Table_1_The complex interplay of hypoxia and sleep disturbance in gray matter structure alterations in obstructive sleep apnea patients.DOCX

BackgroundObstructive Sleep Apnea (OSA) characteristically leads to nocturnal hypoxia and sleep disturbance. Despite clear evidence of OSA-induced cognitive impairments, the literature offers no consensus on the relationship between these pathophysiological processes and brain structure alterations in patients.
ObjectiveThis study leverages the robust technique of structural equation modeling to investigate how hypoxia and sleep disturbance exert differential effects on gray matter structures.
MethodsSeventy-four Male participants were recruited to undergo overnight polysomnography and T1-weighted Magnetic Resonance Imaging. Four structural outcome parameters were extracted, namely, gray matter volume, cortical thickness, sulcal depth, and fractal dimension. Structural equation models were constructed with two latent variables (hypoxia, and sleep disturbance) and three covariates (age, body mass index, and education) to examine the association between gray matter structural changes in OSA and the two latent variables, hypoxia and sleep disturbance.
ResultsThe structural equation models revealed hypoxia-associated changes in diverse regions, most significantly in increased gray matter volume, cortical thickness and sulcal depth. In contrast, sleep disturbance. Was shown to be largely associated with reduce gray matter volume and sulcal depth.
ConclusionThis study provides new evidence showing significant effects of OSA-induced hypoxia and sleep disturbance on gray matter volume and morphology in male patients with obstructive sleep apnea. It also demonstrates the utility of robust structural equation models in examining obstructive sleep apnea pathophysiology.

阻塞性睡眠呼吸暂停（Obstructive Sleep Apnea, OSA）特征性地引发夜间低氧血症与睡眠紊乱。尽管已有明确证据表明OSA可导致认知功能受损，但现有文献尚未就该病理生理过程与患者脑结构改变之间的关联达成共识。
本研究借助稳健的结构方程模型（structural equation modeling）技术，探究低氧血症与睡眠紊乱对脑灰质结构产生的差异化影响。
本研究招募74名男性参与者，令其接受夜间多导睡眠监测与T1加权磁共振成像（T1-weighted Magnetic Resonance Imaging）扫描。共提取四项结构结局参数，即灰质体积（gray matter volume）、皮层厚度（cortical thickness）、脑沟深度（sulcal depth）与分形维数（fractal dimension）。构建以低氧血症、睡眠紊乱为两个潜变量，年龄、体质量指数、受教育程度为三项协变量的结构方程模型，以考察OSA患者脑灰质结构改变与这两个潜变量之间的关联。
结构方程模型结果显示，低氧血症相关的脑区改变涉及多个区域，其中以灰质体积升高、皮层厚度增加与脑沟加深最为显著。与之相反，睡眠紊乱则主要与灰质体积降低及脑沟变浅相关。
本研究为OSA男性患者中，OSA诱导的低氧血症与睡眠紊乱对脑灰质体积及形态学特征产生显著影响提供了新证据。同时，本研究也证实了稳健的结构方程模型在探究OSA病理生理机制中的应用价值。