MR spectroscopy features of brain in patients with mild and severe obstructive sleep apnea syndrome

Published:September 03, 2013DOI:



      We investigated whether there are differences in metabolite ratios of different brain regions between mild and severe obstructive sleep apnea (OSA) patients.

      Materials and methods

      A total of 17 mild OSA and 14 severe OSA patients were enrolled. N-acetyl aspartate (NAA)/creatine (Cr), choline (Cho)/Cr and NAA/Cho ratios were calculated by using multivoxel magnetic resonance spectroscopy (MRS) (TR: 1500, TE: 135 ms) from hippocampus, putamen, insular cortex, thalamus and temporal white matter. The relationship between the two groups was evaluated with Mann–Whitney U test.


      NAA/Cr ratios obtained from hippocampus was found to be significantly increased in severe OSA patients compared to mild OSA patients (P=.004). Cho/Cr ratios obtained from hippocampus and putamen in severe OSA patients were significantly increased when compared to mild OSA patients (P=.003 and P=.004, respectively). In addition, NAA/Cho ratios of putamen were significantly decreased in severe OSA patients when compared to mild OSA (P=.032).


      MRS identified hypoxia-related metabolite and microstructural changes in hippocampus and putamen. The metabolite changes of increase in NAA/Cr and Cho/Cr ratios and decrease in NAA/Cho ratio were more pronounced with increasing severity of OSA syndrome.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Young T
        • Palta M
        • Dempsey J
        • et al.
        The occurrence of sleep disordered breathing among middle aged adults.
        N Engl J Med. 1993; 328: 1230-1235
        • Lim DC
        • Veasey SC
        Neural injury in sleep apnea.
        Curr Neurol Neurosci Rep. 2010; : 47-52
        • Torelli F
        • Moscufo N
        • Garreffa G
        • Placidi F
        • Romigi A
        • Zannino S
        Cognitive profile and brain morphological changes in obstructive sleep apnea.
        Neuroimage. 2011; : 787-793
        • Zimmerman ME
        • Aloia MS
        A review of neuroimaging in obstructive sleep apnea.
        J Clin Sleep Med. 2006; 2: 461-471
        • Aloia MS
        • Arnedt JT
        • Davis JD
        • Riggs RL
        • Byrd D
        Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review.
        Int Neuropsychol Soc. 2004; 10: 772-785
        • Beebe DW
        • Groesz L
        • Wells C
        • Nichols A
        • McGee K
        The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data.
        Sleep. 2003; 26: 298-307
        • Algin O
        • Gokalp G
        • Ocakoglu G
        • Ursavas A
        • Taskapilioglu O
        • Hakyemez B
        Neurochemical-structural changes evaluation of brain in patients with obstructive sleep apnea syndrome.
        Eur J Radiol. 2012; 81: 491-495
        • Desseilles M
        • Dang-Vu T
        • Schabus M
        • et al.
        Neuroimaging insights into the pathophysiology of sleep disorders.
        Sleep. 2008; 31: 777-794
        • Engleman H
        • Joffe D
        Neuropsychological function in obstructive sleep apnoea.
        Sleep Med Rev. 1999; 3: 59-78
        • Alkan A
        • Kutlu R
        • Kocak G
        • Sigirci A
        • Emul M
        • Dogan S
        • Aslan M
        • Sarac K
        • Yakinci C
        Brain MR spectroscopy in children with a history of rheumatic fever with a special emphasis on neuropsychiatric complications.
        Eur J Radiol. 2004; 49: 224-228
        • Alchanatis M
        • Deligiorgis N
        • Zias N
        • et al.
        Frontal brain lobe impairment in obstructive sleep apnoea: a proton MR spectroscopy study.
        Eur Respir J. 2004; 24: 980-986
        • Kumar R
        • Chavez AS
        • Macey PM
        • Woo MA
        • Yan-Go FL
        • Harper RM
        Altered global and regional brain mean diffusivity in patients with obstructive sleep apnea.
        J Neurosci Res. 2012; 90: 2043-2052
        • Ahlhelm F
        • Schneider G
        • Backens M
        • Reith W
        • Hagen T
        Time course of the apparent diffusion coefficient after cerebral infarction.
        Eur Radiol. 2002; 12: 2322-2329
        • Macey PM
        • Kumar R
        • Woo MA
        • et al.
        Brain structural changes in obstructive sleep apnea.
        Sleep. 2008; 31: 967-977
        • Cross RL
        • Kumar R
        • Macey PM
        • et al.
        Neural alterations and depressive symptoms in obstructive sleep apnea patients.
        Sleep. 2008; 31: 1103-1109
        • Yaouhi K
        • Bertran F
        • Clochon P
        • et al.
        A combined neuropsychological and brain imaging study of obstructive sleep apnea.
        J Sleep Res. 2009; 18: 36-48
        • Morrell MJ
        • McRobbie DW
        • Quest RA
        • et al.
        Changes in brain morphology associated with obstructive sleep apnea.
        Sleep Med. 2003; 4: 451-454
        • Bartlett DJ
        • Rae C
        • Thompson CH
        • et al.
        Hippocampal area metabolites relate to severity and cognitive function in obstructive sleep apnea.
        Sleep Med. 2004; 5: 593-596
        • Malhotra A
        • White DP
        Obstructive sleep apnoea.
        Lancet. 2002; 360: 237-245
        • Kamba M
        • Suto Y
        • Ohta Y
        • et al.
        Cerebral metabolism in sleep apnea. Evaluation by magnetic resonance spectroscopy.
        Am J Respir Crit Care Med. 1997; 156: 296-298
        • Kamba M
        • Inoue Y
        • Higami S
        • et al.
        Cerebral metabolic impairment in patients with obstructive sleep apnoea: an independent association of obstructive sleep apnoea with white matter change.
        J Neurol Neurosurg Psychiatry. 2001; 71: 334-339
        • Kumar R
        • Macey PM
        • Cross RL
        • et al.
        Neural alterations associated with anxiety symptoms in obstructive sleep apnea syndrome.
        J Comp Neurol. 2005; 487: 361-471
        • Sarchiellia P
        • Presciuttib O
        • Albertic A
        • et al.
        A H1 magnetic resonance spectroscopy study in patients with obstructive sleep apnea.
        Eur J Neurol. 2008; 15: 1058-1064