Oktay ALĞIN, Burak AKIN, Evrim ÖZMEN, Gökhan OCAKOĞLU

Fully automated morphological analysis of patients with obstructive sleep apnea

Background/aim: Obstructive sleep apnea syndrome (OSAS) is a disease characterized by episodic hypoxia. We aimed to use the Freesurfer program for global evaluation of morphological changes in OSAS patients. Materials and methods: Three-dimensional T1-weighted images were obtained, and intracranial morphology was assessed in 18 patients with OSAS and 20 controls. Results of the volume and the cortical thickness analyses of both groups were compared statistically. Results: The total cortical, left right hemispheres gray matter (GM), corpus callosum, and total GM volumes were lower in OSAS patients when compared with the control group (P < 0.001). The average cortical thickness was lower in OSAS patients bilaterally in pars orbitalis, paracentral, rostral middle frontal, middle frontal, orbital, and superior frontal gyri when compared with the control group (P < 0.05). Furthermore, the volume and average cortical thickness of multiple anatomic regions, apart from the brain parts mentioned above, were decreased unilaterally (e.g., hippocampus, cingulum, putamen, thalamus) in OSAS patients (P < 0.05). Conclusion: Multiple morphologic changes occur in the cerebral structures of OSAS patients due to intermittent ischemia episodes. Detection of those areas with Freesurfer is easier. New studies with large series would be needed for these subjects.

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1. Chokroverty S. Sleep and its disorders (chapter 72). In: Chokroverty S, editor. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. 3rd ed. Philadelphia, PA, USA: Elsevier/Butterworth; 2009.
2. Morrell MJ, McRobbie DW, Quest RA, Cummin AR, Ghiassi R, Corfield DR. Changes in brain morphology associated with obstructive sleep apnea. Sleep Med 2003; 4: 451454.
3. Macey PM, Henderson LA, Macey KE, Alger JR, Frysinger RC, Woo MA, Harper RK, Yan-Go FL, Harper RM. Brain morphology associated with obstructive sleep apnea. Am J Respir Crit Care Med 2002; 166: 13821387.
4. Torelli F, Moscufo N, Garreffa G, Placidi F, Romigi A, Zannino S, Bozzali M, Fasano F, Giulietti G, Djonlagic I et al. Cognitive profile and brain morphological changes in obstructive sleep apnea. Neuroimage 2011; 54: 787793.
5. Algin O, Gokalp G, Ocakoglu G, Ursavas A, Taskapilioglu O, Hakyemez B. Neurochemicalstructural changes evaluation of brain in patients with obstructive sleep apnea syndrome. Eur J Radiol 2012; 81: 491495.
6. ODonoghue FJ, Briellmann RS, Rochford PD, Abbott DF, Pell GS, Chan CH, Tarquinio N, Jackson GD, Pierce RJ. Cerebral structural changes in severe obstructive sleep apnea. Am J Respir Crit Care Med 2005; 171: 11851190.
7. Davies CW, Crosby JH, Mullins RL, Traill ZC, Anslow P, Davies RJ, Stradling JR. Case control study of cerebrovascular damage defined by magnetic resonance imaging in patients with OSA and normal age-matched control subjects. Sleep 2001; 24: 715 720.
8. Fjell AM, Westlye LT, Greve DN, Fischl B, Benner T, van der Kouwe AJW, Salat D, Bjørnerud A, Due-Tønnessen P, Walhovd KB. The relationship between diffusion tensor imaging and volumetry as measures of white matter properties. Neuroimage 2008; 42: 16541668.
9. Wright J, Sheldon TA, Watt I. Sleep apnea. Lancet 1999; 354: 600.
10. Fischl B, Dale AM. Measuring the thickness of human cerebral cortex from magnetic resonance images. Proc Natl Acad Sci USA 2000; 275: 3086430872.
11. Alchanatis M, Deligiorgis N, Zias N, Amfilochiou A, Gotsis E, Karakatsani A, Papadimitriou A. Frontal brain lobe impairment in obstructive sleep apnea: a proton MR spectroscopy study. Eur Respir J 2004; 24: 980986.
12. Collins DL, Neelin P, Peters TM, Evans AC. Automatic 3D intersubject registration of MR volumetric data in standardized Talairach space. J Comput Assist Tomogr 1994; 18: 192205.
13. Dale AM, Fischl B, Sereno MI. cortical surface-based analysis. I. Segmentation and surface reconstruction. Neuroimage 1999; 9: 179194.
14. Fischl B, Salat DH, Busa E, Albert M, Dieterich M, Hasalgrove C, van der Kouwe A, Killiany R, Kennedy D, Klaveness S et al. Whole brain segmentation: automated labeling of neuroanatomical structures in the human brain. Neuron 2002; 33: 341355.
15. Destrieux C, Fischl B, Dale A, Halgren E. Automatic parcellation of human cortical gyri and sulci using standard anatomical nomenclature. Neuroimage 2010; 53: 115.
16. Desseilles M, Dang-Vu T, Schabus M, Sterpenich V, Maquet P, Schwartz S. Neuroimaging insights into the pathophysiology of sleep disorders. Sleep 2008; 31: 777794.
17. Engleman H, Joffe D. Neuropsychological function in obstructive sleep apnea. Sleep Medicine Reviews 1999; 3: 5978.
18. Zimmerman ME, Aloia MS. A review of neuroimaging in obstructive sleep apnea. J Clin Sleep Med 2006; 130: 17721778.
19. Desikan RS, Segonne F, Fischl B, Quinn BT, Dickerson BC, Blacker D, Buckner RL, Dale AM, Maguire RP, Hyman BT et al. An automated labeling system for subdividing the human cerebral cortex on MRI scans into gyral based regions of interest. Neuroimage 2006; 31: 968980.
20. Kamba M, Suto Y, Ohta Y, Inoue Y, Matsuda E. Cerebral metabolism in sleep apnea: evaluation by magnetic resonance spectroscopy. Am J Respir Crit Care Med 1997; 156: 296298.
21. Giuletti G, Torelli F, Bozzali M, Garreffa G, Muscofo N, Zannino S, Serra L, Placidi F, Fasano F, Hagberg G et al. Brain structural changes underlying cognitive disabilities in patients with obstructive sleep apnea syndrome (OSAS): a VBM study. Proc ISMRM 18, 2010: 2417.
22. Kızılgöz V, Aydın A, Tatar IG, Hekimoğlu B, Ardıç S, Fırat H, Dönmez C. Proton magnetic resonance spectroscopy of periventricular white matter and hippocampus in obstructive sleep apnea patients. Pol J Radiol 2013; 78: 714.
23. Sarma MK, Nagarajan R, Macey PM, Kumar R, Villablanca JP, Furuyama J, Thomas MA. Accelerated echo-planar J-resolved spectroscopic imaging in the human brain using compressed sensing: a pilot validation in obstructive sleep apnea. AJNR Am J Neuroradiol 2014; 35: S81S89.
24. Weng HH, Tsai YH, Chen CF, Lin YC, Yang CT, Tsai YH, Yang CY. Mapping gray matter reductions in obstructive sleep apnea: an activation likelihood estimation meta-analysis. Sleep 2014; 37: 167175.
25. Leech R, Sharp DJ. The role of the posterior cingulate in cognition and disease. Brain 2014; 137: 1232.
26. Innes CR, Kelly PT, Hlavac M, Melzer TR, Jones RD. Decreased regional cerebral perfusion in moderatesevere obstructive sleep apnoea during wakefulness. Sleep 2015; 38: 699706.