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  • Print publication year: 2013
  • Online publication date: March 2013

Chapter 36 - Neuroimaging of treatment effects in obstructive sleep apnea

from Section 5 - Neuroimaging of sleep disorders


This chapter reviews brain imaging studies that comment on whether or not there is abnormal brain function in insomnia patients that may in some way relate to their difficulty in sleeping. It provides a systems neuroscience view of a hierarchical arousal network in the central nervous system. Human sleep neuroimaging studies in healthy subjects support the involvement of these basic arousal networks in non-rapid eye movement (NREM) sleep. Blood flow has been shown to correlate negatively with the presence of NREM sleep in the pontine reticular formation, and in the basal forebrain/hypothalamus. Pharmacotherapy for insomnia may have some of its mechanism of action on the limbic and paralimbic structures, especially the antidepressant medications. Traditional sedative-hypnotic approaches appear to target brainstem and hypothalamic arousal networks in insomnia patients while behavioral treatments and frontal cerebral hypothermia appear to target frontal hyperarousal in insomnia patients.


1. BartlettDJ, RaeC, ThompsonCH, et al. Hippocampal area metabolites relate to severity and cognitive function in obstructive sleep apnea. Sleep Med. 2004;5(6):593–6.
2. LanfranchiP, SomersVK. Obstructive sleep apnea and vascular disease. Respir Res. 2001;2(6):315–19.
3. AloiaMS, ArnedtJT, DavisJD, et al. Neuropsychological sequelae of obstructive sleep apnea-hypopnea syndrome: a critical review. J Int Neuropsychol Soc. 2004;10(5):772–85.
4. BeebeDW, GozalD.Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. J Sleep Res. 2002;11(1):1–16.
5. YoungT, PaltaM, DempseyJ, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.
6. ShepertyckyMR, BannoK, KrygerMH. Differences between men and women in the clinical presentation of patients diagnosed with obstructive sleep apnea syndrome. Sleep. 2005;28(3):309–14.
7. O’DonoghueFJ, BriellmannRS, RochfordPD, et al. Cerebral structural changes in severe obstructive sleep apnea. Am J Respir Crit Care Med. 2005;171(10):1185–90.
8. MorrellMJ, McRobbieDW, QuestRA, et al. Changes in brain morphology associated with obstructive sleep apnea. Sleep Med. 2003;4(5):451–4.
9. AlchanatisM, DeligiorgisN, ZiasN, et al. Frontal brain lobe impairment in obstructive sleep apnoea: a proton MR spectroscopy study. Eur Respir J. 2004;24(6):980–6.
10. AyalonL, Ancoli-IsraelS, KlemfussZ, et al. Increased brain activation during verbal learning in obstructive sleep apnea. Neuroimage. 2006;31(4):1817–25.
11. LinL, FinnL, ZhangJ, et al. Angiotensin-converting enzyme, sleep-disordered breathing, and hypertension. Am J Respir Crit Care Med. 2004;170(12):1349–53.
12. MinoguchiK, YokoeT, TazakiT, et al. Silent brain infarction and platelet activation in obstructive sleep apnea. Am J Respir Crit Care Med. 2007;175:612–617.
13. CanessaN, CastronovoV, CappaSF, et al. Obstructive sleep apnea: brain structural changes and neurocognitive function before and after treatment. Am J Respir Crit Care Med. 2011;183(10):1419–26.
14. ThomasRJ, RosenBR, SternCE, et al. Functional imaging of working memory in obstructive sleep-disordered breathing. J Appl Physiol. 2005;98(6):2226–34.
15. CastronovoV, CanessaN, Ferini-StrambiL, et al. Brain activation changes before and after PAP treatment in obstructive sleep apnea. Sleep. 2009;32(9):1161–72.
16. SweetLH, JerskeyBA, AloiaMS. Default network response to a working memory challenge after withdrawal of continuous positive airway pressure treatment for obstructive sleep apnea. Brain Imaging Behav. 2010;4(2):155–63.
17. AloiaMS, SweetLH, JerskeyBA, et al. Treatment effects on brain activity during a working memory task in obstructive sleep apnea. J Sleep Res. 2009;18(4):404–10.
18. MatsuoA, InoueY, NambaK, ChibaH.Changes in cerebral hemoglobin indices in obstructive sleep apnea syndrome with nasal continuous positive airway pressure treatment. Sleep Breath. 2011;15:487–92.
19. TononC, VetrugnoR, LodiR, et al. Proton magnetic resonance spectroscopy study of brain metabolism in obstructive sleep apnoea syndrome before and after continuous positive airway pressure treatment. Sleep. 2007;30(3):305–311.
20. CastronovoV, ScifoP, AloiaMS, et al. White matter integrity in obstructive sleep apnea (OSA): changes in diffusion tensor imaging (DTI) after CPAP treatment. Sleep. 2010;33: A115.
21. MaceyPM, KumarR, WooMA, et al. Brain structural changes in obstructive sleep apnea. Sleep. 2008;31(7):967–77.