重度阻塞性睡眠呼吸暂停患者脑静息态镜像同伦连接的分析

Analysis of resting-state voxel-mirrored homotopic connectivity in severe obstructive sleep apnea

目的应用静息态功能MRI技术探讨重度阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)患者大脑半球间基于体素的镜像同伦连接(voxel-mirrored homotopic connectivity,VMHC)变化。材料与方法前瞻性分析重度OSA患者资料及年龄、性别和受教育程度相匹配的健康对照各50例,收集其临床资料、神经心理量表评分及头颅MRI数据。比较两组间大脑VMHC值的差异,基于差异脑区行种子点功能连接(functional connectivity,FC)分析,并将差异有统计学意义的脑功能指标与临床变量和神经心理量表评分行相关分析。结果与健康对照组相比,重度OSA患者认知评分减低,抑郁及焦虑评分增高,双侧距状回和顶上回VMHC值减低,其与双侧舌回、右侧枕中回及左侧颞中回等多个脑区间FC异常(高斯随机场多重比较校正,体素水平P<0.001,簇水平P<0.05)。重度OSA患者双侧距状回VMHC值与呼吸暂停低通气指数负相关(r=-0.31,P=0.027),与平均血氧饱和度(oxygen saturation of blood,SaO2)正相关(r=0.30,P=0.033);双侧顶上回VMHC值分别与平均和最低SaO2呈正相关(r=0.29,P=0.039;r=0.31,P=0.028),左侧顶上回与角回间的FC值与平均SaO2呈正相关(r=0.29,P=0.041)。结论重度OSA患者存在认知功能受损及潜在抑郁和焦虑风险,其双侧距状回和顶上回半球间功能协同性受损及FC异常可能是重度OSA患者脑损害的重要神经生理机制。

Objective:To utilize the resting-state functional magnetic resonance imaging technology to explore the changes of voxel-mirrored homotopic connectivity(VMHC)in patients with severe obstructive sleep apnea(OSA).Materials and Methods:A total of fifty patients with OSA and fifty healthy controls,matched in terms of age,sex,and education,were included in this study.The data of clinical situations,neuropsychological scale assessment and brain magnetic resonance imaging of all participants were further collected.VMHC and the seed-based functional connectivity(FC)were calculated and compared between these two groups.Additionally,Pearson correlation analysis was conducted to examine the relationship between the significant brain areas for VMHC and FC,and the clinical variables and neuropsychological scale scores.Results:Compared to control group,patients with severe OSA exhibited lower cognitive scores,and higher depression and anxiety scores.In patients with OSA,the VMHC of the bilateral calcarine and the bilateral superior parietal gyrus was significantly decreased.The FC was found to be abnormal in the bilateral lingual gyrus,right middle occipital gyrus,and left middle temporal gyrus(gaussian random field correction,voxel level P<0.001,cluster level P<0.05).The VMHC value of bilateral calcarine gyrus in severe OSA patients showed a negative correlation with the apnea hypopnea index(r=-0.31,P=0.027),and a positive correlation with mean blood oxygen saturation(SaO2)(r=0.30,P=0.033).Additionally,the VMHC value of the bilateral superior parietal gyrus was positively correlated with the mean and minimum SaO2(r=0.29,P=0.039;r=0.31,P=0.028).Furthermore the FC value between the left superior parietal gyrus and the angle gyrus was positively correlated with the mean SaO2(r=0.29,P=0.041).Conclusions:Cognitive function impairment and potential risk of depression and anxiety are observed in severe OSA patients.The alteration of interhemispheric coordination and abnormal FC of the bilateral calcarine and the bilateral superior parietal gyrus may be significant neuropathological mechanisms contributing to cerebral impairments in patients with OSA.