Cerebrovascular Reactivity in Young Subjects with Sleep Apnea

被引:24
|
作者
Buterbaugh, John [1 ]
Wynstra, Charles [1 ,2 ]
Provencio, Natalie [1 ,2 ]
Combs, Daniel [2 ,3 ]
Gilbert, Michael [1 ]
Parthasarathy, Sairam [1 ,2 ,3 ]
机构
[1] Southern Arizona Vet Adm Hlth Care Syst, Tucson, AZ USA
[2] Arizona Resp Ctr, Tucson, AZ USA
[3] Univ Arizona, Dept Med, Tucson, AZ 85724 USA
关键词
cerebral autoregulation; functional magnetic resonance imaging; obstructive sleep apnea; sleep apnea; stroke; GENIOGLOSSUS MOTOR UNITS; LEVEL-DEPENDENT MRI; BLOOD OXYGENATION; BRAIN MORPHOLOGY; CEREBRAL PERFUSION; RISK-FACTOR; RESONANCE; RESPONSES; HUMANS; FMRI;
D O I
10.5665/sleep.4406
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Objectives: Regional brain alterations may be involved in the pathogenesis and adverse consequences of obstructive sleep apnea (OSA). The objectives for the current study were to (1) determine cerebrovascular reactivity in the motor areas that control upper airway musculature in patients with OSA, and (2) determine whether young patients with OSA have decreased cerebrovascular reactivity in response to breath holding. Design: Case-control study. Setting: Academic center. Participants: Twelve subjects with OSA (age 24-42 y; apnea-hypopnea index 17; interquartile range [IQR] 9, 69 per hour) and control subjects (n = 10; age 29-44 y; AHI 2; IQR 1, 3 per hour). Measurements and Results: Subjects underwent blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) while awake, swallowing, and breath holding. In subjects with OSA, during swallowing, there was less activity in the brainstem than in controls (P = 0.03) that remained reduced after adjusting for cortical motor strip activity (P = 0.036). In OSA subjects, brain regions of increased cerebrovascular reactivity (38; IQR 17, 96 cm(3)) was smaller than that in controls (199; IQR 5, 423 cm(3); P = 0.01). In OSA subjects, brain regions of decreased cerebrovascular reactivity during breath hold was greater (P = 0.01), and the ratio of increased-to-decreased brain regions was lower than that of controls (P = 0.006). Adjustment for cerebral volumes, body mass index, and white matter lesions did not change these results substantively. Conclusions: In patients with obstructive sleep apnea (OSA), diminished change in brainstem activity during swallowing and reduced cerebrovascular reactivity may contribute to the etiopathogenesis and adverse cerebrovascular consequences, respectively. We speculate that decreased cerebral auto-regulation may be causative of gray matter loss in OSA.
引用
收藏
页码:241 / 250
页数:10
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