COMISA as an Independent Correlate of White Matter Hyperintensities in OSA Patients: A Cross-Sectional Study and Nomogram Construction

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BACKGROUND: Obstructive sleep apnea (OSA) is a recognized risk factor for white matter hyperintensities (WMH) in cerebral small vessel disease. Identifying risk factors for WMH in OSA patients is important for disease management. METHODS: This cross-sectional study (2021-2023) enrolled OSA patients and collected PSG, MMSE, and brain MRI data. WMH was diagnosed using STRIVE‑2 criteria. Patients were divided into WMH and non‑WMH groups. Risk factors were identified by between‑group comparisons and multivariate logistic regression; a nomogram was constructed and evaluated by ROC and calibration curves. RESULTS: Our findings suggest that COMISA may be the strongest independent correlate of WMH among the factors examined. Higher BMI and increased REM apnea‑hypopnea index were independently associated with higher WMH odds, whereas higher total protein and MMSE scores were associated with lower odds. The nomogram showed potential utility for early screening, though external validation is needed. CONCLUSION: In this study, we identified COMISA as an independent risk factor for WMH in patients with OSA. To our knowledge, this is among the first studies to highlight COMISA as a potentially valuable predictor in this context. These findings may offer a basis for further mechanistic investigations and for identifying individuals at higher risk of WMH, potentially informing early intervention strategies.