Effects of Continuous Positive Airway Pressure on Neuroimaging Biomarkers and Cognition in Adult Obstructive Sleep Apnea: A Randomized Controlled Trial.

The effects of continuous positive airway pressure (CPAP) on neuroimaging biomarkers and cognitive performance among middle-aged patients with OSA and normal cognition remain unclear.

持续气道正压通气（CPAP）对中年阻塞性睡眠呼吸暂停（OSA）患者且认知正常者的神经影像生物标志物和认知表现的影响尚不明确。

Objectives: To investigate the effects of CPAP therapy over 12 months on neuroimaging biomarkers and cognitive performance.

目的：研究持续12个月的CPAP治疗对神经影像生物标志物和认知功能的影响。

Methods: In this multicenter, randomized clinical trial, we randomly assigned 148 participants with normal cognition and an apnea-hypopnea index ⩾15/h into two groups: patients receiving CPAP with best supportive care (BSC); and patients receiving BSC alone.

方法：在这项多中心、随机临床试验中，我们将148名具有正常认知功能且呼吸暂停低通气指数（AHI）⩾15/h的参与者随机分为两组：一组接受CPAP治疗和最佳支持性护理（BSC）；另一组仅接受BSC。

The primary endpoint was Montreal Cognitive Assessment (MoCA) score at 6 months after enrollment.

主要终点是入组后6个月的蒙特利尔认知评估（MoCA）分数。

The secondary endpoints were intranetwork functional connectivity (FC) of default mode network (DMN) and cortical thickness assessed by functional and structural magnetic resonance imaging, other neuroimaging biomarkers, and neurobehavioral tests.

次要终点包括通过功能和结构磁共振成像评估的默认模式网络（DMN）内部网络功能连接（FC）和皮层厚度，以及其他神经影像生物标志物和神经行为测试。

Measurements and Main Results: Between 2017 and 2021, 148 patients were recruited from five hospitals.

测量和主要结果：在2017年至2021年间，从五家医院招募了148名患者。

Linear mixed models showed that there was no significant difference in MoCA scores at 6 months between the CPAP and BSC groups (difference, -0.04; 95% confidence interval[CI], -0.72 to 0.65; P = 0.91).

线性混合效应模型显示，在6个月时，CPAP组和BSC组的MoCA评分没有显著差异（差异，-0.04；95%置信区间[CI]，-0.72至0.65；P = 0.91）。

However, there were significant differences in the FC of DMN (difference, -13.73; 95% CI, -23.40 to -4.06; P = 0.01) and cortical thickness (difference, -0.06 mm; 95% CI, -0.10 to -0.01 mm; P = 0.02) between CPAP and BSC groups at 6 months after treatment.

然而，在治疗后6个月，与BSC组相比，CPAP组在DMN功能连接（差异，-13.73；95%置信区间，-23.40至-4.06；P=0.01）和皮层厚度（差异，-0.06毫米；95%置信区间，-0.10至-0.01毫米；P=0.02）上存在显著差异。

No serious adverse events occurred.

没有发生严重不良事件。

Conclusions: CPAP improved cortical thickness and FC of DMN, suggesting that patients with OSA may recover from brain atrophic processes after CPAP treatment.

结论：CPAP改善了皮层厚度和默认模式网络（DMN）的功能连接（FC），这表明OSA患者在CPAP治疗后可能会从脑萎缩过程中恢复。

However, no improvement in MoCA was found.

然而，未发现MoCA有改善。

Clinical trial registered with www.clinicaltrials.gov (NCT02886156).

该临床试验已在www.clinicaltrials.gov注册（NCT02886156）。