Non-Gaussian Diffusion Imaging Shows Brain Myelin and Axonal Changes in Obstructive Sleep Apnea

Tummala, Sudhakar; Roy, Bhaswati; Vig, Ruchi; Park, Bumhee; Kang, Daniel W.; Woo, Mary A.; Aysola, Ravi; Harper, Ronald M.; Kumar, Rajesh

doi:10.1097/rct.0000000000000537

Cited by 11 publications

(8 citation statements)

References 45 publications

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“…The present study differs from Tummala's study on OSA ( 37 ), which found increased kurtosis parameters in several intracranial regions. They suggested that the hypoxic and ischemic damage caused by OSA may cause swelling of neurons and axons, leading to acute axonal and myelin tissue damage.…”

Section: Discussioncontrasting

confidence: 99%

Diffusion Abnormality in Temporal Lobe Epilepsy Patients With Sleep Disorders: A Diffusion Kurtosis Imaging Study

Guo

Shen

et al. 2022

Front. Psychiatry

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BackgroundPatients with temporal lobe epilepsy (TLE) frequently complain of poor sleep quality, which is a condition that clinicians are typically neglecting. In this study, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and Athens Insomnia Scale (AIS) were used to assess the sleep status of patients with temporal lobe epilepsy (TLE). Simultaneously diffusion kurtosis imaging (DKI) was applied to examine the white matter microstructure abnormalities in patients with TLE and sleep disorders.MethodsTLE patients who have been diagnosed in the cardio-cerebrovascular ward of the Yanan University Affiliated Hospital from October 2020 to August 2021 were recruited. Finally, 51 patients and 30 healthy controls were enrolled in our study, with all subjects completing the sleep evaluation questionnaire and undergoing a DKI examination. Using independent sample t-test, analysis of variance (ANOVA), and Mann-Whitney U test to compare groups.ResultsThirty patients (58.82%) complained of long-term sleep difficulties. The overall differences among the evaluation of AIS, ESS, and PSQI are significant (P = 0.00, P = 0.00, P = 0.03). The scores of AIS, ESS in Left and Right-TLE (L/R-TLE) with sleep disorders, as well as PSQI in L-TLE, are statistically higher than the control group (P = 0.00, P = 0.00, P = 0.00, P = 0.00, P = 0.02). L-TLE with sleep disorders showed decreased MK on affected sides (P = 0.01). However, statistical differences in MD and FA have not been observed (P = 0.34, P = 0.06); R-TLE with sleep disorders showed significantly decreased MK and increased MD on affected sides (P = 0.00, P = 0.00), but FA's statistical difference has not been observed (P = 0.20).ConclusionsTLE patients with sleep disorders have different DKI parameters than individuals who do not have sleep issues. During this process, the kurtosis parameter (MK) was more sensitive than the tensor parameters (MD, FA) in detecting the patient's aberrant white matter diffusion. DKI may be a better choice for in vivo investigation of anomalous craniocerebral water diffusion.

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Section: Discussioncontrasting

confidence: 99%

Diffusion Abnormality in Temporal Lobe Epilepsy Patients With Sleep Disorders: A Diffusion Kurtosis Imaging Study

Guo

Shen

et al. 2022

Front. Psychiatry

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“…The compromised WM fiber tracts observed in this study reside in autonomic or respiratory control regions (insular cortices, midline pons, cerebellar peduncles, and cerebellar vermis), as well as in neuropsychologic, motor, or cognitive regulatory areas (hippocampus, amygdala, internal and external capsules, ventral putamen, frontal, parietal, and temporal white matter regions), all of which are relevant to OSA [50]. For example, the corona radiata propagates from the frontal/parietal cortex to the brain stem via internal capsule, which involves a number of fiber tracts (e.g., ACR.R, ALIC.R, PLIC.R, ALIC.L).…”

Section: Discussionmentioning

confidence: 99%

“…Further improvement may also be achieved by including BMI as another covariate. Like several other recent imaging studies on OSA [5,50,52], the present study did not include BMI as a covariate because of the following reasons. First, although individuals with higher BMI tend to have a higher prevalence of OSA, WM change affected by BMI has not been fully established in the literature, despite recent reports on a limited number of tracts [53,54].…”

Section: Discussionmentioning

confidence: 99%

White matter structural differences in OSA patients experiencing residual daytime sleepiness with high CPAP use: a non-Gaussian diffusion MRI study

