STUDY OBJECTIVES:Population-based studies have demonstrated associations between sleep-disordered breathing (SDB), hypertension, and cardiovascular disease; few large-scale studies have examined associations of SDB with objective measures of cerebrovascular disease. This study tested the significance of associations of SDB with evidence of brain injury or ischemia determined by cerebral magnetic resonance imaging (MRI) studies. DESIGN:Cross-sectional and longitudinal analyses in a nested sample of Cardiovascular Health Study participants in the Sleep Heart Health Study. PARTICIPANTS:The 843 individuals (mean age 77, SD 4.3 years, 58% women) who had MRI studies as part of the Cardiovascular Health Study before and after polysomnography obtained as part of the Sleep Heart Health Study. MEASUREMENTS:A 12-channel polysomnogram was used to derive indexes of sleep-disordered breathing. Repeated MRI measurements provided indexes of infarct (presence and size) and white matter disease. Logistic regression analyses were used to model MRI changes of infarct-like lesions and white matter disease as a function of age, baseline white matter grade, and indexes of central and obstructive sleep-disordered breathing. RESULTS:Individuals who showed progression in white matter disease compared to those who did not were significantly more likely to show a Cheyne-Stokes respiration pattern and to have an increased number of central but not obstructive apneas. CONCLUSIONS:An association between change in white matter grade and measures of central sleep apnea was demonstrated that was consistent with a causal pathway in which central sleep apnea contributes to the progression of white matter disease; alternatively, central sleep apnea may be a marker of subclinical cerebrovascular or cardiovascular disease.

译文

研究目的:基于人口的研究表明睡眠呼吸障碍(SDB),高血压和心血管疾病之间存在关联。很少有大规模研究检查了SDB与脑血管疾病客观指标的关联。这项研究测试了SDB与通过脑磁共振成像(MRI)研究确定的脑损伤或局部缺血的证据之间的相关性。
设计:在睡眠心脏健康研究中的心血管健康研究参与者的嵌套样本中进行横断面和纵向分析。
参与者:843名个体(平均年龄77岁,标准年龄4.3岁,女性占58%)在多导睡眠监测仪前后进行了MRI研究,作为心血管健康研究的一部分,该研究是睡眠心脏健康研究的一部分。
测量:使用12通道多导睡眠图来得出睡眠呼吸障碍的指标。重复进行MRI测量可提供梗塞(存在和大小)和白质疾病的指数。使用Logistic回归分析来模拟梗塞样病变和白质疾病的MRI变化与年龄,基线白质等级以及中枢性和阻塞性睡眠呼吸障碍指数的关系。
结果:与未出现白质病进展的患者相比,未出现白质病进展的患者更可能显示Cheyne-Stokes呼吸模式,中枢性呼吸暂停但无阻塞性呼吸暂停的次数增加。
结论:白质分级的变化与中枢性睡眠呼吸暂停的措施之间存在关联,这与中枢性睡眠呼吸暂停导致白质疾病进展的因果关系一致;或者,中枢性睡眠呼吸暂停可能是亚临床脑血管或心血管疾病的标志。

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