OSAHS患者脑功能异常及发生机制:基于rs-fMRI度中心度法

Study on brain dysfunction and its mechanism in patients with obstructive sleep apnea hypopnea syndrome based on rs-fMRI degree centrality method

目的:基于静息态功能磁共振成像(rs-fMRI)度中心度(DC)法探讨阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者脑功能异常及其神经病理学机制。方法:受试者包括在本院呼吸内科经多导睡眠监测(PSG)初次诊断且未经过治疗的30例男性OSAHS患者(患者组)及同时间段经PSG监测为睡眠正常且年龄、受教育程度相匹配的30例健康志愿者(对照组)。采用蒙特利尔认知评估量表(MoCA)对所有受试者的认知功能进行评分,然后进行rs-fMRI检查,获取脑组织的血氧水平依赖(BOLD)信号,将OSAHS组与对照组间BOLD信号有显著差异的脑区作为感兴趣区域(ROI),提取每个ROI的DC值,将其与MoCA评分以及PSG监测的睡眠指标[呼吸紊乱指数(AHI)、微觉醒指数(AI)、最低血氧饱和度(Mini-SaO_(2))]进行相关性分析。结果:与对照组比较,患者组中DC值增加的脑区有左侧脑桥、右侧边缘叶、左侧颞上回、右侧额下回、左侧额上回和右侧额上回;DC值减低的脑区有右侧小脑后叶和左侧楔叶。右侧小脑后叶的DC值与MoCA评分呈显著正相关(r=0.656,P<0.001),左侧楔叶的DC值与Mini-SaO_(2)(r=0.519,P=0.003)呈显著正相关。结论:OSAHS患者多个脑区的度中心度发生了改变,右侧小脑后叶度中心度减低可能与认知功能的减低有关,左侧楔叶的度中心度减低可能与缺氧密切相关。

Objective:To study the abnormalities of brain function and the possible neuropathological mechanism in patients with obstructive sleep apnea-hypopnea syndrome(OSAHS)by resting state functional magnetic resonance imaging(rs-fMRI)degree centrality(DC)method.Methods:A total of 30 male patients with OSAHS who were first diagnosed and untreated by polysomnography(PSG)in the department of respiratory medicine in our hospital were collected.Thirty volunteers with normal sleep,similar age and education level were selected as normal control(NC)group after PSG monitoring in the same period.All subjects received Montreal Cognitive Assessment(MoCA)scores,and then underwent resting state functional magnetic resonance imaging(rs-fMRI)examination to obtain blood oxygen level dependent(BOLD)signal.DC analysis was used to compare the OSAHS group with the NC group to find out the brain regions with significant differences.The different brain regions were regarded as regions of interest(ROI)to record the average DC value,then the correlation analysis of MoCA score and sleep indexes[including apnea hypopnea index(AHI),arousal index(AI)and minimal arterial oxygen saturation(Mini-SaO_(2))]monitored by PSG was conducted to explore the possible neuropathological mechanism of brain function damage of OSAHS.Results:Compared with NC group,there were left pons,right limbic lobes,left superior temporal gyrus,right inferior frontal gyrus,left superior frontal gyrus,and right superior frontal gyrus in brain regions with increased DC value.The DC value decreased in the right posterior lobe of cerebellum and the left cuneus.The mean DC value of the right posterior lobe was positively correlated with the MoCA score(r=0.656,P<0.001).There was a significant positive correlation between the mean DC of the left wedge and Mini-SaO_(2)(r=0.519,P=0.003).Conclusion:The change of degree centrality in multiple brain regions in OSAHS patients,the decrease of degree centrality in the right posterior lobe of cerebellum may be related to the decrease of cognitive function,and the decrease of degree centrality in the left cuneus may be closely related to hypoxia.