetic resonance spectroscopy can provide an objective imaging basis for the early diagnosis and treatment of OSA in clinical practice.
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Huang X, Tang S, Lyu X, Yang C, Chen X. Structural and functional brain alterations in obstructive sleep apnea: a multimodal meta-analysis. Sleep Med 2019; 54:195-204. [DOI: 10.1016/j.sleep.2018.09.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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Sklerov M, Dayan E, Browner N. Functional neuroimaging of the central autonomic network: recent developments and clinical implications. Clin Auton Res 2018; 29:555-566. [PMID: 30470943 PMCID: PMC6858471 DOI: 10.1007/s10286-018-0577-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/07/2018] [Indexed: 12/08/2023]
Abstract
Purpose The central autonomic network (CAN) is an intricate system of brainstem, subcortical, and cortical structures that play key roles in the function of the autonomic nervous system. Prior to the advent of functional neuroimaging, in vivo studies of the human CAN were limited. The purpose of this review is to highlight the contribution of functional neuroimaging, specifically functional magnetic resonance imaging (fMRI), to the study of the CAN, and to discuss recent advances in this area. Additionally, we aim to emphasize exciting areas for future research. Methods We reviewed the existing literature in functional neuroimaging of the CAN. Here, we focus on fMRI research conducted in healthy human subjects, as well as research that has been done in disease states, to understand CAN function. To minimize confounding, papers examining CAN function in the context of cognition, emotion, pain, and affective disorders were excluded. Results fMRI has led to significant advances in the understanding of human CAN function. The CAN is composed of widespread brainstem and forebrain structures that are intricately connected and play key roles in reflexive and modulatory control of autonomic function. Conclusions fMRI technology has contributed extensively to current knowledge of CAN function. It holds promise to serve as a biomarker in disease states. With ongoing advancements in fMRI technology, there is great opportunity and need for future research involving the CAN.
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Affiliation(s)
- Miriam Sklerov
- Department of Neurology, University of North Carolina, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599, USA.
| | - Eran Dayan
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, 130 Mason Farm Road, CB# 7513, Chapel Hill, NC, 27599, USA
| | - Nina Browner
- Department of Neurology, University of North Carolina, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599, USA
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Ogren JA, Tripathi R, Macey PM, Kumar R, Stern JM, Eliashiv DS, Allen LA, Diehl B, Engel J, Rani MRS, Lhatoo SD, Harper RM. Regional cortical thickness changes accompanying generalized tonic-clonic seizures. Neuroimage Clin 2018; 20:205-215. [PMID: 30094170 PMCID: PMC6073085 DOI: 10.1016/j.nicl.2018.07.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/27/2018] [Accepted: 07/15/2018] [Indexed: 12/12/2022]
Abstract
Objective Generalized tonic-clonic seizures are accompanied by cardiovascular and respiratory sequelae that threaten survival. The frequency of these seizures is a major risk factor for sudden unexpected death in epilepsy (SUDEP), a leading cause of untimely death in epilepsy. The circumstances accompanying such fatal events suggest a cardiovascular or respiratory failure induced by unknown neural processes rather than an inherent cardiac or lung deficiency. Certain cortical regions, especially the insular, cingulate, and orbitofrontal cortices, are key structures that integrate sensory input and influence diencephalic and brainstem regions regulating blood pressure, cardiac rhythm, and respiration; output from those cortical regions compromised by epilepsy-associated injury may lead to cardiorespiratory dysregulation. The aim here was to assess changes in cortical integrity, reflected as cortical thickness, relative to healthy controls. Cortical alterations in areas that influence cardiorespiratory action could contribute to SUDEP mechanisms. Methods High-resolution T1-weighted images were collected with a 3.0-Tesla MRI scanner from 53 patients with generalized tonic-clonic seizures (Mean age ± SD: 37.1 ± 12.6 years, 22 male) at Case Western Reserve University, University College London, and the University of California at Los Angeles. Control data included 530 healthy individuals (37.1 ± 12.6 years; 220 male) from UCLA and two open access databases (OASIS and IXI). Cortical thickness group differences were assessed at all non-cerebellar brain surface locations (P < 0.05 corrected). Results Increased cortical thickness appeared in post-central gyri, insula, and subgenual, anterior, posterior, and isthmus cingulate cortices. Post-central gyri increases were greater in females, while males showed more extensive cingulate increases. Frontal and temporal cortex, lateral orbitofrontal, frontal pole, and lateral parietal and occipital cortices showed thinning. The extents of thickness changes were sex- and hemisphere-dependent, with only males exhibiting right-sided and posterior cingulate thickening, while females showed only left lateral orbitofrontal thinning. Regional cortical thickness showed modest correlations with seizure frequency, but not epilepsy duration. Significance Cortical thickening and thinning occur in patients with generalized tonic-clonic seizures, in cardiovascular and somatosensory areas, with extent of changes sex- and hemisphere-dependent. The data show injury in key autonomic and respiratory cortical areas, which may contribute to dysfunctional cardiorespiratory patterns during seizures, as well as to longer-term SUDEP risk.
