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• Clinical Article •
Association between amide proton transfer signal and cognitive impairment in patients with obstructive sleep apnea syndrome
WEI Hongyue  LU Xueting  LIN Shiwei  LI Shuo  QIU Yingwei 

Cite this article as: WEI H Y, LU X T, LIN S W, et al. Association between amide proton transfer signal and cognitive impairment in patients with obstructive sleep apnea syndrome[J]. Chin J Magn Reson Imaging, 2026, 17(9): 75-83. DOI:10.12015/issn.1674-8034.2026.09.011.


[Abstract] Objective Using amide proton transfer (APT) imaging, we analyzed APT signal alterations in patients with obstructive sleep apnea (OSA) and the associations between cerebral APT signals, obesity, cognitive performance, and daytime sleepiness.Materials and Methods A total of 121 subjects were prospectively enrolled, including 81 patients with OSA and 40 healthy controls. All participants underwent 3.0 T cranial APT-weighted imaging and conventional MRI sequences. Fourteen whole-brain regions of interest (ROIs) were manually delineated to extract APT values. Multi-dimensional cognitive assessments and the Epworth Sleepiness Scale (ESS) were performed concurrently. The Mann-Whitney U test was used to compare intergroup differences in regional APT values. Partial correlation analyses adjusted for confounding factors were performed to explore correlations among variables. Mediation effect tests were conducted using the Bootstrap method with 5000 resamples, and the false discovery rate (FDR) correction was applied for multiple comparisons.Results APT values of the left frontal lobe, the bilateral parietal lobes, left temporal lobe, and bilateral hippocampi were significantly higher in the OSA group than those in the control group (Z = -3.223, -2.700, -4.143, -3.923, -3.218, and -3.813, respectively; all P < 0.05 after FDR correction). After adjustment for age, sex, and education level, APT signals of these abnormal brain regions were correlated with body mass index (BMI), multiple cognitive metrics, and ESS scores. Mediation analyses demonstrated that left temporal lobe APT signals exerted partial mediating effects on the associations between BMI and digit symbol test performance, baseline processing speed, conflict-processing speed, global cognitive function, and ESS scores [standardized indirect effect β = -0.052, 95% confidence interval (CI): -0.109 to -0.007; β = 0.078, 95% CI: 0.012 to 0.149; β = 0.081, 95% CI: 0.013 to 0.153; β = 0.080, 95% CI: 0.014 to 0.155; β = 0.054, 95% CI: 0.008 to 0.113; mediating effect proportions were 14.2%, 33.4%, 31.4%, 32.2%, and 12.8%, respectively].Conclusions Patients with OSA exhibit characteristic regional alterations in APT signals. Associations were observed among BMI, cerebral APT values, and cognitive impairment in all subjects. The left temporal lobe APT signal alterations may represent a potential cerebral intermediate link between BMI and cognitive impairment as well as daytime sleepiness. APT signals may serve as potential non-invasive neuroimaging biomarkers for assessing cognitive damage in patients with OSA.
[Keywords] obstructive sleep apnea；amide proton transfer imaging；magnetic resonance imaging；cognitive function；body mass index；mediation effect

WEI Hongyue1   LU Xueting2   LIN Shiwei2   LI Shuo3   QIU Yingwei1, 2*  

1 School of First Clinical, Ningxia Medical University, Yinchuan 750001, China

2 Department of Radiology, Shenzhen Nanshan People's Hospital, Shenzhen University, Shenzhen 518000, China

3 Department of Otorhinolaryngology, Shenzhen Nanshan People's Hospital, Shenzhen University, Shenzhen 518000, China

Corresponding author: QIU Y W, E-mail: qiuyw1201@gmail.com

Conflicts of interest   None.

Received  2026-07-03
Accepted  2026-09-12
DOI: 10.12015/issn.1674-8034.2026.09.011
Cite this article as: WEI H Y, LU X T, LIN S W, et al. Association between amide proton transfer signal and cognitive impairment in patients with obstructive sleep apnea syndrome[J]. Chin J Magn Reson Imaging, 2026, 17(9): 75-83. DOI:10.12015/issn.1674-8034.2026.09.011.

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