Association of Inflammatory Biomarkers with White Matter Lesions and Silent Lacunar Infarction in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

Yanpeng Li^1*Yanpeng Li²Xiaomeng Du³Yongqing Ding³Jin Sun¹Xiaoyan Lang¹Zhiyong Kang¹Xiaodong Li³

• ¹First Affiliated Hospital of Hebei North University, Zhangjiakou, China
• ²Zhangjiakou First Hospital, Zhangjiakou, China
• ³The First Affiliated Hospital of Hebei North University, Zhangjiakou, China

Background: While obstructive sleep apnoea-hypopnoea syndrome (OSAHS) is linked to cerebrovascular diseases like white matter lesions (WMLs) and silent lacunar infarction (SLI), this association is often confounded by shared metabolic risk factors. This study aims to investigate the independent association of OSAHS and related inflammatory markers with the presence of WMLs and SLI. Methods: In this prospective, single-center, case-control study, 89 participants were enrolled and divided into a simple OSAHS group (n=30), a combined group (OSAHS with SLI, n=29), and a control group (n=30). OSAHS patients were further categorized by severity (mild, n=25; moderate, n=19; severe, n=15) based on the Apnea-Hypopnea Index (AHI). Serum levels of amyloid A (SAA), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured. Brain MRI was used to assess WMLs and SLI. Multivariable logistic regression and correlation analyses were performed. Results: The prevalence and severity of WMLs were significantly higher in the simple OSAHS and combined groups compared to controls (P<0.001). Levels of SAA, TNF-α, and IL-6 were significantly elevated in both OSAHS groups compared to controls (P<0.001) and correlated positively with both AHI and WML severity scores (all P<0.001). After adjusting for age, BMI, hypertension, diabetes, hyperlipidemia, and smoking, multivariable logistic regression showed that moderate (Adjusted Odds Ratio [aOR]=3.5, 95% CI: 1.0–12.2) and severe OSAHS (aOR=5.8, 95% CI: 1.5–22.5) remained independent predictors of WMLs. Similarly, elevated SAA (aOR=1.9), TNF-α (aOR=2.2), and IL-6 (aOR=2.5) levels were also independent predictors (all P<0.05). Conclusion: Our findings demonstrate that OSAHS and its associated systemic inflammation are independently associated with an increased risk of WMLs and SLI, even after accounting for traditional metabolic risk factors. These findings highlight a strong association and suggest that inflammation may be a key factor in the cerebrovascular complications of OSAHS. Further longitudinal research is required to confirm potential causal relationships.