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Affiliation(s)
- Jennifer A Ogren
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA
| | - Raghav Tripathi
- Department of Neurobiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - 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
| | - Rajesh Kumar
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA; Department of Anesthesiology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA
| | - Dawn S Eliashiv
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA
| | - Luke A Allen
- Institute of Neurology, University College London, London, United Kingdom
| | - Beate Diehl
- Institute of Neurology, University College London, London, United Kingdom
| | - Jerome Engel
- 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; Department of Neurology, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA
| | | | | | - 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.
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Liu YT, Zhang HX, Li HJ, Chen T, Huang YQ, Zhang L, Huang ZC, Liu B, Yang M. Aberrant Interhemispheric Connectivity in Obstructive Sleep Apnea-Hypopnea Syndrome. Front Neurol 2018; 9:314. [PMID: 29867724 PMCID: PMC5951937 DOI: 10.3389/fneur.2018.00314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/20/2018] [Indexed: 01/06/2023] Open
Abstract
Objective To determine the changes in interhemispheric functional coordination in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) relative to controls, using a recently introduced method of analysis: voxel-mirrored homotopic connectivity (VMHC). Methods Twenty-nine patients with OSAHS and twenty-six normal sex-, age-, and education-matched controls were recruited and resting-state functional magnetic resonance imaging data were obtained. We employed VMHC to analyze the interhemispheric functional connectivity differences between groups. The z-values of alterations in VMHC in brain region were correlated with clinical characteristics. Results Compared with controls, patients with OSAHS had significantly higher scores for body mass index (t = 5.749, P < 0.001), apnea–hypopnea index (AHI; t = 7.706, P < 0.001), oxygen desaturation index (t = 6.041, P < 0.001), and Epworth sleepiness scale (t = 3.711, P < 0.001), but significantly lower scores on the Rey–Osterrieth complex figure test-immediate recall (t = −3.727, P < 0.05). On the same basis, the VMHC showed significant increases in bilateral calcarine cortex and precuneus. Moreover, significant, positive correlations were found in only these areas between the AHI and the VMHC change coefficients (r = 0.399, P = 0.032; r = 0.378, P = 0.043). Conclusion We found a memory defect in patients with OSAHS. The correlation between the abnormal VMHC and the AHI in patients with OSAHS suggested that AHI might be a key factor in cognitive dysfunction, which might offer new insights into the neural pathophysiology underlying OSAHS-related cognitive deficits.
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Affiliation(s)
- Yu-Ting Liu
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hui-Xin Zhang
- School of Medicine, Southeast University, Nanjing, China
| | - Hui-Jun Li
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Chen
- School of Medicine, Southeast University, Nanjing, China
| | - Ya-Qing Huang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Lian Zhang
- Department of Otolaryngology-Head and Neck Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zhi-Chun Huang
- Department of Otolaryngology-Head and Neck Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bin Liu
- Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Ming Yang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
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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.
