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Sleep Apnea and Smaller Brain Volume: The Study

SCOFA-Sleep-Apnea-and-Smaller-Brain-Volume-The-Study-1

 
Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.

 
 
What Is Brain Volume? | How Does OSA Lead to Smaller Brain Volume? |
Some Astonishing Statistics | How Can You Prevent or Treat OSA? |
Prevent Your Brain from Getting Smaller

 

Overview

Hearing your partner snore throughout the night is nothing short of infuriating. But what if we told you that your partner’s snoring may be related to a sleeping disorder that can result in your partner not getting sufficient rest? Or worse yet, what if we told you that your partner’s sleep condition may be affecting the physical structure of their brain? 

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated pauses in breathing during sleep that ultimately result in your brain being starved of oxygen, forcing you to wake up intermittently throughout the night.[1] These pauses can last from a few seconds to minutes and can occur hundreds of times per night.[1]

As OSA progresses, the brain starts receiving an insufficient supply of oxygen, which can lead to deficits in cognitive function and increase your risk of developing conditions such as dementia.[2,3] 

One recent study, however, found that OSA can cause anatomical changes in the brain, causing the section of the brain connected to memory – the medial temporal lobe – to shrink.[4]

And so, with our profound knowledge about sleep behaviors and their effect on brain aging, we’ve decided to delve deeper into the brain’s anatomy and find out what sleep, or lack of it, does to the brain.

 

What is Brain Volume?

The brain plays a vital role in facilitating psychological function. One possible way to measure the brain’s capacity is by identifying the brain volume using magnetic resonance imaging (MRI) scans.[5,6] Brain volume is the term used to refer to the size or amount of brain tissue you have. 

Larger brain volumes generally mean you have a greater cognitive function, including better capacity for memory and overall brain performance. 

Conversely, a small brain volume – a consequence of OSA – can increase your risk of developing cognitive impairments such as dementia.[7] 

 

How Does OSA Lead to Smaller Brain Volume?

Several studies have shown that OSA is linked to smaller brain volumes in various regions of the brain that are involved in memory, mood, executive functioning (high-level thinking skills), and attention.[8,10] These include the hippocampus, the frontal cortex, the temporal lobe, and the white matter.[9,10]

Those struggling with OSA often experience sleep quality and quantity disruptions, which are vital to optimal brain health.[11] 

Sleep deprivation can reduce the production of new neurons and synapses in the hippocampus, which is how the brain sends signals across the brain.[12] The consequential sleep deprivation of OSA can impair your attention, concentration, memory, and mood, decreasing your overall quality of life.[12]

With OSA, your brain becomes deprived of the oxygen needed to thrive.[13] As your muscles require oxygen to grow, your brain relies on oxygen to perform essential functions.[14] If oxygen supply is limited, which can occur during sleep apnea, your brain cells and tissues become damaged and inflamed, and eventually, the brain cells die out.[14] 

A build-up of these stressful events can also break down the blood-brain barrier, the protective layer preventing harmful substances from entering the brain.[15]

One final hypothesis suggests that OSA can result in oxidative stress in the temporal lobe, damaging multiple signaling molecules and increasing your risk for cardiovascular complications.[16] 

Overall, OSA can affect more than the quality of your sleep. Therefore, getting any symptoms of OSA checked out is vital.

 

SCOFA-Sleep-Apnea-and-Smaller-Brain-Volume-The-Study-2


Some Astonishing Statistics

A study carried out earlier this year found that people with severe sleep-disordered breathing, such as that experienced by those with OSA, have smaller volumes in the hippocampus and surrounding subregions of the medial temporal lobe.[4] Those affected also had signs of beta-amyloid plaques — a hallmark sign of Alzheimer’s disease.[4]

The hippocampus and medial temporal lobe aren’t all affected by OSA. One 2014 study found that the effects of severe untreated OSA were far-reaching, affecting how the white matter in the brain is broken down.[17] 

The study also found that OSA treatment with continuous positive airway pressure (CPAP) therapy improved white matter integrity and cognitive function.[17]

 

How Can You Prevent or Treat OSA?

