Proton magnetic resonance spectroscopy study of brain metabolism in obstructive sleep apnoea syndrome before and after continuous positive airway pressure treatment

Caterina Tonon, Roberto Vetrugno, Raffaele Lodi, Roberto Gallassi, Federica Provini, Stefano Iotti, Giuseppe Plazzi, Pasquale Montagna, Elio Lugaresi, Bruno Barbiroli

Research output: Contribution to journalArticle

Abstract

Study Objectives: Obstructive sleep apnoea syndrome (OSAS) causes sleep related oxygen desaturation, excessive daytime sleepiness (EDS), and cognitive impairment. The role of hypoxic brain damage, sleep fragmentation, and the associated comorbidities (hypertension, vascular disorders) in the pathogenesis of cognitive deficits remains controversial. The aim of this study was to evaluate the cerebral metabolism of OSAS patients in vivo before and after CPAP treatment. Design and Patients: Fourteen OSAS patients without cardiovascular or cerebrovascular impairment underwent the same protocol before and after 6 months of CPAP including: overnight videopolysomnography (VPSG), Multiple Sleep Latency Test (MSLT), and within the next 2 days neuropsychological and 1H-MRS evaluations. Single voxel 1H-MRS was performed in the parietal-occipital cortex, and absolute concentrations of N-acetyl-aspartate (NAA), creatine, and choline were measured, acquiring spectra at multiple echo-times and using water as internal standard. Ten matched controls were also studied. Results: OSAS patients had a mean RDI of 58/hr, a mean arousal index of 57/hr, and a mean nadir SpO2 of 71%. Before CPAP, all patients showed a normal global cognitive functioning, with only a small number of pathological tasks in working memory and attention tests in a minority of patients. CPAP therapy was effective in resolving sleep apnoea and normalizing sleep structure, and improving EDS and neuropsychological alterations. Before CPAP treatment cortical [NAA] in OSAS (11.86 mM±0.80, mean±SD) was significantly lower than in controls (12.85±0.93; P = 0.01) and positively correlated with minimum SpO2 during sleep (r = 0.69; P = 0.006) and MSLT scores (r = 0.62; P = 0.01). Cortical [NAA] reduction persisted after therapy (11.94±1.33; P = 0.87 versus pre-CPAP). Conclusions: OSAS patients have cortical metabolic changes consistent with neuronal loss even in the absence of vascular comorbidities. Metabolic changes persisted after CPAP in the absence of EDS, nocturnal arousals, and major cognitive deficits, likely related to hypoxic damage prior to CPAP treatment.

Original languageEnglish
Pages (from-to)305-311
Number of pages7
JournalSleep
Volume30
Issue number3
Publication statusPublished - Mar 1 2007

Fingerprint

Continuous Positive Airway Pressure
Obstructive Sleep Apnea
Sleep
Brain
Arousal
Therapeutics
Blood Vessels
Comorbidity
Brain Hypoxia
Occipital Lobe
Parietal Lobe
Sleep Deprivation
Creatine
Sleep Apnea Syndromes
Choline
Proton Magnetic Resonance Spectroscopy
Short-Term Memory
Oxygen
Hypertension
Water

Keywords

  • Chronic hypoxia
  • Follow-up
  • N-acetyl-aspartate
  • Nasal continuous positive airway pressure
  • Obstructive sleep apnoea syndrome
  • Polysomnography
  • Proton magnetic resonance spectroscopy

ASJC Scopus subject areas

  • Physiology

Cite this

Proton magnetic resonance spectroscopy study of brain metabolism in obstructive sleep apnoea syndrome before and after continuous positive airway pressure treatment. / Tonon, Caterina; Vetrugno, Roberto; Lodi, Raffaele; Gallassi, Roberto; Provini, Federica; Iotti, Stefano; Plazzi, Giuseppe; Montagna, Pasquale; Lugaresi, Elio; Barbiroli, Bruno.

In: Sleep, Vol. 30, No. 3, 01.03.2007, p. 305-311.

