阻塞性睡眠呼吸暂停中的血管周围间隙影像标志物与类淋巴功能：系统综述与荟萃分析
Perivascular space imaging marker and glymphatic function in obstructive sleep apnea: A systematic review and meta-analysis.
文献信息
| PMID | 42946145 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Pongsakorn Tanayapong |
| 作者单位 | Division of Sleep Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. |
| 期刊 | Neurobiology of disease |
| SCI 分区 | Q1 |
| IF | 6.5 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景与目的： 阻塞性睡眠呼吸暂停（OSA）是公认的心血管疾病和痴呆风险因素，既往有报道称其与提示脑小血管病（CSVD）的脑内血管周围间隙（PVS）扩大以及类淋巴功能受损相关。我们旨在评估OSA与神经影像可见的PVS以及沿血管周围间隙的弥散张量成像分析（DTI-ALPS，作为类淋巴功能的替代标志物）之间的关联。
方法： 对MEDLINE、Scopus和Embase进行了系统检索，截止日期为2026年10月11日。该荟萃分析纳入探讨OSA严重程度与PVS负荷及DTI-ALPS之间关联的观察性研究。采用随机效应模型汇总不同OSA疾病严重程度下报告的PVS或类淋巴参数的效应估计值。
结果： 共16项研究（N=2618）符合纳入标准。结果显示，与无OSA者相比，OSA患者记录到PVS的比值显著更高（OR=4.97，95% CI 2.51至9.82）。呼吸暂停低通气指数每增加一个单位，对应PVS比值增加3%（OR=1.03，95% CI 1.01至1.04）。OSA与DTI-ALPS指数所指示的类淋巴相关弥散显著降低相关（平均差=-0.2，95% CI -0.35至-0.06）。这种降低在所有OSA严重程度中持续存在，包括轻度（平均差=-0.17，95% CI -0.32至-0.02）和中重度（平均差=-0.10，95% CI -0.17至-0.04）OSA。
结论： 我们的荟萃分析表明，OSA与PVS负荷增加及类淋巴功能替代指标受损之间存在强关联，可能提示OSA参与CSVD和痴呆的发病机制。需要进一步的前瞻性研究来确认所观察关联的因果关系和效应方向。注册：PROSPERO注册号CRD420261279540。缩写与首字母缩略词。
英文摘要
BACKGROUND AND OBJECTIVES: Obstructive sleep apnea (OSA) is a recognized cardiovascular and dementia risk factor that has been previously reported in association with enlarged cerebral perivascular spaces (PVS) indicative of cerebral small vessel disease (CSVD) and impaired glymphatic function. We aimed to evaluate associations between OSA and neuroimaging-visible PVS and Diffusion Tensor Imaging Analysis Along the Perivascular Space (DTI-ALPS), as a surrogate marker of glymphatic function.
METHODS: A systematic search of MEDLINE, Scopus, and Embase was conducted through Oct 11, 2026. The meta-analysis included observational studies exploring associations between OSA severity and PVS burden and DTI-ALPS. Reported effect estimates for PVS or glymphatic parameters across OSA disease severity were pooled using a random-effect model.
RESULTS: Sixteen studies (N = 2618) met the inclusion criteria. Results showed that patients with OSA had a significantly higher odds of documented PVS compared to those without OSA (OR = 4.97, 95% CI 2.51 to 9.82). Each per unit increase in apnea-hypopnea index corresponded to a 3% increase in the odds of PVS (OR = 1.03, 95% CI 1.01 to 1.04). OSA was linked to a significant decrease in glymphatic-related diffusion as indicated by DTI-ALPS index (mean difference = -0.2, 95% CI -0.35 to -0.06). This reduction persisted across all OSA severities, including mild (mean difference = -0.17, 95% CI -0.32 to -0.02), and moderate-to-severe (mean difference = -0.10, 95% CI -0.17 to -0.04) OSA.
CONCLUSIONS: Our meta-analysis demonstrated a strong link between OSA and both increased PVS burden and impaired surrogate of glymphatic function, potentially implicating OSA in the pathogenesis of both CSVD and dementia. Further prospective studies are necessary to confirm causality and direction of effect of the observed association. Registration PROSPERO registration number, CRD420261279540. ABBREVIATIONS AND ACRONYMS.