Assessing subtle brain injury related to cognitive impairment in obese pediatric obstructive sleep apnea using 3D MRI texture analysis

Obstructive sleep apnea (OSA) is a frequent complication of childhood obesity associated with neurocognitive impairment. Subtle brain injury caused by intermittent hypoxia and sleep fragmentation has been implicated, yet cannot be detected by structural MRI. This study investigated whether three-dimensional texture analysis (3D TA) of T2-weighted MRI could detect subtle microstructural alterations in brain regions affected by cognitive impairment in obese children with moderate to severe OSA compared to healthy age-matched controls. Texture features were extracted, ranked using the Fisher Criterion, and classified with k-nearest neighbors across regions of interest. Among 23 children with OSA and 26 healthy controls, classification accuracy was highest in the left amygdala (87%), right hippocampus (82%), and left insula (82%), with intensity-based features proving most discriminative. In two patients treated with continuous positive airway pressure (CPAP), follow-up scans indicated normalization of brain texture features. These results highlight 3D TA as a sensitive, clinically accessible method for detecting subtle brain changes in pediatric obesity related OSA. Incorporating this approach into clinical practice may improve treatment monitoring and outcomes, though validation in larger cohorts is needed to confirm its validity and to further assess how these markers change with therapies such as CPAP.