The Study On The Association Of White Matter Lesions And Obstructive Sleep Apnea Hypopnea Syndrome

[Background and objective]Cerebral white matter lesions(white matter,lesions,WMLs)also called leukoaraiosis(leukoaraiosis,LA)and white matter hyperintensities(white matter hyperintensity,WMH),refered to the periventricular white matter,Centrum semiovale or subcortical areas of punctate or patchy changes in diffuse white matter abnormalities.Which showed high signal in low density of brain computed tomography(CT),T2 weighted magnetic resonance imaging(MRI)and fluid attenuated inversion recovery(FLAIR)sequence。WMLs was mainly divided into 2 types according to the lesion location,one was periventricular white matter lesions(periventricular white matter lesions,PVWMLs),the other was deep/subcortical white matter lesions(deep/subcortical white,matter lesions,DWMLs).Obstructive sleep apnea syndrome(obstructive sleep apnea hypopnea syndrome(OSAHS)was a common sleep disorder,its main characteristic was complete or partial obstruction of upper airway repeatedly in the process of sleep at night,leading to apnea and hypopnea which produced repeated intermittent hypoxia,carbon dioxide retention and repeated intrapleural pressure increase.Repeated awakening and abnormal sleep structure would lead to daytime sleepiness,memory decline,reduced efficiency,and autonomic dysfunction.[Methods]All cases were from the department of Neurology,the Second Hospital of Kunming Medical University.91 cases of hospitalized patients from March,2015 to July,2016 were collected,and 30 cases obstructive were sleep apnea hypopnea syndrome with cerebral white matter lesions(WML with OSAHS group).Among them,according to the degree of white matter lesions were divided into:mild group of 21 people,moderate group of 15 people,25 people in the severe group;30 cases were obstructive sleep apnea hypopnea syndrome without cerebral white matter lesions(WML without OSAHS group).Among them,according to the degree of white matter lesions were divided into:mild group of 14 people,moderate group of 12 people,4 people in the severe group,To Record general condition of the patients,including gender,age,height,weight,hypertension/diabetes/hyperlipemia history,smoking/drinking history and years of education,All selected patients were collected venous blood in the next morning,to determinate ambulatory blood pressure monitoring and serum triglyceride,cholesterol,low density lipoprotein and high density lipoproteins.All selected patients performed conventional cranial MRI(T1-weighted images,T2-weighted images and fluid-attenuated inversion recovery sequences and diffusion-weighted Imaging)as well as the polysomnography/ambulatory blood pressure monitoring.All selected patients were required to carry out and complete white matter hyperintensity standard for evaluation and the to ambulatory blood pressure monitoring the function of and record the score.(1)all patients underwent cranial MRI examination,T1,T2 weighted images,T2-FLAIR and DWI to detect the patients with brain white matter lesions.(2)all the study subjects were received multiple polysomnography(PSG)monitoring for7 hours to detect patients with obstructive sleep apnea syndrome.(3).All subjects were tested for 24 hours ambulatory blood pressure.Recording time from 9:00 to 9:00 the next day,once every 30min record.Using statistical software SPSS 20.0 compared two groups(WML with OSAHA,group.and WML without OSAHA group)of areas of ambulatory blood pressure monitoring function score and the difference,and analyzed the correlation with Metabolic syndrome.[Results]By Comparative analysis of patients of WML with OSAHS group)and WHL without obstructive sleep apnea syndrome groups generally have statistic difference in age,hypertension,TC,TG,LDL-C,NONHDL,aPoB and Hcy(P<0.05),and the former was higher than the latter in age,AHI,TC,TG,the lowest SP02 index,LDL-C,NONHDL,aPoB and Hcy.Furthermore,they had significant difference(P<0.01)especially in age,AHI,SPO2,TG,the lowest index of hypertension,TC,LDL-C and NONHDL.Beyond that,the degree of cerebral white matter lesions and OSAHS apnea hypopnea index and the degree of hypoxia,all day long average systolic blood pressure,nighttime systolic blood pressure was positively correlated;Furthermore,the white matter lesions in the patients with obstructive sleep syndrome()were significantly higher than that in the white matter lesions and the difference in the circadian rhythm of blood pressure(p=0.034<0.05).1.OSAHS in patients with blood pressure variability increased significantly,especially in the nocturnal blood pressure variation.Moreover,they were prone to occur morning blood pressure surge phenomenon and showed reversed-dipper blood pressure curve.Lead to aggravate cerebral white matter lesion.2.no increase with blood pressure in patients without OSAHS.3.OSAHS in patients with the higher the degree of blood pressure classification and target organ damage,the more serious brain white matter lesions.[Conclusion]1.OSAHS and cerebral white matter lesions were correlated.2.OSAHS with cerebral white matter lesions in patients with blood pressure variability increased significantly,especially in the nocturnal blood pressure variation,and were prone to occur morning blood pressure surge phenomenon and showed reversed-dipper blood pressure curve.3.no increase in blood pressure in patients without OSAHS complicated with cerebral white matter lesions.4.OSAHS in the combined cerebral white matter lesion group,the higher the degree of blood pressure and target organ damage,the more severe cerebral white matter lesions.5.the increase of blood pressure,blood pressure variability,circadian rhythm abnormalities and metabolic syndrome were all the factors that lead to the early damage of white matter in the brain.