The association between obstructive sleep apnea and total cerebral small vessel disease burden-Neurovascular insights of OSA.

OBJECTIVE: This study was conducted to assess the relationship between the severity of obstructive sleep apnea (OSA) and the total burden score of cerebral small vessel disease (CSVD), global cerebral blood flow (CBF), and cognitive function. Moreover, the internal pathway through which OSA induces cognitive impairment by affecting cerebral perfusion, and overall cerebral small vessel lesions was determined in this study. METHODS: In total, 94 patients who received polysomnography (PSG) at the Mental Health Center of Inner Mongolia Autonomous Region from October 2024 to February 2026 were included in this study. Based on the apnea-hypopnea index (AHI), all individuals were classified into the control and the mild group (AHI < 15 times/h, n = 26), the moderate OSA group (15 ≤ AHI < 30 times/h, n = 27), and the severe OSA group (AHI ≥ 30 times/h, n = 41). Demographic information was collected from all patients, and their cognitive performance was evaluated using the Mini-Mental State Examination (MMSE), Trail Making Test (TMT), Choice Reaction Time task (CRT), Digit Symbol Substitution Task (DSST), and the Trails test with a paradigm similar to Part B of the Trail Making Test. Each patient underwent 3.0T magnetic resonance imaging, including conventional sequences, susceptibility weighted imaging (SWI), and arterial spin labeling (ASL). Finally, the total CSVD burden score was assessed. RESULTS: The total CSVD burden and perivascular space (PVS) score in the severe OSA group were significantly higher than those in the moderate group and the control group (P < 0.05). The total CSVD burden was significantly positively correlated with the mean global CBF (P < 0.05). After the BMI was adjusted, the severity of OSA remained independently associated with the mean global CBF (P < 0.05). Total CSVD burden, PVS, lacunes, and global CBF were significantly associated with cognitive function domains (P < 0.05), which indicated that CSVD and global CBF abnormalities may jointly participate in OSA-related cognitive function. CONCLUSION: The severity of OSA might be related to the CSVD burden score. Neuroimaging characteristics strongly related to cognitive function in patients suffering from OSA, and abnormal global CBF may serve as a non-invasive imaging marker for evaluating neurocognitive damage.