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@ARTICLE{Zacharias:162920,
      author       = {Zacharias, Helena U and Weihs, Antoine and Habes, Mohamad
                      and Wittfeld, Katharina and Frenzel, Stefan and Rashid,
                      Tanweer and Stubbe, Beate and Obst, Anne and Szentkirályi,
                      András and Bülow, Robin and Berger, Klaus and Fietze, Ingo
                      and Penzel, Thomas and Hosten, Norbert and Ewert, Ralf and
                      Völzke, Henry and Grabe, Hans},
      title        = {{A}ssociation {B}etween {O}bstructive {S}leep {A}pnea and
                      {B}rain {W}hite {M}atter {H}yperintensities in a
                      {P}opulation-{B}ased {C}ohort in {G}ermany.},
      journal      = {JAMA network open},
      volume       = {4},
      number       = {10},
      issn         = {2574-3805},
      address      = {Chicago, Ill.},
      publisher    = {American Medical Association},
      reportid     = {DZNE-2021-01573},
      pages        = {e2128225},
      year         = {2021},
      note         = {(CC BY)},
      abstract     = {Underlying pathomechanisms of brain white matter
                      hyperintensities (WMHs), commonly observed in older
                      individuals and significantly associated with Alzheimer
                      disease and brain aging, have not yet been fully elucidated.
                      One potential contributing factor to WMH burden is chronic
                      obstructive sleep apnea (OSA), a disorder highly prevalent
                      in the general population with readily available treatment
                      options.To investigate potential associations between OSA
                      and WMH burden.Analyses were conducted in 529 study
                      participants of the Study of Health in Pomerania-Trend
                      baseline (SHIP-Trend-0) study with complete WMH, OSA, and
                      important clinical data available. SHIP-Trend-0 is a general
                      population-based, cross-sectional, observational study to
                      facilitate the investigation of a large spectrum of common
                      risk factors, subclinical disorders, and clinical diseases
                      and their relationships among each other with patient
                      recruitment from Western Pomerania, Germany, starting on
                      September 1, 2008, with data collected until December 31,
                      2012. Data analysis was performed from February 1, 2019, to
                      January 31, 2021.The apnea-hypopnea index (AHI) and oxygen
                      desaturation index (ODI) were assessed during a
                      single-night, laboratory-based polysomnography
                      measurement.The primary outcome was WMH data automatically
                      segmented from 1.5-T magnetic resonance images.Of 529 study
                      participants (mean [SD] age, 52.15 [13.58] years; 282 female
                      $[53\%]),$ a total of 209 $(40\%)$ or 102 $(19\%)$
                      individuals were diagnosed with OSA according to AHI or ODI
                      criteria (mean [SD] AHI, 7.98 [12.55] events per hour; mean
                      [SD] ODI, 3.75 [8.43] events per hour). Both AHI (β =
                      0.024; $95\%$ CI, 0.011-0.037; P <.001) and ODI (β = 0.033;
                      $95\%$ CI, 0.014-0.051; P <. 001) were significantly
                      associated with brain WMH volumes. These associations
                      remained even in the presence of additional vascular,
                      metabolic, and lifestyle WMH risk factors. Region-specific
                      WMH analyses found the strongest associations between
                      periventricular frontal WMH volumes and both AHI (β =
                      0.0275; $95\%$ CI, 0.013-0.042, P < .001) and ODI (β =
                      0.0381; $95\%$ CI, 0.016-0.060, P < .001) as well as
                      periventricular dorsal WMH volumes and AHI (β = 0.0165;
                      $95\%$ CI, 0.004-0.029, P = .008).This study found
                      significant associations between OSA and brain WMHs,
                      indicating a novel, potentially treatable WMH
                      pathomechanism.},
      keywords     = {Adult / Aged / Aging: physiology / Cohort Studies /
                      Cross-Sectional Studies / Female / Germany: epidemiology /
                      Humans / Magnetic Resonance Imaging: methods / Magnetic
                      Resonance Imaging: statistics $\&$ numerical data / Male /
                      Middle Aged / Sleep Apnea, Obstructive: complications /
                      Sleep Apnea, Obstructive: diagnostic imaging / Sleep Apnea,
                      Obstructive: epidemiology / White Matter: abnormalities /
                      White Matter: physiopathology},
      cin          = {AG Grabe / AG Hoffmann},
      ddc          = {610},
      cid          = {I:(DE-2719)5000001 / I:(DE-2719)1510600},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:34609493},
      pmc          = {pmc:PMC8493431},
      doi          = {10.1001/jamanetworkopen.2021.28225},
      url          = {https://pub.dzne.de/record/162920},
}