Brain MRI changes following continuous positive airway pressure therapy in adults with obstructive sleep apnea: a systematic review.
Maryam Jalali, Maziar Jalalvandi, Atefeh Tahmasebzadeh et al.
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In 30 seconds
This systematic review synthesized longitudinal brain MRI studies in adults with obstructive sleep apnea (OSA) before and after continuous positive airway pressure (CPAP), including comparisons with control groups. Thirty studies reported changes across structural, white matter, functional, perfusion, cerebrovascular, and other MRI domains. Findings were heterogeneous across imaging methods, brain regions, treatment duration, adherence definitions, comparators, and analyses. The review concludes that CPAP may be associated with domain-specific brain changes, but the evidence is exploratory and does not establish reproducible MRI treatment effects.
Key findings
- The review included 30 studies of longitudinal MRI changes following CPAP in adults with OSA.
- Reported changes spanned gray and white matter, functional connectivity and activity, perfusion, cerebrovascular reactivity, and preliminary metabolic and other measures.
- Results varied across MRI techniques, anatomical targets, CPAP duration, adherence definitions, comparator groups, and analytical methods.
Why it matters
Brain MRI findings are being investigated as potential indicators of OSA-related brain changes and response to CPAP. This review shows that reported changes are not yet consistent across studies, so MRI findings cannot currently be interpreted as a reproducible measure of treatment effect. The evidence highlights the need for better-harmonized longitudinal research before imaging can inform assessment of response.
What to keep in mind
The evidence was largely exploratory: most studies were small and nonrandomized, with heterogeneous imaging and analytical approaches.