Associations between the physiological consequences of sleep apnea and cerebral small vessel disease in community dwelling adults
Bibliographic record
Abstract
Obstructive sleep apnea (OSA), a highly prevalent disorder, is increasingly recognized as a significant modifiable risk factor for cerebral small vessel disease (CSVD), a major contributor to cognitive impairment and dementia. Despite growing evidence linking OSA to CSVD, the specific physiological aspects of OSA driving these associations and the potential for therapeutic intervention remain unclear. This doctoral thesis systematically investigates the intricate relationship between OSA endophenotypes and CSVD pathology using multi-modal approaches. The first study, a cross-sectional analysis of 614 community-dwelling adults, utilized home sleep apnea testing to identify latent physiological variables of OSA and advanced quantitative MRI to measure PVS burden. It revealed that a higher "apnea burden factor" (reflecting respiratory event frequency and intermittent hypoxia) was significantly associated with increased basal ganglia perivascular spaces (BG-PVS), a key neuroimaging marker of CSVD, independent of traditionalvascular risk factors. Building on this, the second study examined postmortem brain tissue from 84 older community- dwelling individuals. This unique investigation demonstrated a significant association between the ante-mortem "apnea burden factor" and a higher burden of macroscopic cerebral infarcts at death, providing direct pathological evidence for OSA-related brain injury. Finally, a prospective longitudinal study of 64 adults with moderate-to-severe hypoxic sleep apnea investigated the impact of continuous positive airway pressure (CPAP) therapy. It showed compelling evidence that optimal CPAP adherence stabilized the progression of BG-PVS volumes, whereas suboptimal adherence led to continued PVS expansion. This beneficial effect was most pronounced in individuals with greater baseline OSA severity. Collectively, these findings highlight that distinct physiological consequences of OSA, particularly the frequency and burden of intermittent hypoxic insults, are differentially and robustly associated with various manifestations of CSVD. Crucially, this thesis provides strong evidence that effective OSA treatment can favorably modify the trajectory of CSVD markers. This work refines our understanding of OSA's neurovascular impact and underscores the immense public health potential of targeted OSA management as a strategy to mitigate brain microvascular damage and potentially delay or prevent cognitive decline and dementia.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".