TOPLINE:

Moderate-to-severe obstructive sleep apnea (OSA) was associated with a twofold higher risk for cerebral microbleeds (CMBs) over an 8-year follow-up than not having OSA in middle-aged and older adults, even after accounting for APOE-ε4 genetic status, a population-based, prospective cohort study showed.

METHODOLOGY:

• Researchers analyzed data from the ongoing Korean Genome and Epidemiology Study of more than 1400 participants (mean age, 58 years; 53% women) who underwent at-home overnight polysomnography and brain MRI at baseline (2011-2014) with follow-up at 4 and 8 years.
• Participants were categorized as having no OSA (0-4.9 events per hour, n = 812), mild OSA (5-14.9 events per hour, n = 436), or moderate-to-severe OSA (≥ 15 events per hour, n = 193).
• Outcome included relative risk (RR) of incident CMBs at follow-up. Potential confounders included age, sex, BMI, physical activity, and alcohol and smoking status.
• Sensitivity analyses were performed after excluding the 21 participants with a history of continuous positive airway pressure (CPAP) use and by additionally adjusting for APOE-ε4 genotype carrier status.

TAKEAWAY:

• The cumulative incidence of CMBs at 8 years was higher in participants with moderate-to-severe OSA (7%) than those with mild OSA (3%) or no OSA (3%).
• After adjusting for all confounders, the group with moderate-to-severe OSA had a significantly increased risk for CMBs at 8 years (RR, 2.1; P = .02) compared with the group without OSA. Mild OSA was not associated with increased CMB risk at either 4-year or 8-year follow-up.
• Excluding CPAP users did not alter the findings. Even after accounting for APOE-ε4 carrier status, moderate-to-severe OSA remained associated with a significantly higher risk for CMBs at 8 years (RR, 2.9; P = .01).

IN PRACTICE:

“To our knowledge, no [other] study to date has investigated the association between OSA and risk of incident CMBs longitudinally,” the investigators of the study wrote.

Because OSA is a modifiable risk factor, the findings suggest that “moderate-to-severe OSA should be a potential target for early diagnosis and treatment to prevent incident CMBs and potentially prevent future strokes and dementia in aging populations,” they added.

SOURCE:

The study was led by Ali Tanweer Siddiquee, PhD, College of Medicine, Korea University Ansan Hospital, Ansan, South Korea. It was published online on October 28 in JAMA Network Open.

LIMITATIONS:

Study limitations included the low prevalence of APOE-ε4 carriers (n = 234), which restricted genetic analyses; the small number of cases of incident CMB; and the use of less sensitive MRI sequences, which may have underestimated CMBs. Potential selection bias due to participant dropouts and deaths, along with a possible healthy cohort effect from long-term follow-up, may have limited the generalizability of the results.

DISCLOSURES:

The study was funded by grants from the National Institute of Health in South Korea, the National Biobank of Korea, and the US National Institutes of Health. One investigator reported receiving equity from and serving as cofounder, scientific advisor, and consultant for Beacon Biosignals. Another investigator reported owning a patent with royalties from MyCardio, LLC, and receiving personal fees from Guidepoint and GLG Councils. The other 11 investigators reported having no relevant financial relationships.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.