Multimodal indicators significantly improved diagnostic accuracy for cognitive impairment in patients with cerebral small vessel disease (AUC 0.835; 95% CI 0.794-0.911).
Observational (n=116)
Autonomic dysfunction, measured by heart rate fragmentation, mediates the relationship between sleep apnea and cerebral small vessel disease severity, and multimodal assessment improves detection of cognitive impairment.
Effect estimate: AUC 0.835 (95% CI 0.794-0.911)
Abstract Background and aims Obstructive sleep apnea and autonomic dysfunction are intimately linked with cerebral small vessel disease (CSVD). Heart rate fragmentation (HRF) serves as a quantitative marker of cardiac autonomic dysfunction and demonstrates correlations with both sleep apnea severity and cognitive decline. This study aimed to explore the associations between sleep apnea parameters, autonomic function, CSVD burden, plasma neurobiomarkers, and cognitive function, and to clarify the predictive value of multimodal indicators for cognitive impairment. Methods A total of 116 patients with CSVD were enrolled. Polysomnography was used to measure sleep parameters and the HRF indicator, percentage of inflection points (PIP). Magnetic resonance imaging based CSVD features were evaluated using a visual rating scale. Plasma concentrations of P-tau217 and NfL were measured. Cognitive function was assessed using the Montreal Cognitive Assessment. Structural equation modeling (SEM) was employed to explore the pathways among apnea-hypopnea index (AHI), PIP, P-tau217, and NfL. Results AHI was positively correlated with both PIP and deep brain lesions (both P0.05). PIP demonstrated positive correlations with deep brain lesions, P-tau217, and NfL levels (all P0.05). Multimodal indicators significantly improved diagnostic accuracy for cognitive impairment (AUC=0.835, 95% CI: 0.794–0.911). SEM revealed that PIP mediated the effect of AHI on deep CSVD lesions and indirectly influenced P-tau217 and NfL levels through deep lesion severity. Conclusions This study reveals the potential associations among obstructive sleep apnea, autonomic nervous function and CSVD. The adoption of a multimodal assessment strategy holds significant clinical utility for the early identification and timely intervention in the diagnosis and management of CSVD. Conflict of interest Along Hou, Cheng Wenbin, Xiong Xinli, Chen Xiaohan, Sun Wenjing, Xiong Ran, Xu Wei, Shen Lei, You Yin and Li Gang. nothing to disclose
Hou et al. (Fri,) conducted a observational in Cerebral small vessel disease (CSVD) (n=116). Multimodal indicators (sleep apnea parameters, autonomic function, CSVD burden, plasma neurobiomarkers) was evaluated on Diagnostic accuracy for cognitive impairment (AUC 0.835, 95% CI 0.794-0.911). Multimodal indicators significantly improved diagnostic accuracy for cognitive impairment in patients with cerebral small vessel disease (AUC 0.835; 95% CI 0.794-0.911).