With proper treatment and prevention strategies, OSA can be managed and prevented. Here are some steps you can take to protect your brain from OSA:

  • Get Diagnosed and Treated for OSA. If you suspect you have OSA, consult a sleep specialist and undergo the necessary tests to commence a proper management plan, such as CPAP or lifestyle intervention.
  • Improve Sleep Hygiene. You can improve sleep quality by following a regular sleep schedule, avoiding caffeine, alcohol, nicotine, and heavy meals before bed, keeping your bedroom dark, quiet, and comfortable, and avoiding screens and stimulating activities before bed.
  • Exercise Regularly. Physical activity can improve cardiovascular health, oxygen delivery, brain function, and mood. It can also help you lose weight, reducing the severity of OSA and counteract some of the consequences of bad sleep. Strive for 150 minutes of moderate-intensity weekly exercise, preferably in the morning or afternoon. 
  • Eat a Healthy Diet. A balanced diet can give your brain essential nutrients, antioxidants, and anti-inflammatory compounds to protect your neurons and synapses from damage.
  • Manage Stress Levels. Stress can impair sleep quality, increase inflammation and oxidative stress in the brain, and worsen cognitive performance.[18] Stress levels can be decreased by practicing relaxation techniques, like deep breathing and meditation, and we urge you to seek support from friends, family, and mental health professionals should you need more coping strategies.

 

Prevent Your Brain from Getting Smaller

The newly distinguished link between OSA and brain volume holds promise in allowing researchers to work towards better-tailored treatments. However, these studies also confirm why preventing and managing sleep apnea should be of utmost importance. 

If we don’t look after our sleep and prioritize it as one of our most important health metrics, we put ourselves at risk for potentially irreversible cognitive decline. 

Identify your symptoms, implement a healthy sleep routine, and, most importantly, do not hesitate to contact a specialist when needing help.

 

References:

