Association between periventricular white matter hyperintensity and moderate-to-severe patients with sleep apnea syndrome.

Purpose: The association between sleep apnea syndrome (SAS) severity and white matter hyperintensities (WMHs) has been previously described. However, the associated anatomical details of WMHs remain unclear. The WMHs were divided into periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DWMH). PVH is characterized as a non-vascular entity, whereas DWMH is vascular in nature. This study aimed to clarify the association between SAS and the anatomical details of WMHs.

Methods: Patients (n = 237) diagnosed with neurologically asymptomatic SAS (1999-2016) were enrolled. Any symptomatic SAS patients, whose MRI was conducted more than six months prior to SAS diagnosis, or whose data were incomplete were excluded. For patients with multiple MRI scans, the most recent imaging was employed. SAS diagnosis was defined as an apnea-hypopnea index (AHI) ≥ 5. PVH and DWMH were graded from 0 to IV according to severity. Age, sex, medical history, body mass index, AHI, estimated duration of SAS, and MRI findings were collected. Factors associated with PVH and DWMH grade ≥ I were analyzed.

Results: PVH grade ≥ I was associated with the estimated duration of SAS (odds ratio, 1.01; 95% confidence interval, 1.00-1.02), DWMH grade ≥ I (102.04; 21.40-486.49), hypertension (4.05; 1.53-10.74), and cerebral atrophy (17.47; 1.36-225.28). Age (1.07; 1.03-1.12) and PVH grade ≥ I (88.73; 19.07-412.86) were significantly associated with DWMH grade ≥ I.

Conclusion: This study confirmed that PVH rather than DWMH is associated with SAS. This study may contribute to research on the mechanism of WMHs caused by SAS.