Cerebrovascular reactivity in young subjects with sleep apnea

John Buterbaugh, Charles Wynstra, Natalie Provencio, Daniel Combs, Michael Gilbert, Sairam Parthasarathy

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Study Objectives: Regional brain alterations may be involved in the pathogenesis and adverse consequences of obstructive sleep apnea (OSA). The objectives for the current study were to (1) determine cerebrovascular reactivity in the motor areas that control upper airway musculature in patients with OSA, and (2) determine whether young patients with OSA have decreased cerebrovascular reactivity in response to breath holding. Design: Case-control study. Setting: Academic center. Participants: Twelve subjects with OSA (age 24-42 y; apnea-hypopnea index 17; interquartile range [IQR] 9, 69 per hour) and control subjects (n = 10; age 29-44 y; AHI 2; IQR 1, 3 per hour). Measurements and Results: Subjects underwent blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) while awake, swallowing, and breath holding. In subjects with OSA, during swallowing, there was less activity in the brainstem than in controls (P = 0.03) that remained reduced after adjusting for cortical motor strip activity (P = 0.036). In OSA subjects, brain regions of increased cerebrovascular reactivity (38; IQR 17, 96 cm3) was smaller than that in controls (199; IQR 5, 423 cm3; P = 0.01). In OSA subjects, brain regions of decreased cerebrovascular reactivity during breath hold was greater (P = 0.01), and the ratio of increased-to-decreased brain regions was lower than that of controls (P = 0.006). Adjustment for cerebral volumes, body mass index, and white matter lesions did not change these results substantively. Conclusions: In patients with obstructive sleep apnea (OSA), diminished change in brainstem activity during swallowing and reduced cerebrovascular reactivity may contribute to the etiopathogenesis and adverse cerebrovascular consequences, respectively. We speculate that decreased cerebral auto-regulation may be causative of gray matter loss in OSA.

Original languageEnglish (US)
Pages (from-to)241-250
Number of pages10
JournalSleep
Volume38
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Sleep Apnea Syndromes
Obstructive Sleep Apnea
Deglutition
Breath Holding
Motor Cortex
Brain
Brain Stem
Airway Management
Apnea
Case-Control Studies
Motor Activity
Body Mass Index
Magnetic Resonance Imaging
Oxygen

Keywords

  • Cerebral autoregulation
  • Functional magnetic resonance imaging
  • Obstructive sleep apnea
  • Sleep apnea
  • Stroke

ASJC Scopus subject areas

  • Physiology (medical)
  • Clinical Neurology

Cite this

Buterbaugh, J., Wynstra, C., Provencio, N., Combs, D., Gilbert, M., & Parthasarathy, S. (2015). Cerebrovascular reactivity in young subjects with sleep apnea. Sleep, 38(2), 241-250. https://doi.org/10.5665/sleep.4406

Cerebrovascular reactivity in young subjects with sleep apnea. / Buterbaugh, John; Wynstra, Charles; Provencio, Natalie; Combs, Daniel; Gilbert, Michael; Parthasarathy, Sairam.

In: Sleep, Vol. 38, No. 2, 01.02.2015, p. 241-250.

Research output: Contribution to journalArticle

Buterbaugh, J, Wynstra, C, Provencio, N, Combs, D, Gilbert, M & Parthasarathy, S 2015, 'Cerebrovascular reactivity in young subjects with sleep apnea', Sleep, vol. 38, no. 2, pp. 241-250. https://doi.org/10.5665/sleep.4406
Buterbaugh J, Wynstra C, Provencio N, Combs D, Gilbert M, Parthasarathy S. Cerebrovascular reactivity in young subjects with sleep apnea. Sleep. 2015 Feb 1;38(2):241-250. https://doi.org/10.5665/sleep.4406
Buterbaugh, John ; Wynstra, Charles ; Provencio, Natalie ; Combs, Daniel ; Gilbert, Michael ; Parthasarathy, Sairam. / Cerebrovascular reactivity in young subjects with sleep apnea. In: Sleep. 2015 ; Vol. 38, No. 2. pp. 241-250.
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abstract = "Study Objectives: Regional brain alterations may be involved in the pathogenesis and adverse consequences of obstructive sleep apnea (OSA). The objectives for the current study were to (1) determine cerebrovascular reactivity in the motor areas that control upper airway musculature in patients with OSA, and (2) determine whether young patients with OSA have decreased cerebrovascular reactivity in response to breath holding. Design: Case-control study. Setting: Academic center. Participants: Twelve subjects with OSA (age 24-42 y; apnea-hypopnea index 17; interquartile range [IQR] 9, 69 per hour) and control subjects (n = 10; age 29-44 y; AHI 2; IQR 1, 3 per hour). Measurements and Results: Subjects underwent blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) while awake, swallowing, and breath holding. In subjects with OSA, during swallowing, there was less activity in the brainstem than in controls (P = 0.03) that remained reduced after adjusting for cortical motor strip activity (P = 0.036). In OSA subjects, brain regions of increased cerebrovascular reactivity (38; IQR 17, 96 cm3) was smaller than that in controls (199; IQR 5, 423 cm3; P = 0.01). In OSA subjects, brain regions of decreased cerebrovascular reactivity during breath hold was greater (P = 0.01), and the ratio of increased-to-decreased brain regions was lower than that of controls (P = 0.006). Adjustment for cerebral volumes, body mass index, and white matter lesions did not change these results substantively. Conclusions: In patients with obstructive sleep apnea (OSA), diminished change in brainstem activity during swallowing and reduced cerebrovascular reactivity may contribute to the etiopathogenesis and adverse cerebrovascular consequences, respectively. We speculate that decreased cerebral auto-regulation may be causative of gray matter loss in OSA.",
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