Sleep Apnea associated with diminished cognition and altered white matter integrity: JAMA

Obstructive sleep apnea (OSA) is associated with cognitive impairment and brain structural alterations, but longitudinal outcomes are understudied.

A Study was conducted to examine the associations of OSA with cognition and white matter (WM) integrity over a 4-year period.

This prospective cohort study was conducted in a community-based adult population among participants who had both baseline (2011-2014) and 4-year follow-up (2015-2018) polysomnography, diffusion tensor imaging, and cognitive assessment data. Participants with neurological disorders, anomalous findings on brain magnetic resonance imaging, or inadequate quality of the evaluations were excluded. Data were analyzed from March to November 2021.

The main outcomes were proportional changes over a 4-year period in neuropsychological performance and WM integrity. The neuropsychological assessment battery included verbal and visual memory, verbal fluency, Digit Symbol-coding, Trail Making Test-A, and Stroop Test. WM integrity was assessed by fractional anisotropy, axial, and radial diffusivity. To examine interactions with age and sex, participants were subgrouped by age older than 60 years vs 60 years or younger and men vs women.

Results:

• A total of 1998 individuals were assessed for eligibility, and 888 were excluded based on exclusion criteria, leaving 1110 participants for analysis, including 458 participants grouped as OSA-free, 72 participants with resolved OSA, 163 participants with incident OSA, and 417 participants with persistent OSA.
• Incident OSA was associated with altered WM integrity and with concomitant changes in sustained attention compared with participants without OSA
• Participants with resolved OSA showed better visual recall at the follow-up with concordant changes in diffusion parameters at the relevant anatomic areas. In the older group only (age >60 years), persistent OSA was associated with altered WM integrity and cognition.
• Sex also was associated with modifying the association of OSA with WM integrity of the left posterior internal capsule, the left genu of corpus callosum, and the right middle cerebellar peduncle only in men and with cognition only in women

These findings suggest that dynamic changes in OSA status were significantly associated with WM integrity and cognition, which varied by age and sex. It is possible that adequate interventions for OSA could better preserve brain health in middle to late adulthood.

Reference:

Lee MH, Lee SK, Kim S, Kim REY, Nam HR, Siddiquee AT, Thomas RJ, Hwang I, Yoon JE, Yun CH, Shin C. Association of Obstructive Sleep Apnea With White Matter Integrity and Cognitive Performance Over a 4-Year Period in Middle to Late Adulthood. JAMA Netw Open. 2022 Jul 1;5(7):e2222999. doi: 10.1001/jamanetworkopen.2022.22999. PMID: 35857321.

Keywords:

Obstructive sleep apnea, white matter integrity, middle, late adulthood, JAMA Netw Open, Min-Hee Lee, Seung Ku Lee, Soriul Kim, Regina E Y Kim, Hye Ryeong Nam, Ali T Siddiquee , Robert J Thomas, Inha Hwang, Jee-Eun Yoon, Chang-Ho Yun, Chol Shin