White matter damage and systemic inflammation in obstructive sleep apnea

Hsiu Ling Chen, Cheng Hsien Lu, Hsin Ching Lin, Pei Chin Chen, Kun Hsien Chou, Wei Ming Lin, Nai Wen Tsai, Yu Jih Su, Michael Friedman, Ching Po Lin*, Wei Che Lin

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

95 Scopus citations


Study Objectives: To evaluate white matter integrity in patients with obstructive sleep apnea (OSA) using diffusion tensor imaging (DTI) and to assess its relationship with systemic inflammation. Design: Cross-sectional study. Setting: One tertiary medical center research institute. Patients or Participants: Twenty patients with severe OSA (apnea-hypopnea index [AHI] > 30, 18 men and 2 women) and 14 healthy volunteers (AHI < 5, 11 men and 3 women). Interventions: N/A. Measurements and Results: Patients with severe OSA and healthy volunteers underwent polysomnography to determine the severity of sleep apnea, and DTI scanning to determine fiber integrity. Early or late phase changes in leukocyte apoptosis and its subsets were determined by flow cytometry. DTI-related indices (including fractional anisotropy [FA], axial diffusivity [AD], radial diffusivity [RD], and mean diffusivity [MD]) were derived from DTI. The FA maps were compared using voxel-based statistics to determine differences between the severe OSA and control groups. The differences in DTI indices, clinical severity, and leukocyte apoptosis were correlated after adjusting for age, sex, body mass index, and systolic blood pressure. Exploratory group-wise comparison between the two groups revealed that patients with OSA exhibited low FA accomplished by high RD in several brain locations, without any differences in AD and MD. The FA values were negatively correlated with clinical disease severity and leukocyte early apoptosis. Conclusions: Obstructive sleep apnea impairs white matter integrity in vulnerable regions, and this impairment is associated with increased disease severity. The possible interactions between systemic inflammation and central nervous system microstructural damage may represent variant hypoxic patterns and their consequent processes in obstructive sleep apnea.

Original languageEnglish
Pages (from-to)361-370
Number of pages10
Issue number3
StatePublished - 01 03 2015

Bibliographical note

Publisher Copyright:
© 2015, Associated Professional Sleep Societies, LLC. All rights reserved.


  • Diffusion tensor imaging
  • Leukocyte apoptosis
  • Magnetic resonance imaging
  • Obstructive sleep apnea
  • Oxidative stress


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