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Changes in brain morphology in patients with obstructive sleep apnoea
  1. M J Morrell1,2,
  2. M L Jackson3,4,
  3. G L Twigg1,
  4. R Ghiassi5,
  5. D W McRobbie6,
  6. R A Quest6,
  7. H Pardoe7,
  8. G S Pell7,
  9. D F Abbott7,
  10. P D Rochford7,
  11. G D Jackson7,
  12. R J Pierce4,
  13. F J O'Donoghue7,4,
  14. D R Corfield8
  1. 1National Heart and Lung Institute, Imperial College, London, UK
  2. 2Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust, London, UK
  3. 3Sleep and Performance Research Center, Washington State University, Spokane, Washington, USA
  4. 4Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
  5. 5Respiratory Medicine, Charing Cross Hospital, London, UK
  6. 6Radiological Sciences Unit, Imperial College, London, UK
  7. 7Brain Research Institute, Florey Neuroscience Institutes (Austin), Melbourne, Australia
  8. 8Institute for Science and Technology in Medicine, Keele University, Staffordshire, UK
  1. Correspondence to Mary J Morrell, Clinical and Academic Unit of Sleep and Breathing, Royal Brompton Hospital, Sydney Street, London SW6 3NP, UK; m.morrell{at}


Background Obstructive sleep apnoea (OSA) is a common disease that leads to daytime sleepiness and cognitive impairment. Attempts to investigate changes in brain morphology that may underlie these impairments have led to conflicting conclusions. This study was undertaken to aim to resolve this confusion, and determine whether OSA is associated with changes in brain morphology in a large group of patients with OSA, using improved voxel-based morphometry analysis, an automated unbiased method of detecting local changes in brain structure.

Methods 60 patients with OSA (mean apnoea hypopnoea index 55 (95% CI 48 to 62) events/h, 3 women) and 60 non-apnoeic controls (mean apnoea hypopnoea index 4 (95% CI 3 to 5) events/h, 5 women) were studied. Subjects were imaged using T1-weighted 3-D structural MRI (69 subjects at 1.5 T, 51 subjects at 3 T). Differences in grey matter were investigated in the two groups, controlling for age, sex, site and intracranial volume. Dedicated cerebellar analysis was performed on a subset of 108 scans using a spatially unbiased infratentorial template.

Results Patients with OSA had a reduction in grey matter volume in the right middle temporal gyrus compared with non-apnoeic controls (p<0.05, corrected for topological false discovery rate across the entire brain). A reduction in grey matter was also seen within the cerebellum, maximal in the left lobe VIIIb close to XI, extending across the midline into the right lobe.

Conclusion These data show that OSA is associated with focal loss of grey matter that could contribute to cognitive decline. Specifically, lesions in the cerebellum may result in both motor dysfunction and working memory deficits, with downstream negative consequences on tasks such as driving.

  • Sleep
  • obstructive sleep apnoea
  • MRI
  • voxel based morphometry
  • cortical grey matter
  • imaging/CT MRI etc
  • respiratory measurement
  • sleep apnoea

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  • Funding The study was funded by The Wellcome Trust, Hammersmith Hospitals Trust, The National Heart and Lung Institute Foundation, The Australian National Health and Medical Research Council, Austin Health Medical Research Foundation, the Operational Infrastructure Support Program of the State government of Victoria, Australia, and ResMed Australia. It was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College London.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Royal Brompton Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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