الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Obstructive sleep apnea is the most common form of SRBDs that occurs due to repetitive episodes of collapse to the upper airways. It is associated with increased morbidity and mortality. Associated comorbidities include daytime sleepiness, motor vehicle crashes, psychological problems, decreased cognitive function, hypertension, CAD, CHF, stroke, DM and metabolic syndrome.
The aim of this work was to study the relation between structural brain changes using structural MRI of the brain to assess WMCs, neurocognitive function, depression and fatigue using multiple questionnaires (MoCA score, BDI-П and FSS, respectively) and CCA-IMT using Doppler ultrasound in OSA patients with different severities.
This study was conducted on 30 patients referred to sleep unit, Alexandria Main university hospitals, and 10 controls (matched with patients regarding age, gender, BMI and associated comorbidities) in the duration between October 2016 and September 2018. Patients were divided in to 3 groups. Groups І (moderate OSA) included 12 patients (40%), group П (severe OSA) included 14 patients (46.67%) and group Ш (very severe OSA) included 4 patients (13.33%). We excluded patients with mild OSA, patients with known chronic lung disease, cerebrovascular disease or using psychoactive medications, patients previously treated with CPAP, patients with body weight >120 kg or with pacemaker and patients on tracheostomy or on oxygen therapy.
All patients were subjected to full history taking, Complete physical examination, routine laboratory investigations and lipid profile, ABG, ECG, STOP-BANG Questionnaire, ESS, many anthropometric measures (height, weight, BMI, neck circumference, NHR, waist and hip circumference), PSG, MoCA score, BDI-П, FSS, MRI scan of the brain and carotid arterial Doppler.
In our study, 56.7% of the patients were females and 43.3% were males with a mean age of 58.17±4.09 years. Patients and control subjects suffered from several comorbidities (DM, hypertension and hyperlipidemia were the most common). Symptoms reported by our patients were chocking attacks at night, snoring, witnessed apneas, EDS, recurrent arousal at night, unrefreshing sleep, fatigue, dry mouth, nocturia and morning headache in descending order.
Comparing patients to control group, there was no statistically significant difference between both groups regarding the presence of WMCs in general but there was a significant difference regarding the presence of subcortical and corpus callosal hyperintensities. Also, there was no statistically significant difference between both groups regarding increased CCA-IMT. But, there was a statistically significant difference between both groups regarding MoCA score, BDI-П and FSS. All cognitive domains assessed by MoCA score were affected in our study with a significant difference between patients and control group regarding all of them except abstraction. The most commonly affected cognitive domains were visuospatial/executive skills, abstraction, attention, concentration and working memory (100% of the patients showed abnormal MoCA score) followed by delayed recall, orientation, language and naming (in 89.5%, 84.5%,57.9% and 42.1% of the patients showed abnormal MoCA score, respectively).
For the relation between the assessed parameters among our patients, there was a strong negative correlation between AHI and MoCA score and a strong positive correlation between AHI and BDI-П, FSS and CCA-IMT. Also, there was a strong negative correlation between MoCA score and CCA-IMT. Moreover, the group of patients with WMCs had a significantly higher AHI, a significantly increased CCA-IMT and a significantly lower MoCA score.