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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
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Chen LT, Fan XL, Li HJ, Ye CL, Yu HH, Xin HZ, Gong HH, Peng DC, Yan LP. Aberrant brain functional connectome in patients with obstructive sleep apnea. Neuropsychiatr Dis Treat 2018; 14:1059-1070. [PMID: 29713176 PMCID: PMC5912371 DOI: 10.2147/ndt.s161085] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is accompanied by widespread abnormal spontaneous regional activity related to cognitive deficits. However, little is known about the topological properties of the functional brain connectome of patients with OSA. This study aimed to use the graph theory approaches to investigate the topological properties and functional connectivity (FC) of the functional connectome in patients with OSA, based on resting-state functional magnetic resonance imaging (rs-fMRI). METHODS Forty-five male patients with newly diagnosed untreated severe OSA and 45 male good sleepers (GSs) underwent a polysomnography (PSG), clinical evaluations, and rs-fMRI scans. The automated anatomical labeling (AAL) atlas was used to construct the functional brain connectome. The topological organization and FC of brain functional networks in patients with OSA were characterized using graph theory methods and investigated the relationship between functional network topology and clinical variables. RESULTS Both the patients with OSA and the GSs exhibited high-efficiency "small-world" network attributes. However, the patients with OSA exhibited decreased σ, γ, Eglob; increased Lp, λ; and abnormal nodal centralities in several default-mode network (DMN), salience network (SN), and central executive network (CEN) regions. However, the patients with OSA exhibited abnormal functional connections between the DMN, SN, and CEN. The disrupted FC was significantly positive correlations with the global network metrics γ and σ. The global network metrics were significantly correlated with the Epworth Sleepiness Scale (ESS) score, Montreal Cognitive Assessment (MoCA) score, and oxygen desaturation index. CONCLUSION The findings suggest that the functional connectome of patients with OSA exhibited disrupted functional integration and segregation, and functional disconnections of the DMN, SN, and CEN. The aberrant topological attributes may be associated with disrupted FC and cognitive functions. These topological abnormalities and disconnections might be potential biomarkers of cognitive impairments in patients with OSA.
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Affiliation(s)
- Li-Ting Chen
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Xiao-Le Fan
- Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hai-Jun Li
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Cheng-Long Ye
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hong-Hui Yu
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hui-Zhen Xin
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Hong-Han Gong
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - De-Chang Peng
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
| | - Li-Ping Yan
- Department of Cardiology, People’s Hospital of Jiangxi Province, Nanchang, Jiangxi Province, China
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Sunwoo JS, Lee S, Kim JH, Lim JA, Kim TJ, Byun JI, Jeong MH, Cha KS, Choi JW, Kim KH, Lee ST, Jung KH, Park KI, Chu K, Kim M, Lee SK, Jung KY. Altered Functional Connectivity in Idiopathic Rapid Eye Movement Sleep Behavior Disorder: A Resting-State EEG Study. Sleep 2018; 40:3738526. [PMID: 28431177 DOI: 10.1093/sleep/zsx058] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Idiopathic rapid eye movement sleep behavior disorder (iRBD) is considered as a prodromal stage of synucleinopathy. Although loss of functional connectivity is implicated in neurodegenerative diseases, network characteristics of electroencephalography (EEG) in iRBD are unknown. Therefore, we evaluated resting-state EEG functional connectivity to identify the brain network changes in patients with iRBD. Methods We prospectively enrolled 20 patients with polysomnography-confirmed iRBD and 16 controls. Four patients with mild cognitive impairment were excluded from the analysis after cognitive function tests. EEG was recorded during relaxed wakefulness. We computed the weighted phase lag index as a measure of functional connectivity from EEG recordings. Results All patients with iRBD (mean age 64.3 years; men, 68.8%) had no overt manifestations of neurodegenerative diseases such as Parkinsonism or dementia. The mean duration from symptom onset was 4.8 years. Overall connectivity strength did not differ between the two groups in all frequency bands. However, comparisons of each functional connection with the nonparametric permutation test demonstrated iRBD had decreased delta-band functional connectivity in the frontal regions. There were no significantly increased functional connections in all frequencies. The altered connections had a significant correlation with RBD questionnaire scores. Notably, delta-band weighted phase lag index between left frontal and central regions was correlated with verbal fluency performance (r = 0.486, p = .007). Conclusions Resting-state brain network of iRBD was characterized by a loss of delta-band functional connectivity. Therefore, functional networks in iRBD are altered at the early phase of disease.
