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Glymphatic imaging and serum glial biomarkers in children with obstructive sleep apnea
Birce Sunman1, Ömer Faruk İpek1, Ekim Gümeler2
1Hacettepe University Faculty of Medicine, Department of Pediatric Pulmonology, Ankara, Türkiye.
Insights
Obstructive sleep apnea (OSA) in obese children is linked to impaired glymphatic system function. This is shown by a lower diffusion tensor imaging-along the perivascular space (DTI-ALPS) index and higher glial fibrillary acidic protein (GFAP) levels.
Area of Science:
- Neuroscience
- Pediatrics
- Sleep Medicine
Background:
- The glymphatic system clears waste from the brain, primarily during sleep.
- Obstructive sleep apnea (OSA) may disrupt glymphatic function.
- Biomarkers like GFAP and S100B may indicate brain injury or inflammation.
Purpose of the Study:
- To assess glymphatic system function in obese children with OSA.
- To correlate glymphatic function with serum biomarkers (GFAP, S100B).
- To utilize the DTI-ALPS index for glymphatic evaluation.
Main Methods:
- Enrolled obese children undergoing polysomnography (PSG) to diagnose OSA.
- Included age- and sex-matched healthy non-obese children as controls.
- Acquired brain MRI for DTI-ALPS index calculation and blood samples for GFAP/S100B levels.
Main Results:
- Obese children with OSA showed a significantly lower DTI-ALPS index compared to obese non-OSA and healthy controls.
- Serum GFAP levels were significantly elevated in the obese OSA group.
- No significant difference in S100B levels was observed between groups.
Conclusions:
- Obese children with OSA exhibit impaired glymphatic function.
- Reduced DTI-ALPS index and elevated GFAP suggest glial activation and dysfunction.
- Further longitudinal research is needed to establish causality.
Objectives:
The glymphatic system, which is most active during sleep, may be disrupted in obstructive sleep apnea (OSA). We evaluated glymphatic function in children with OSA using diffusion tensor imaging-along the perivascular space (DTI-ALPS) index together with serum glial fibrillary acidic protein (GFAP) and S100 calcium-binding protein B (S100B) levels.
Methods:
Obese children scheduled for overnight polysomnography (PSG) were enrolled and classified as having OSA or not, based on PSG findings. Age- and sex-matched healthy non-obese children served as controls, with those showing Epworth Sleepiness Scale scores suggestive of OSA excluded. All participants underwent brain magnetic resonance imaging (MRI) for DTI-ALPS index calculation and blood sampling for GFAP and S100B measurement.
Results:
Eighty-four children were included: 31 with obesity + OSA, 35 with obesity + non-OSA, and 18 healthy controls. The groups were comparable in age and sex, while body mass index differed significantly. The median value of DTI-ALPS index was lowest in obese + OSA compared with obese + non-OSA and healthy groups (1.50, 1.66, 2.00, respectively; p = 0.030). Following adjustment for age and sex, post-hoc analyses demonstrated significantly lower DTI-ALPS index in the obese + OSA group compared to healthy controls (p = 0.021). Serum GFAP levels were significantly higher in obese + OSA group (p = 0.004), however S100B did not differ significantly between groups (p = 0.101).
Conclusion:
Our results suggest impaired glymphatic function in obese children with OSA, reflected by reduced DTI-ALPS index and elevated serum GFAP levels, independent of age and sex. Larger longitudinal studies are required to confirm causality.
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