Regional cerebral blood flow during wakeful rest in older subjects with mild to severe obstructive sleep apnea
Cerebral perfusion in OSA
Article [Accepted Manuscript]
Is part of
Sleep ; vol. 38, no. 9, pp. 1439-1449.Publisher(s)
Oxford University PressAuthor(s)
Abstract(s)
Objectives: To evaluate changes in regional cerebral blood flow (rCBF) during wakeful rest in older
subjects with mild to severe obstructive sleep apnea (OSA) and healthy controls, and to identify
markers of OSA severity that predict altered rCBF.
Design: High-resolution 99mTc-HMPAO SPECT images during wakeful rest.
Setting: Research sleep laboratory affiliated with a University hospital.
Participants: Fifty untreated OSA patients aged between 55 and 85 years divided into mild, moderate
and severe OSA and 20 age-matched healthy controls.
Interventions: N/A
Measurements: Using statistical parametrical mapping, rCBF was compared between groups and
correlated with clinical, respiratory and sleep variables.
Results: Whereas no rCBF change was observed in mild and moderate groups, participants with severe
OSA had reduced rCBF compared to controls in the left parietal lobules, precentral gyrus, bilateral
postcentral gyri, and right precuneus. Reduced rCBF in these regions and in areas of the bilateral
frontal and left temporal cortex was associated with more hypopneas, snoring, hypoxemia, and
sleepiness. Higher apnea, micro-arousal, and body mass indexes were correlated to increased rCBF in
the basal ganglia, insula, and limbic system.
Conclusions: While older individuals with severe OSA had hypoperfusions in the sensorimotor and
parietal areas, respiratory variables and subjective sleepiness were correlated with extended regions of
hypoperfusion in the lateral cortex. Interestingly, OSA severity, sleep fragmentation and obesity
correlated with increased perfusion in subcortical and medial cortical regions. Anomalies with such a
distribution could result in cognitive deficits and reflect impaired vascular regulation, altered neuronal
integrity, and/or undergoing neurodegenerative processes.
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