title: Moderate-to-severe obstructive sleep apnea is associated with cerebral small vessel disease.
abstract: Cerebral small vessel disease (SVD) is associated with increased risk of cerebral infarction and hemorrhage. Obstructive sleep apnea (OSA) is known to increase the risk of cerebrovascular disease. This study aimed to investigate the association between cerebral SVD and severity of OSA.
  
  
  
  A total of 170 patients were included from the patient registry at the present Sleep Center; these patients underwent both magnetic resonance imaging (MRI) of the brain and polysomnography (PSG) for suspected OSA. The presence and burden of white matter hyperintensities (WMHs), asymptomatic lacunar infarctions (ALIs), cerebral microbleeds (CMBs), and perivascular spaces (PVSs) were determined by MRI, and their relationships with the apnea-hypopnea index (AHI), as determined by PSG, were investigated.
  
  
  
  Among the 170 patients, 25 (14.7%) had high-grade WMHs, 21 (12.4%) had ALIs, 21 (12.4%) had CMBs, and 34 (20.0%) had high-grade PVSs. In the multivariable analysis, after adjusting for factors including age, sex, and other variables for which p <0.1 in univariable analysis (hypertension, diabetes mellitus, previous stroke, minimal SaO2and arousal index), moderate-to-severe OSA was associated with high-grade WMHs (odds ratio [OR] 4.72; 95% confidence interval [CI] 1.14-19.47), CMBs (OR 3.47; 95% CI 0.89-15.18), or high-grade PVSs (OR 3.64; 95% CI 1.02-13.01), but not with ALIs. The total SVD score was independently associated with increased AHI (p = 0.017), particularly in patients with moderate-to-severe OSA (β [standard error] = 0.448 (0.204), p = 0.030].
  
  
  
  Moderate-to-severe OSA is positively associated with multiple indicators of cerebral SVD, including WMHs, CMBs, and PVSs.
authors.affiliation: Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Song
authors.affiliation: Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Ewha Medical Research Institute, Seoul, Republic of Korea.
authors.forename: Kang Hyun
authors.initials: KH
authors.lastname: Choi
authors.affiliation: Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yoonkyung
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Ewha Medical Research Institute, Seoul, Republic of Korea.
authors.forename: Jangsup
authors.initials: J
authors.lastname: Moon
authors.affiliation: Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Ewha Medical Research Institute, Seoul, Republic of Korea.
authors.forename: Ju-Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Ewha Medical Research Institute, Seoul, Republic of Korea.
authors.forename: Yunseo
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yong-Jae
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Department of Medical Science, Ewha Womans University School of Medicine, Seoul, Republic of Korea; Ewha Medical Research Institute, Seoul, Republic of Korea. Electronic address: leeh@ewha.ac.kr.
authors.forename: Hyang Woon
authors.initials: HW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D059345:Cerebral Small Vessel Diseases / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020181:Sleep Apnea, Obstructive / Q000150:complications*
keywords: Apnea–hypopnea index; Obstructive sleep apnea; Small vessel disease