Brain MRI Changes Following Continuous Positive Airway Pressure Therapy in Adults with Obstructive Sleep Apnea

Résumé fourni par la source

This systematic review examines longitudinal brain magnetic resonance imaging (MRI) changes following continuous positive airway pressure (CPAP) therapy in adults with obstructive sleep apnea (OSA). OSA has been associated with structural, microstructural, functional, vascular, and metabolic brain alterations, potentially related to intermittent hypoxemia, sleep fragmentation, sympathetic activation, and impaired vascular regulation. Although CPAP is the first-line treatment for OSA, the extent to which OSA-related brain abnormalities recover, stabilize, or persist following treatment remains uncertain. The purpose of this review is to systematically synthesize the available longitudinal MRI evidence on brain changes following CPAP therapy in adults with OSA. The review encompasses multiple neuroimaging domains, including structural MRI, diffusion MRI, resting-state and task-based functional MRI, cerebral perfusion and cerebrovascular reactivity imaging, magnetic resonance spectroscopy, susceptibility-related imaging, and perivascular-space assessment. Eligible studies include longitudinal pre- and post-CPAP investigations as well as studies comparing CPAP-treated participants with untreated OSA, sham CPAP, best supportive care/usual care, or healthy control groups. The review also examines whether reported neuroimaging changes vary according to factors such as CPAP treatment duration and adherence, baseline OSA severity, comparator group, MRI technique, and anatomical region or brain network. Because the available studies are substantially heterogeneous in imaging methodology, acquisition and processing approaches, treatment exposure, outcome definitions, and statistical reporting, the evidence is synthesized qualitatively rather than through quantitative meta-analysis. The project is intended to provide an integrated overview of the extent and pattern of treatment-related brain changes reported after CPAP, identify areas in which findings are consistent or heterogeneous across neuroimaging modalities, and highlight methodological and evidence gaps that should be addressed in future longitudinal studies. Ultimately, the review aims to clarify the current evidence regarding the potential reversibility or stabilization of OSA-related brain MRI abnormalities following CPAP therapy and to inform future research on reproducible and treatment-sensitive neuroimaging biomarkers.

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