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Related Experiment Video

Updated: Jul 22, 2026

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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Glymphatic pathway dysfunction in severe obstructive sleep apnea: A meta-analysis.

Sadegh Ghaderi1, Sana Mohammadi2, Farzad Fatehi2

  • 1Neuromuscular Research Center, Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Sleep Medicine
|April 23, 2025
PubMed
Summary

Severe obstructive sleep apnea (OSA) impairs glymphatic function, as indicated by reduced Diffusion Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) index. This suggests a link between OSA and cognitive decline via glymphatic system dysfunction.

Keywords:
Diffusion tensor imagingGlymphatic systemObstructive sleep apneaPerivascular space

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Area of Science:

  • Neuroscience
  • Sleep Medicine
  • Radiology

Background:

  • Obstructive sleep apnea (OSA) is linked to cognitive decline and potential glymphatic system dysfunction.
  • The glymphatic system clears waste from the brain, and its impairment may contribute to neurodegenerative processes.

Purpose of the Study:

  • To investigate glymphatic function in severe OSA using the Diffusion Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) index.
  • To determine if DTI-ALPS is a reliable indicator of glymphatic dysfunction in severe OSA patients.

Main Methods:

  • Systematic review and meta-analysis following PRISMA guidelines.
  • Searched major databases (PubMed, Web of Science, Scopus, Embase) for studies using DTI-ALPS in OSA.
  • Included four studies with 137 severe OSA patients and 170 healthy controls; performed random-effects meta-analysis and meta-regression.

Main Results:

  • Severe OSA patients exhibited a significantly reduced DTI-ALPS index compared to healthy controls (SMD: -0.95, p < 0.001).
  • Apnea-hypopnea index and Epworth Sleepiness Scale scores were identified as sources of heterogeneity.
  • No significant publication bias was detected, and studies had high methodological quality.

Conclusions:

  • Severe OSA significantly disrupts glymphatic system activity.
  • The DTI-ALPS index is a promising biomarker for assessing glymphatic dysfunction in OSA.
  • This dysfunction may be a contributing factor to the cognitive decline observed in OSA patients.