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Obstructive sleep apnea and white matter hyperintensities: correlation or causation?

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Abstract

Obstructive sleep apnea (apnea) is thought to cause small vessel ischemic episodes in the brain from hypoxic events, postulated as white matter hyperintensities (hyperintensities) identified on MRI which are implicated in cognitive decline. This study sought to evaluate these correlations. A retrospective evaluation of adults who underwent polysomnography (4/1/2016 to 4/30/2017) and a brain MRI prior to apnea diagnosis or within a year post-diagnosis was completed. MRI visual evaluation of hyperintensities using Fazekas scores were collected blind to clinical data. Collated clinical/MRI data were stratified and analyzed using chi-square, fishers t-tests, ANOVA/ANCOVA and linear regression. Stratification by apnea category revealed no significant differences in any variables including hyperintensity measures (Fazekas p=0.1584; periventricular p=0.3238; deep p=0.4618; deep total p=0.1770). Stratification by Fazekas category, periventricular and deep hyperintensities revealed increasing prevalence with age (p=0.0001); however, apnea categories were not significantly associated (Fazekas p=0.1479; periventricular p=0.3188; deep p=0.4503), nor were any individual apnea indicators. Continuous apnea measurements werre not associated with any hyperintensity factor; total deep hyperintensities were not associated with any apnea factors. Continuous BMI was not found to be associated with any apnea or hyperintensity factors. Only hypertension was noted to be associated with Fazekas (p=0.0045), deep (p=0.0010) and total deep (p=0.0021) hyperintensities; however, hypertension was not associated with apnea category (p=0.3038) or any associated factors. These data suggest apneas alone from OSA are insufficient to cause WMH, but other factors appear to contribute to the complex development of small vessel ischemic injury associated with age and cognitive decline.

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Authors and Affiliations

  1. University of South Carolina School of Medicine—Greenville, Greenville, SC, USA

    Noah C. Schammel, Trevor VandeWater & Ronald Cowley

  2. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Greenville, SC, USA

    Stella Self

  3. Department of Mathematics and Statistics, Clemson University, Clemson, SC, United States

    Christopher Wilson

  4. Department of Pathology, Pathology Associates, 8 Memorial Medical Ct., Greenville, SC, 29605, USA

    Christine M. G. Schammel

  5. Department of Radiology, Prisma Health—Upstate, Greenville, SC, USA

    Ronald Cowley & Lee A. Madeline

  6. Division of Pediatric Sleep Medicine, Prisma Health—Upstate, Greenville, SC, USA

    Dominic B. Gault

Authors
  1. Noah C. Schammel
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  2. Trevor VandeWater
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  4. Christopher Wilson
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Contributions

Noah Schammel—data collection clinical and sleep apnea data; writing/editing.

Trevor Vandewater—data collection MRI data; writing/editing.

Stella Self—statistical analysis; writing.

Christopher Wilson—statistical analysis; writing.

Christine Schammel—project coordinator; primary writer/editor.

Ronald Cowley—project concept; editing.

Dominic Gault—project concept; writing/editing.

Lee Madeline—project concept; primary editor.

Corresponding author

Correspondence to Christine M. G. Schammel.

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The submitted work is original and has not been published elsewhere in any form or language.

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This project was approved by the Prisma Health/SC IRB prior to initiation. A universal consent was used for data collection and all data was de-identified.

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Schammel, N.C., VandeWater, T., Self, S. et al. Obstructive sleep apnea and white matter hyperintensities: correlation or causation?. Brain Imaging and Behavior 16, 1671–1683 (2022). https://doi.org/10.1007/s11682-022-00642-9

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  • DOI: https://doi.org/10.1007/s11682-022-00642-9

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