A LARGE Korean cohort study has found that middle-aged and older adults with Obstructive Sleep Apnea (OSA) face a higher risk of developing cerebral microbleeds over an eight-year period.
Understanding Obstructive Sleep Apnea and Its Neurological Impact
Obstructive Sleep Apnea is a common sleep disorder that causes repeated pauses in breathing during sleep, leading to intermittent drops in oxygen levels and disrupted rest. It is already known to increase the risk of hypertension, stroke, and cardiovascular disease. However, its link to brain microvascular injury, such as cerebral microbleeds (CMBs), has been less clear. These small brain haemorrhages, visible on magnetic resonance imaging, are associated with cognitive decline and higher stroke risk. This new study sought to investigate if OSA contributes to such neurological damage.
Methods and Key Findings
Researchers followed 1,441 adults from a Korean community cohort who underwent overnight polysomnography and brain MRI scans at baseline and at two follow-up points, four and eight years later. Participants were categorised by OSA severity: no OSA (0–4.9 events/hour), mild OSA (5.0–14.9 events/hour), and moderate to severe OSA (≥15.0 events/hour).
At eight years, cumulative incidence rates of CMBs were 3.33% in the non-OSA group, 3.21% in mild OSA, and 7.25% in moderate to severe OSA. After adjusting for multiple confounders, those with moderate to severe Obstructive Sleep Apnea had more than double the risk of developing CMBs compared with those without OSA (RR 2.14; 95% CI 1.08–4.23; P = .02). The association persisted regardless of APOE-ε4 genetic status, a known risk factor for cognitive decline.
Clinical Implications and Future Directions
These findings highlight Obstructive Sleep Apnea as a potential modifiable risk factor for brain microvascular damage. Early screening and effective management of OSA could play a key role in preventing cerebral microbleeds and reducing long-term risks of stroke and dementia. Clinicians are urged to consider sleep assessments in patients presenting with neurological symptoms or vascular risk factors. Future research should examine whether treatment with continuous positive airway pressure (CPAP) or other interventions can mitigate these brain changes.
Reference
Siddiquee AT et al. Obstructive sleep apnea and cerebral microbleeds in middle-aged and older adults. JAMA Netw Open. 2025;8(10):e2539874.