et al. 2019

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Objectives: To investigate factors associated with residual sleepiness in patients who were highly adherent to continuous positive airway pressure (CPAP). Nocturnal inactivity, comorbidities, concomitant medications, and, in particular, white matter (WM) differences using diffusion magnetic resonance imaging (MRI) were explored using a continuous-time random-walk (CTRW) model. Methods: Twenty-seven male patients (30–55 years of age) with obstructive sleep apnea (OSA) received CPAP as the only treatment (CPAP ≥ 6hr./night) for at least 30 days. Based on the Psychomotor Vigilance Task (PVT) results, participants were divided into a non-sleepy group (lapses ≤ 5; n = 18) and a sleepy group (lapses > 5; n = 9). Mean nocturnal inactivity (sleep proxy) was measured using actigraphy for one week. Diffusion-weighted imaging (DWI) with high b-values, as well as diffusion tensor imaging (DTI), was performed on a 3 Tesla MRI scanner. The DWI dataset was analyzed using the CTRW model that yielded three parameters: temporal diffusion heterogeneity α, spatial diffusion heterogeneity β, and an anomalous diffusion coefficient Dm. The differences in α, β, Dm, and the combination of α and β between the two groups were investigated by a whole-brain analysis using tract-based spatial statistics (TBSS), followed by a regional analysis on individual fiber tracts using a standard parcellation template. Results from the CTRW model were compared with those obtained from DTI. The three CTRW parameters were also correlated with the clinical assessment scores, Epworth Sleepiness Scale (ESS), PVT lapses, and PVT mean reaction time (MRT) in specific fiber tracts. Results: There were no differences between groups in mean sleep duration, comorbidities, and the number or type of medications, including alerting and sedating medications. In the whole-brain DWI analysis, the sleepy group showed higher α (17.27% of the WM voxels) and Dm (17.14%) when compared to the non-sleepy group (P < 0.05), whereas no significant difference in β was observed. In the regional fiber analysis, the sleepy and non-sleepy groups showed significant differences in α, β, or their combinations in a total of twelve fiber tracts, whereas similar differences were not observed in DTI parameters, when age was used as a covariate. Additionally, moderate to strong correlations between the CTRW parameters (α, β, or Dm) and the sleepiness assessment scores (ESS, PVT lapses, or PVT MRT) were observed in specific fiber tracts (|R| = 0.448–0.654, P = 0.0003–0.019). Conclusions: The observed differences in the CTRW parameters between the two groups indicate that WM alterations can be a possible mechanism to explain reversible versus residual sleepiness observed in OSA patients with identical high level of CPAP use. The moderate to strong correlations between the CTRW parameters and the clinical scores suggest the possibility of developing objective and quantitative imaging markers to complement clinical assessment of OSA patients.

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“…In a related approach, diffusion imaging studies reveal widespread alterations in white matter integrity in sleep apnea patients relative to controls, particularly in regions implicated in sleep/wake control and cognitive functioning (bilateral prefrontal cortex, hippocampus, amygdala, insula, cerebellum, medulla, pons, basal forebrain, basal ganglia, right posterior parietal lobe, and right occipital cortex)[104]. Greater apnea-hypopnea index [105], via acute hypoxic injury [106, 107], worsens the negative effects of sleep apnea on white matter integrity.…”

Section: Neuroimaging Studies In Patients With Sleep Disordered Breatmentioning

confidence: 99%

Do Older Adults Need Sleep? A Review of Neuroimaging, Sleep, and Aging Studies

Scullin

2017

Curr Sleep Medicine Rep

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Purpose of Review Sleep habits, sleep physiology, and sleep disorders change with increasing age. However, there is a longstanding debate regarding whether older adults need sleep to maintain health and daily functioning (reduced-sleep-need view). An alternative possibility is that all older adults need sleep, but that many older adults have lost the ability to obtain restorative sleep (reduced-sleep-ability view). Prior research using behavioral and polysomnography outcomes has not definitively disentangled the reduced-sleep-need and reduced-sleep-ability views. Therefore, this review examines the neuroimaging literature to determine whether age-related changes in sleep cause—or are caused by—age-related changes in brain structure, function, and pathology. Recent Findings In middle-aged and older adults, poorer sleep quality, greater nighttime hypoxia, and shorter sleep duration related to cortical thinning in frontal regions implicated in slow wave generation, in frontoparietal networks implicated in cognitive control, and in hippocampal regions implicated in memory consolidation. Furthermore, poor sleep quality was associated with higher amyloid burden and decreased connectivity in the default mode network, a network that is disrupted in the pathway to Alzheimer’s disease. Summary All adults need sleep, but cortical thinning and amyloidal deposition with advancing age may weaken the brain’s ability to produce restorative sleep. Therefore, sleep in older adults may not always support identical functions for physical, mental, and cognitive health as in young adults.

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Non-Gaussian Diffusion Imaging Shows Brain Myelin and Axonal Changes in Obstructive Sleep Apnea

Cited by 11 publications

References 45 publications

Diffusion Abnormality in Temporal Lobe Epilepsy Patients With Sleep Disorders: A Diffusion Kurtosis Imaging Study

Diffusion Abnormality in Temporal Lobe Epilepsy Patients With Sleep Disorders: A Diffusion Kurtosis Imaging Study

White matter structural differences in OSA patients experiencing residual daytime sleepiness with high CPAP use: a non-Gaussian diffusion MRI study

Do Older Adults Need Sleep? A Review of Neuroimaging, Sleep, and Aging Studies

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