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Published on: August 14, 2019
Characterisation of brain microstructural alterations in children with obstructive sleep apnea syndrome using
Yanhua Li1, Hongwei Wen2,3, Hongbin Li4
1Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Centre for Children's Health, Beijing, China.
Insights
Children with obstructive sleep apnea (OSA) show altered white matter (WM) integrity. Diffusional kurtosis imaging (DKI) revealed decreased kurtosis fractional anisotropy (KFA) in complex WM regions, differentiating OSA patients from controls.
Area of Science:
- Neuroimaging
- Pediatric Neurology
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) is a prevalent chronic sleep disorder in children.
- Previous research using diffusion tensor imaging (DTI) indicated widespread white matter (WM) alterations in pediatric OSA.
- Diffusional kurtosis imaging (DKI) offers enhanced sensitivity over DTI for detecting subtle neural tissue changes.
Purpose of the Study:
- To investigate whole-brain white matter microstructural differences in children with OSA using DTI and DKI.
- To compare kurtosis and diffusion parameters between children with OSA and healthy controls.
- To explore the correlation between DKI metrics and sleep parameters in pediatric OSA.
Main Methods:
- Whole-brain DTI and DKI analyses were performed on 41 children with OSA and 32 healthy controls.
- Tract-based spatial statistics (TBSS) was used for between-group comparisons (p < 0.05, TFCE corrected).
- Partial correlations assessed relationships between DKI metrics and sleep parameters, controlling for age and gender.
Main Results:
- Children with OSA exhibited significantly reduced kurtosis fractional anisotropy (KFA) in complex WM regions (posterior corona radiate, superior longitudinal fasciculus, inferior fronto-occipital fasciculus).
- Reduced fractional anisotropy (FA) was observed in coherent WM regions (posterior limb of internal capsule, anterior thalamic radiation, corpus callosum) in OSA patients.
- ROC curve analysis confirmed KFA's significant ability (p < 0.001) to differentiate children with OSA from controls.
Conclusions:
- DKI-derived kurtosis and diffusion parameters provide complementary neuroimaging biomarkers for assessing WM alterations in pediatric OSA.
- These advanced imaging metrics can reveal pathological changes and aid in monitoring disease progression.
- KFA in specific complex WM regions showed significant correlations with sleep parameters in children with OSA.
Abstract:
Obstructive sleep apnea (OSA) is a common chronic sleep-related breathing disorder in children. Previous studies showed widespread alterations in white matter (WM) in children with OSA mainly by using diffusion tensor imaging (DTI), while diffusional kurtosis imaging (DKI) extended DTI and exhibited improved sensitivity in detecting developmental and pathological changes in neural tissues. Therefore, we conducted whole-brain DTI and DKI analyses and compared the differences in kurtosis and diffusion parameters within the skeleton between 41 children with OSA and 32 healthy children. Between-group differences were evaluated by tract-based spatial statistics (TBSS) analysis (p < 0.05, TFCE corrected), and partial correlations between DKI metrics and sleep parameters were assessed considering age and gender as covariates. Compared with the controls, children with OSA showed significantly decreased kurtosis fractional anisotropy (KFA) mainly in white matter regions with a complex fibre arrangement including the posterior corona radiate (PCR), superior longitudinal fasciculus (SLF), and inferior fronto-occipital fasciculus (IFOF), while decreased FA in white matter regions with a coherent fibre arrangement including the posterior limb of internal capsule (PLIC), anterior thalamic radiation (ATR), and corpus callosum (CC). Notably, the receiver operating characteristic (ROC) curve analysis demonstrated the KFA value in complex tissue regions significantly (p < 0.001) differentiated children with OSA from the controls. In addition, the KFA value in the left PCR, SLF, and IFOF showed significant partial correlations to the sleep parameters for children with OSA. Combining DKI derived kurtosis and diffusion parameters can provide complementary neuroimaging biomarkers for assessing white matter alterations, and reveal pathological changes and monitor disease progression in paediatric OSA.