  1. Kim, H., Joo, E. Y., Suh, S., Kim, J., Kim, S. W., & Hong, S. B. (2016). Effects of long-term treatment on brain volume in patients with obstructive sleep apnea syndrome. Human Brain Mapping, 37(1), 395–409. https://doi.org/10.1002/hbm.23038 
  2. Beebe, D. W., Groesz, L. M., Wells, C. K., Nichols, A., & McGee, K. F. (2003). The Neuropsychological Effects of Obstructive Sleep Apnea: A Meta-Analysis of Norm-Referenced and Case-Controlled Data. Sleep, 26(3), 298–307. https://doi.org/10.1093/sleep/26.3.298
  3. Gosselin, N., Baril, A., Osorio, R. S., Kaminska, M., & Carrier, J. (2019). Obstructive Sleep Apnea and the Risk of Cognitive Decline in Older Adults. American Journal of Respiratory and Critical Care Medicine, 199(2), 142–148. https://doi.org/10.1164/rccm.201801-0204pp
  4. André, C., Kuhn, E., Rehel, S., Ourry, V., Demeilliez-Servouin, S., Palix, C., Felisatti, F., Champetier, P., Dautricourt, S., Yushkevich, P. A., Vivien, D., De La Sayette, V., Chételat, G., De Flores, R., & Rauchs, G. (2023). Association of Sleep-Disordered Breathing and Medial Temporal Lobe Atrophy in Cognitively Unimpaired Amyloid-Positive Older Adults. Neurology, 10.1212/WNL.0000000000207421. https://doi.org/10.1212/wnl.0000000000207421 
  5. Van Elderen, S. G. C., Zhang, Q., Sigurdsson, S., Haight, T. J., Lopez, O. L., Eiriksdottir, G., Jonsson, P. V., De Jong, L. I. T., Harris, T. B., Garcia, M. E., Gudnason, V., Van Buchem, M. A., & Launer, L. J. (2016). Brain Volume as an Integrated Marker for the Risk of Death in a Community-Based Sample: Age Gene/Environment Susceptibility—Reykjavik Study. The Journals of Gerontology, 71(1), 131–137. https://doi.org/10.1093/gerona/glu192
  6. Narayanan, S., Nakamura, K., Fonov, V. S., Maranzano, J., Caramanos, Z., Giacomini, P. S., Collins, D. L., & Arnold, D. L. (2020). Brain volume loss in individuals over time: Source of variance and limits of detectability. NeuroImage, 214, 116737. https://doi.org/10.1016/j.neuroimage.2020.116737
  7. Nalini, A., Tiemeier, H., Mirza, S. S., Adams, H. H., Niessen, W. J., Hofman, A., Prasad, K., Van Der Lugt, A., Vernooij, M. W., & Ikram, M. A. (2017). Brain Volumes and Longitudinal Cognitive Change. Alzheimer Disease & Associated Disorders, 32(1), 43–49. https://doi.org/10.1097/wad.0000000000000235
  8. Kim, H., Joo, E. Y., Suh, S., Kim, J., Kim, S. W., & Hong, S. B. (2016). Effects of long-term treatment on brain volume in patients with obstructive sleep apnea syndrome. Human Brain Mapping, 37(1), 395–409. https://doi.org/10.1002/hbm.23038
  9. Kim, R. E. Y., Abbott, R. D., Kim, S., Thomas, R., Yun, C., Kim, H. J., Johnson, H. J., & Shin, C. (2021). Sleep Duration, Sleep Apnea, and Gray Matter Volume. Journal of Geriatric Psychiatry and Neurology, 35(1), 47–56. https://doi.org/10.1177/0891988720988918
  10. Musso, M. F., Lindsey, H. M., Wilde, E. A., Hunter, J. V., Glaze, D. G., Goodrich-Hunsaker, N. J., Wu, T. C., Black, G., Biekman, B., Zhang, W., Zhu, H., Anand, G. S., & Friedman, E. M. (2020). Volumetric brain magnetic resonance imaging analysis in children with obstructive sleep apnea. International Journal of Pediatric Otorhinolaryngology, 138, 110369. https://doi.org/10.1016/j.ijporl.2020.110369
  11. Obstructive Sleep Apnea. (2023, January 1). PubMed. https://pubmed.ncbi.nlm.nih.gov/29083619/
  12. Meerlo, P., Mistlberger, R. E., Jacobs, B. L., Heller, H. C., & McGinty, D. (2009). New neurons in the adult brain: The role of sleep and consequences of sleep loss. Sleep Medicine Reviews, 13(3), 187–194. https://doi.org/10.1016/j.smrv.2008.07.004
  13. Rosenzweig, I., Williams, S., & Morrell, M. J. (2014). The impact of sleep and hypoxia on the brain. Current Opinion in Pulmonary Medicine, 20(6), 565–571. https://doi.org/10.1097/mcp.0000000000000099
  14. Lacerte, M. (2023, January 27). Hypoxic Brain Injury. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK537310/
  15. Bailey, D. M., Bain, A. R., Hoiland, R. L., Barak, O. F., Drvis, I., Hirtz, C., Lehmann, S., Marchi, N., Janigro, D., Macleod, D., Ainslie, P. N., & Dujic, Z. (2022). Hypoxemia increases blood-brain barrier permeability during extreme apnea in humans. Journal of Cerebral Blood Flow and Metabolism, 42(6), 1120–1135. https://doi.org/10.1177/0271678×221075967
  16. Meliante, P. G., Zoccali, F., Cascone, F., Di Stefano, V., Greco, A., De Vincentiis, M., Petrella, C., Fiore, M., Minni, A., & Barbato, C. (2023). Molecular Pathology, Oxidative Stress, and Biomarkers in Obstructive Sleep Apnea. International Journal of Molecular Sciences, 24(6), 5478. https://doi.org/10.3390/ijms24065478
  17. Castronovo, V., Scifo, P., Castellano, A., Aloia, M. S., Iadanza, A., Marelli, S., Cappa, S. F., Strambi, L. F., & Falini, A. (2014). White Matter Integrity in Obstructive Sleep Apnea before and after Treatment. Sleep, 37(9), 1465–1475. https://doi.org/10.5665/sleep.3994
  18. Sleep apnea and smaller brain volume: The Study – Google Docs. (n.d.). Google Docs. https://docs.google.com/document/d/1SuxVStXoqFrYiDF9hb4qsEYZVeYGR1bKVC1zM-OdSp8/edit#