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Affiliation(s)
- Jun-Sang Sunwoo
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Sanghun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Department of Mathematical Sciences, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jung-Hoon Kim
- Weldon School of Biomedical Engineering, College of Engineering, Purdue University, West Lafayette, IN
| | - Jung-Ah Lim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, National Center for Mental Health, An affiliate of the Ministry for Health & Welfare, Seoul, South Korea
| | - Tae-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Ick Byun
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Min Hee Jeong
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Kwang Su Cha
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Jeong Woo Choi
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Kyung Hwan Kim
- Department of Biomedical Engineering, College of Health Science, Yonsei University, Wonju, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Protein Metabolism Medical Research Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Young Jung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Allen LA, Harper RM, Kumar R, Guye M, Ogren JA, Lhatoo SD, Lemieux L, Scott CA, Vos SB, Rani S, Diehl B. Dysfunctional Brain Networking among Autonomic Regulatory Structures in Temporal Lobe Epilepsy Patients at High Risk of Sudden Unexpected Death in Epilepsy. Front Neurol 2017; 8:544. [PMID: 29085330 PMCID: PMC5650686 DOI: 10.3389/fneur.2017.00544] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sudden unexpected death in epilepsy (SUDEP) is common among young people with epilepsy. Individuals who are at high risk of SUDEP exhibit regional brain structural and functional connectivity (FC) alterations compared with low-risk patients. However, less is known about network-based FC differences among critical cortical and subcortical autonomic regulatory brain structures in temporal lobe epilepsy (TLE) patients at high risk of SUDEP. METHODS 32 TLE patients were risk-stratified according to the following clinical criteria: age of epilepsy onset, duration of epilepsy, frequency of generalized tonic-clonic seizures, and presence of nocturnal seizures, resulting in 14 high-risk and 18 low-risk cases. Resting-state functional magnetic resonance imaging (rs-fMRI) signal time courses were extracted from 11 bilateral cortical and subcortical brain regions involved in autonomic and other regulatory processes. After computing all pairwise correlations, FC matrices were analyzed using the network-based statistic. FC strength among the 11 brain regions was compared between the high- and low-risk patients. Increases and decreases in FC were sought, using high-risk > low-risk and low-risk > high-risk contrasts (with covariates age, gender, lateralization of epilepsy, and presence of hippocampal sclerosis). RESULTS High-risk TLE patients showed a subnetwork with significantly reduced FC (t = 2.5, p = 0.029) involving the thalamus, brain stem, anterior cingulate, putamen and amygdala, and a second subnetwork with significantly elevated FC (t = 2.1, p = 0.031), which extended to medial/orbital frontal cortex, insula, hippocampus, amygdala, subcallosal cortex, brain stem, thalamus, caudate, and putamen. CONCLUSION TLE patients at high risk of SUDEP showed widespread FC differences between key autonomic regulatory brain regions compared to those at low risk. The altered FC revealed here may help to shed light on the functional correlates of autonomic disturbances in epilepsy and mechanisms involved in SUDEP. Furthermore, these findings represent possible objective biomarkers which could help to identify high-risk patients and enhance SUDEP risk stratification via the use of non-invasive neuroimaging, which would require validation in larger cohorts, with extension to patients with other epilepsies and subjects who succumb to SUDEP.
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Affiliation(s)
- Luke A Allen
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Ronald M Harper
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States
| | - Rajesh Kumar
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,UCLA Brain Research Institute, Los Angeles, CA, United States.,Department of Anaesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.,Department of Bioengineering, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Maxime Guye
- Aix Marseille University, CNRS, CRMBM UMR 7339, Marseille, France
| | - Jennifer A Ogren
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Samden D Lhatoo
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Louis Lemieux
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom
| | - Catherine A Scott
- Institute of Neurology, University College London, London, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - Sjoerd B Vos
- Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Translational Imaging Group, University College London, London, United Kingdom
| | - Sandhya Rani
- The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.,Epilepsy Centre, Neurological Institute, University Hospitals Case Medical Centre, Cleveland, OH, United States
| | - Beate Diehl
- Institute of Neurology, University College London, London, United Kingdom.,Epilepsy Society, Chalfont St. Peter, United Kingdom.,The Center for SUDEP Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
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40
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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.
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Khazaie H, Veronese M, Noori K, Emamian F, Zarei M, Ashkan K, Leschziner GD, Eickhoff CR, Eickhoff SB, Morrell MJ, Osorio RS, Spiegelhalder K, Tahmasian M, Rosenzweig I. Functional reorganization in obstructive sleep apnoea and insomnia: A systematic review of the resting-state fMRI. Neurosci Biobehav Rev 2017; 77:219-231. [PMID: 28344075 PMCID: PMC6167921 DOI: 10.1016/j.neubiorev.2017.03.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/24/2017] [Accepted: 03/21/2017] [Indexed: 12/12/2022]
Abstract
Resting state functional MRI studies is a promising non-invasive tool for better understanding of the pathophysiology of sleep disorders. The salience network is involved in hyperarousal and affective symptoms in insomnia. The posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea. Disruption of intrinsic networks have been demonstrated in major depression, which is a common co-morbidity of sleep disorders.
