1. CHANGES IN BRAIN MORPHOLOGY ASSOCIATED WITH OBSTRUCTIVE SLEEP APNEA Mary J. Morrell et al. 2003 Presented by Karen Hu PSYCH 260

2. WHAT IS OBSTRUCTIVE SLEEP APNEA ?

3. INTRODUCTION. Obstructive Sleep Apnea (OSA) : Caused by upper airway dysfunction during sleep - repeated arousals/ awakening - periodic breathing Breathing stops for ≥ 10 seconds - episodic hypoxemia Periods of significant decrease in O2 saturation in the blood

4. INTRODUCTION. Obstructive Sleep Apnea (OSA) affects: 1-4% of middle aged adults 24- 30% of elderly SYMPTOMS Excessive daytime sleepiness and fatigue Loud snoring Increased risk of hypertension and cardiovascular diseases Cognitive deficits NO!

5. INTRODUCTION. Cognitive Deficits by OSA : OSA patients have shown impairment in memory, learning and attention HIPPOCAMPUS: region closely associated with neural processing of memory - sensitive to hypoxic (low O2) conditions

6. CURRENT STUDY Investigates the effects of OSA on the morphology or structural changes of the brain Focusing on the CA1 region of HIPPOCAMPUS and other cortical regions HYPOTHESIS: There would be a focal loss of grey matter within the hippocampus and other cortical areas linked with memory function

7. METHODS MRI scan Newly OSA diagnosed patients selected from sleep clinic 7 OSA patients and 7 non-apneic controls –Age range= 28-65 yrs old All male and right handed

8. METHODS Voxel based morphometry (VBM) Images were normalized and compared to a standardized brain template Signal intensity represented grey matter concentration Images were compared to determine any significance

9. RESULTS Control vs. OSA Significantly lower grey matter concentration in the OSA patients in the LEFT HIPPOCAMPUS by 6%

10. RESULTS NO SIGNIFICANT DIFFERENCE in focal grey matter concentration in the RIGHT HIPPOCAMPUS and other cortical regions

11. DISCUSSION Reduction of grey matter in left hippocampus: –Hippocampal sensitivity to low O2 conditions cause neurons to die off Absence of grey matter difference in the right hippocampus –Due to relatively moderate hypoxemia in the OSA patients Repetitive hypoxia reduces neuron excitability in the CA1 region –Similar effects of sleep deprivation Findings emphasize that grey matter loss is associated with less severe OSA

12. LIMITATIONS Small sample size –Limited validity of results and implications Obese patients were excluded Only male subjects used Could not relate grey matter loss directly to cognitive deficits or specific characteristics of OSA

13. FUTURE IMPLICATIONS - relate severity of OSA to grey matter loss - larger sample size, include females - explore how sleep fragmentation affects brain structure - correlate grey matter loss with cognitive deficits

14. PERSONAL THOUGHTS -Short and simplified -Well organized -Easy to understand -Addressed just the changes in morphology -At times, lacked detail -Discussion and intro was weak -Lacked a strong possible implication -Did not specify which cortical areas they were comparing

15. FINAL EXAM SWAG. Obstructive Sleep Apnea ( OSA) : - repeated arousal, periodic breathing, episodic hypoxemia, fragmented sleep - leads to damage in cortical areas associated with memory and learning, cognitive deficits and excessive daytime sleepiness Methods - Voxel based, MRI, 7 OSA patients, 7 controls, all right-handed males Results - significantly lower grey matter in left hippocampus in OSA group - no significant grey matter differences in right hippocampus or other cortical areas - no significant difference in total volume of grey matter Discussion - low O2 levels may have resulted in grey matter loss in left hippocampus - no significance in right hippocampus due to moderate OSA severity - repetitive hypoxia reduces neuron excitability in CA1 of hippocampus

16. REFERENCE Morrell, M.J., McRobbie, D.W., Quest, R.A., Cummin, A.R.C., Ghiassi, R. and Corfield, D. 2003. Changes in brain morphology associated with obstructive sleep apnea. Sleep Medicine, 4, 451-454.

17. QUESTIONS?