STUDY OBJECTIVES Obstructive sleep apnea (OSA) patients show impaired autonomic regulation, perhaps related to functional reorganization of the insula, which in healthy individuals shows sex-specific anterior and right-dominance during sympathetic activation. We examined insular organization of responses to a Valsalva maneuver in OSA with functional magnetic resonance imaging (fMRI). METHODS We studied 43 newly-diagnosed OSA (age mean±std:46.8±8.7years; AHI±std:32.1±20.1events/hour;34male) and 63 healthy (47.2±8.8years;40male) participants. Participants performed four 18s Valsalva maneuvers (1min intervals, pressure≥30mmHg) during scanning. fMRI timetrends from five insular gyri-anterior short (ASG); mid short (MSG); posterior short (PSG); anterior long (ALG); and posterior long (PLG)-were assessed for within-group responses and between-group differences with repeated measures ANOVA (p<0.05); age and resting heart-rate (HR) influences were also assessed. RESULTS Right and anterior fMRI signal dominance appeared in OSA and controls, with no between-group differences. Separation by sex revealed group differences. Left-ASG anterior signal dominance was lower in OSA versus control males. Left-ASG and ALG anterior-dominance was higher in OSA versus control females. In all right gyri, only OSA females showed greater anterior-dominance than controls. Right-dominance was apparent in PSG and ALG in all groups; females showed right-dominance in MSG and PLG. OSA males did not show PLG right-dominance. Responses were influenced substantially by HR but modestly by age. CONCLUSIONS Anterior and right insular fMRI dominance appears similar in OSA vs control participants during the sympathetic phase of the Valsalva maneuver. OSA and control similarities were present in just males, but not necessarily females, which may reflect sex-specific neural injury.

中文翻译：

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Valsalva期间阻塞性睡眠呼吸暂停的男性和女性脑岛的功能组织

研究目标 阻塞性睡眠呼吸暂停 (OSA) 患者表现出自主神经调节受损，这可能与脑岛的功能重组有关，健康个体在交感神经激活期间表现出性别特异性的前部和右侧优势。我们使用功能性磁共振成像 (fMRI) 检查了 OSA 中对 Valsalva 动作反应的岛叶组织。方法 我们研究了 43 名新诊断的 OSA（平均年龄±标准：46.8±8.7 岁；AHI±标准：32.1±20.1 事件/小时；34 名男性）和 63 名健康（47.2±8.8 岁；40 名男性）参与者。参与者在扫描过程中进行了四次 18 秒 Valsalva 动作（间隔 1 分钟，压力≥30 毫米汞柱）。fMRI 时间趋势从五个岛状回前短 (ASG)；中空（味精）；后短（PSG）；前长 (ALG); 和后长 (PLG) - 用重复测量方差分析评估组内反应和组间差异（p < 0.05）；还评估了年龄和静息心率 (HR) 的影响。结果 OSA 和对照组出现右侧和前部 fMRI 信号优势，无组间差异。性别分离揭示了群体差异。与对照男性相比，OSA 中的左 ASG 前信号优势较低。与对照女性相比，OSA 中的左 ASG 和 ALG 前部优势更高。在所有右脑回中，只有 OSA 女性比对照组表现出更大的前部优势。在所有组的 PSG 和 ALG 中，权利优势都很明显；女性在 MSG 和 PLG 中显示出正确的优势。OSA 男性没有表现出 PLG 的权利优势。反应受 HR 影响很大，但受年龄影响不大。结论 在 Valsalva 动作的交感神经阶段，OSA 与对照组参与者的前部和右侧岛叶 fMRI 优势似乎相似。OSA 和对照组的相似性仅存在于男性中，但不一定存在于女性中，这可能反映了性别特异性神经损伤。