Research output: Contribution to journalArticle

Tonon, C, Vetrugno, R, Lodi, R, Gallassi, R, Provini, F, Iotti, S, Plazzi, G, Montagna, P, Lugaresi, E & Barbiroli, B 2007, 'Proton magnetic resonance spectroscopy study of brain metabolism in obstructive sleep apnoea syndrome before and after continuous positive airway pressure treatment', Sleep, vol. 30, no. 3, pp. 305-311.
Tonon, Caterina ; Vetrugno, Roberto ; Lodi, Raffaele ; Gallassi, Roberto ; Provini, Federica ; Iotti, Stefano ; Plazzi, Giuseppe ; Montagna, Pasquale ; Lugaresi, Elio ; Barbiroli, Bruno. / Proton magnetic resonance spectroscopy study of brain metabolism in obstructive sleep apnoea syndrome before and after continuous positive airway pressure treatment. In: Sleep. 2007 ; Vol. 30, No. 3. pp. 305-311.
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abstract = "Study Objectives: Obstructive sleep apnoea syndrome (OSAS) causes sleep related oxygen desaturation, excessive daytime sleepiness (EDS), and cognitive impairment. The role of hypoxic brain damage, sleep fragmentation, and the associated comorbidities (hypertension, vascular disorders) in the pathogenesis of cognitive deficits remains controversial. The aim of this study was to evaluate the cerebral metabolism of OSAS patients in vivo before and after CPAP treatment. Design and Patients: Fourteen OSAS patients without cardiovascular or cerebrovascular impairment underwent the same protocol before and after 6 months of CPAP including: overnight videopolysomnography (VPSG), Multiple Sleep Latency Test (MSLT), and within the next 2 days neuropsychological and 1H-MRS evaluations. Single voxel 1H-MRS was performed in the parietal-occipital cortex, and absolute concentrations of N-acetyl-aspartate (NAA), creatine, and choline were measured, acquiring spectra at multiple echo-times and using water as internal standard. Ten matched controls were also studied. Results: OSAS patients had a mean RDI of 58/hr, a mean arousal index of 57/hr, and a mean nadir SpO2 of 71{\%}. Before CPAP, all patients showed a normal global cognitive functioning, with only a small number of pathological tasks in working memory and attention tests in a minority of patients. CPAP therapy was effective in resolving sleep apnoea and normalizing sleep structure, and improving EDS and neuropsychological alterations. Before CPAP treatment cortical [NAA] in OSAS (11.86 mM±0.80, mean±SD) was significantly lower than in controls (12.85±0.93; P = 0.01) and positively correlated with minimum SpO2 during sleep (r = 0.69; P = 0.006) and MSLT scores (r = 0.62; P = 0.01). Cortical [NAA] reduction persisted after therapy (11.94±1.33; P = 0.87 versus pre-CPAP). Conclusions: OSAS patients have cortical metabolic changes consistent with neuronal loss even in the absence of vascular comorbidities. Metabolic changes persisted after CPAP in the absence of EDS, nocturnal arousals, and major cognitive deficits, likely related to hypoxic damage prior to CPAP treatment.",
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AU - Tonon, Caterina

AU - Vetrugno, Roberto

AU - Lodi, Raffaele

AU - Gallassi, Roberto

AU - Provini, Federica

AU - Iotti, Stefano

AU - Plazzi, Giuseppe

AU - Montagna, Pasquale

AU - Lugaresi, Elio

AU - Barbiroli, Bruno

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N2 - Study Objectives: Obstructive sleep apnoea syndrome (OSAS) causes sleep related oxygen desaturation, excessive daytime sleepiness (EDS), and cognitive impairment. The role of hypoxic brain damage, sleep fragmentation, and the associated comorbidities (hypertension, vascular disorders) in the pathogenesis of cognitive deficits remains controversial. The aim of this study was to evaluate the cerebral metabolism of OSAS patients in vivo before and after CPAP treatment. Design and Patients: Fourteen OSAS patients without cardiovascular or cerebrovascular impairment underwent the same protocol before and after 6 months of CPAP including: overnight videopolysomnography (VPSG), Multiple Sleep Latency Test (MSLT), and within the next 2 days neuropsychological and 1H-MRS evaluations. Single voxel 1H-MRS was performed in the parietal-occipital cortex, and absolute concentrations of N-acetyl-aspartate (NAA), creatine, and choline were measured, acquiring spectra at multiple echo-times and using water as internal standard. Ten matched controls were also studied. Results: OSAS patients had a mean RDI of 58/hr, a mean arousal index of 57/hr, and a mean nadir SpO2 of 71%. Before CPAP, all patients showed a normal global cognitive functioning, with only a small number of pathological tasks in working memory and attention tests in a minority of patients. CPAP therapy was effective in resolving sleep apnoea and normalizing sleep structure, and improving EDS and neuropsychological alterations. Before CPAP treatment cortical [NAA] in OSAS (11.86 mM±0.80, mean±SD) was significantly lower than in controls (12.85±0.93; P = 0.01) and positively correlated with minimum SpO2 during sleep (r = 0.69; P = 0.006) and MSLT scores (r = 0.62; P = 0.01). Cortical [NAA] reduction persisted after therapy (11.94±1.33; P = 0.87 versus pre-CPAP). Conclusions: OSAS patients have cortical metabolic changes consistent with neuronal loss even in the absence of vascular comorbidities. Metabolic changes persisted after CPAP in the absence of EDS, nocturnal arousals, and major cognitive deficits, likely related to hypoxic damage prior to CPAP treatment.

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