The association of sleep-disordered breathing and white matter hyperintensities in heart failure patients

Abstract

Heart failure patients often manifest white matter hyperintensites on brain magnetic resonance imaging (MRI). White matter hyperintnsities have also been linked with cognitive problems in patients with heart failure. Sleep disordered breathing may contribute to structural brain changes in heart failure. The purpose of this study was to test the extent to which the apnea hypopnea index is associated with global and regional white matter hyperintensities, and is a moderating factor in the relationship between age and white matter hyperintensites. A total of 28 HF patients [mean age (SD) = 67.89 (5.8)] underwent T1-weighted and T2FLAIR MRI and a home sleep monitoring study. The apnea hypopnea index cut off of 10 was used to compare between higher and lower risks of sleep disordered breathing. Regression analysis was used to test the association between apnea hypopnea index and both global and regional white matter hyperintensities. The interaction term was entered to identify the moderation effect. Apnea hypopnea index was associated with higher regional white matter hyperintensities but not global white matter hyperintensities. There was a significant interaction between the apnea hypopnea index and age, such that older participants with the apnea hypopnea index ≥10 showed greater regional white matter hyperintensities than those with the apnea hypopnea index <10. The results of this preliminary study indicate that a higher apnea hypopnea index is associated with more white matter hyperintensities. The age-related white matter hyperintensities appear to be exacerbated by apnea hypopnea index in our individuals with heart failure. Future studies are needed to further investigate the underlying mechanisms.

Association Between Obstructive Sleep Apnea and Brain White Matter Hyperintensities in a Population-Based Cohort in Germany

“… 19 Likewise, the lack of statistically significant associations of OSA with global WMHs in 28 patients with heart failure and 109 patients with a minor stroke or transient ischemic attack after adjustment for age, hypertension, and diabetes might have been attributable to the rather small study samples and in-home PSG measurements. 20 , 21 …”

“… 11 Obstructive sleep apnea has been identified as a significant risk factor for cardiovascular, metabolic, and psychiatric disorders. 11 , 13 So far, however, the association between OSA and white matter disease, both highly prevalent in older individuals, has been investigated by only a few human studies, 10 , 18 , 19 , 20 , 21 with contradictory findings. Previous studies suffer from restrictions to specific subpopulations 10 with high comorbidity burden 20 , 21 or because they used nonuniform OSA assessment methods, 10 were carried out in an in-home setting, 19 , 20 , 21 were based on sleep questionnaire data only, 22 or had relatively small sample sizes, 20 and few used fully automated WMH ratings.…”

“… 11 , 13 So far, however, the association between OSA and white matter disease, both highly prevalent in older individuals, has been investigated by only a few human studies, 10 , 18 , 19 , 20 , 21 with contradictory findings. Previous studies suffer from restrictions to specific subpopulations 10 with high comorbidity burden 20 , 21 or because they used nonuniform OSA assessment methods, 10 were carried out in an in-home setting, 19 , 20 , 21 were based on sleep questionnaire data only, 22 or had relatively small sample sizes, 20 and few used fully automated WMH ratings. 22 Thus, additional general population studies that investigate the association between OSA and WMHs with highly standardized data collection and thorough covariate adjustment are needed.…”

“…Potential reasons for these different findings compared with our study might be the investigation of a smaller and slightly older study sample with PSG measurements only available from less reliable portable devices performed in an unattended, in-home setting and a rather large gap of 15 years between OSA and MRI measurements in the Atherosclerosis Risk in Communities study 19. Likewise, the lack of statistically significant associations of OSA with global WMHs in 28 patients with heart failure and 109 patients with a minor stroke or transient ischemic attack after adjustment for age, hypertension, and diabetes might have been attributable to the rather small study samples and in-home PSG measurements 20,21.…”

Cerebrovascular pathology mediates associations between hypoxemia during rapid eye movement sleep and medial temporal lobe structure and function in older adults

“…Obstructive sleep apnea (OSA) is a common, though underdiagnosed, sleep disorder 1 that increases in prevalence with age 2 and is characterized by recurring episodes of complete or partial upper airway collapse during sleep 3 . OSA has been independently associated with reduced regional white matter integrity [4][5][6][7][8][9][10][11][12][13] , altered medial temporal lobe (MTL) morphometry [14][15][16][17][18][19][20] , cerebrovascular pathology [21][22][23][24][25][26][27][28][29][30][31] , and increased risk for cognitive decline [32][33][34] . The relative contributions of distinct OSA features (e.g., sleep architecture changes, hypoxemia severity) to the severity of neuropathological, neurodegenerative, and behavioral consequences remains unclear.…”