Functional neuroimaging techniques have accelerated progress in the study of sleep disorders. Considering the striking prevalence of these disorders in the general population, however, as well as their strong bidirectional relationship with major neuropsychiatric disorders, including major depressive disorder, their numbers are still surprisingly low. This review examines the contribution of resting state functional MRI to current understanding of two major sleep disorders, insomnia disorder and obstructive sleep apnoea. An attempt is made to learn from parallels of previous resting state functional neuroimaging findings in major depressive disorder. Moreover, shared connectivity biomarkers are suggested for each of the sleep disorders. Taken together, despite some inconsistencies, the synthesis of findings to date highlights the importance of the salience network in hyperarousal and affective symptoms in insomnia. Conversely, dysfunctional connectivity of the posterior default mode network appears to underlie cognitive and depressive symptoms of obstructive sleep apnoea.
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Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Mattia Veronese
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK
| | - Khadijeh Noori
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - Farnoosh Emamian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Keyoumars Ashkan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Department of Neurosurgery, King's College Hospital, London, UK
| | - Guy D Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
| | - Claudia R Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany; Institute of Clinical Neuroscience & Medical Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Mary J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College London, UK and NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust,Sydney Street, London, SW3 6NP, UK
| | - Ricardo S Osorio
- Center for Brain Health, NYU School of Medicine, New York, NY, United States
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany
| | - Masoud Tahmasian
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran; Institute of Medical Sciences and Technology, Shahid Beheshti University, Tehran, Iran; School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College, London, UK; Sleep Disorders Centre, Guy's and St Thomas' Hospital, London, UK
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Tummala S, Roy B, Park B, Kang DW, Woo MA, Harper RM, Kumar R. Associations between brain white matter integrity and disease severity in obstructive sleep apnea. J Neurosci Res 2016; 94:915-923. [PMID: 27315771 PMCID: PMC4990476 DOI: 10.1002/jnr.23788] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/18/2016] [Accepted: 05/20/2016] [Indexed: 12/27/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent upper airway blockage, with continued diaphragmatic efforts to breathe during sleep. Brain structural changes in OSA appear in various regions, including white matter sites that mediate autonomic, mood, cognitive, and respiratory control. However, the relationships between brain white matter changes and disease severity in OSA are unclear. This study examines associations between an index of tissue integrity, magnetization transfer (MT) ratio values (which show MT between free and proton pools associated with tissue membranes and macromolecules), and disease severity (apnea-hypopnea index [AHI]) in OSA subjects. We collected whole-brain MT imaging data from 19 newly diagnosed, treatment-naïve OSA subjects (50.4 ± 8.6 years of age, 13 males, AHI 39.7 ± 24.3 events/hr], using a 3.0-Tesla MRI scanner. With these data, whole-brain MT ratio maps were calculated, normalized to common space, smoothed, and correlated with AHI scores by using partial correlation analyses (covariates, age and gender; P < 0.005). Multiple brain sites in OSA subjects, including superior and inferior frontal regions, ventral medial prefrontal cortex and nearby white matter, midfrontal white matter, insula, cingulate and cingulum bundle, internal and external capsules, caudate nuclei and putamen, basal forebrain, hypothalamus, corpus callosum, and temporal regions, showed principally lateralized negative correlations (P < 0.005). These regions showed significant correlations even with correction for multiple comparisons (cluster-level, family-wise error, P < 0.05), except for a few superior frontal areas. Predominantly negative correlations emerged between local MT values and OSA disease severity, indicating potential usefulness of MT imaging for examining the OSA condition. These findings indicate that OSA severity plays a significant role in white matter injury. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sudhakar Tummala
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Bhaswati Roy
- UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Bumhee Park
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Daniel W. Kang
- Department of Medicine, 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
| | - Ronald M. Harper
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Rajesh Kumar
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA 90095, USA
- Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA 90095, USA
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Obstructive Sleep Apnoea and Hypertension: the Role of the Central Nervous System. Curr Hypertens Rep 2016; 18:59. [DOI: 10.1007/s11906-016-0665-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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44
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Daurat A, Sarhane M, Tiberge M. Syndrome d’apnées obstructives du sommeil et cognition : une revue. Neurophysiol Clin 2016; 46:201-15. [DOI: 10.1016/j.neucli.2016.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 04/13/2016] [Accepted: 04/29/2016] [Indexed: 11/29/2022] Open
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