Metabolic Brain Disease

, Volume 33, Issue 6, pp 2019–2029 | Cite as

The association of sleep-disordered breathing and white matter hyperintensities in heart failure patients

  • Chooza MoonEmail author
  • Barbara B. Bendlin
  • Kelsey E. Melah
  • Lisa C. Bratzke
Original Article


Heart failure patients often manifest white matter hyperintensites on brain magnetic resonance imaging (MRI). White matter hyperintnsities have also been linked with cognitive problems in patients with heart failure. Sleep disordered breathing may contribute to structural brain changes in heart failure. The purpose of this study was to test the extent to which the apnea hypopnea index is associated with global and regional white matter hyperintensities, and is a moderating factor in the relationship between age and white matter hyperintensites. A total of 28 HF patients [mean age (SD) = 67.89 (5.8)] underwent T1-weighted and T2FLAIR MRI and a home sleep monitoring study. The apnea hypopnea index cut off of 10 was used to compare between higher and lower risks of sleep disordered breathing. Regression analysis was used to test the association between apnea hypopnea index and both global and regional white matter hyperintensities. The interaction term was entered to identify the moderation effect. Apnea hypopnea index was associated with higher regional white matter hyperintensities but not global white matter hyperintensities. There was a significant interaction between the apnea hypopnea index and age, such that older participants with the apnea hypopnea index ≥10 showed greater regional white matter hyperintensities than those with the apnea hypopnea index <10. The results of this preliminary study indicate that a higher apnea hypopnea index is associated with more white matter hyperintensities. The age-related white matter hyperintensities appear to be exacerbated by apnea hypopnea index in our individuals with heart failure. Future studies are needed to further investigate the underlying mechanisms.


Sleep apnea syndrome Heart failure White matter hyperintensities Structural MRI 



field of view


heart failure


The International Consortium for Brain Mapping


Intracranial volume


left ventricular ejection fraction


magnetic resonance imaging


Montreal Neurological Institute


apnea hypopnea index


sleep disordered breathing


statistical parametric mapping 8


T2 Fluid attenuation inversion recovery


echo time


inversion time


repetition time


white matter hyperintensities


white matter hyperinensity percent



Authors thank to members of the Wisconsin Alzheimer's Diesease Research Center for advices regarding MRI data acquisition and analysis.


The project described in this paper was supported by the Sigma Theta Tau Beta-Eta at Large chapter and the National Institute of Nursing Research, award Number R00NR012773 (Brain Alterations and Cognitive Impairment in Older Adults with Heart Failure). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Nursing Research or the National Institutes of Health.

Compliance with ethical standards

Conflict of interest

The authors have indicated no financial conflicts of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.College of NursingUniversity of IowaIowa CityUSA
  2. 2.School of NursingUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.Wisconsin Alzheimer’s Disease Research Center, Wisconsin Alzheimer’s Institute, School of Medicine and Public HealthUniversity of Wisconsin-MadisonMadisonUSA

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