Einfluss der obstruktiven Schlafapnoe auf strukturelle Hirnanomalien und Kognition – Erkenntnisse aus der Hamburg-City-Health-Study (HCHS)

Introduction: Obstructive sleep apnea (OSA) is known to increase the risk of cognitive disorders. There is evidence for OSA to be a risk factor for developing dementia. The HCHS aims to examine 45,000 people from the Hamburg metropolitan area between the ages of 45 and 74. The aim of this study was to identify associations between OSA and structural brain anomalies, specifically vascular brain injury assessed by magnetic resonance imaging (MRI) and cognitive performance.

Material and Methods: Subjects with striking questionnaire items (combination of ESS > 10/24, STOP-BANG > 3 x 'yes", present snoring, and history of nighttime breathing pauses) were compared with 350 control subjects using the matched pair technique. Imaging markers of cerebral structure integrity were evaluated by MRI. Cognitive test results were included and the groups were compared. Additionally, a cohort of 139 subjects was investigated in terms of association between pAHI (WatchPAT 200) and PSMD.

Results: Significant reductions in gray matter volume and brain volume were seen in the suspected OSA group (1218.75 ± 118.73 mL vs. 1236.35 ± 122.80 mL (p = 0.019). In addition, subjects in the OSA group showed significantly worse results in the animal naming test (23.77 ± 6.83 vs. 25.25 ± 6.61 (p = 0.009). We detected a linear trend of increased PSMD (higher cerebral small vessel disease) and higher pAHI (p=0.31). Linear regression analysis revealed that the percentage of time spent in deep sleep was significantly associated with PSMD.

Discussion: The results presented provide strong evidence of the effects of sleep disorders on structural changes in the central nervous system and subsequent cognitive impairments. We were able to show that a reduced proportion of deep sleep is associated with PSMD.

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