This retrospective observational study aims to investigate the potential role of inflammatory markers associated with Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAHS) in the pathogenesis of white matter lesions (WML) and asymptomatic lacunar infarction (ALI). The study compares inflammatory marker levels (SAA, TNF-α, IL-6) and the severity of white matter lesions among patients with OSAHS alone, OSAHS with ALI, and a healthy control group to explore the relationship between the severity of OSAHS, inflammation, and cerebrovascular changes.

Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a prevalent condition characterized by recurrent upper airway obstruction during sleep, leading to chronic intermittent hypoxia, systemic inflammation, and endothelial dysfunction. These pathological changes are known risk factors for cerebrovascular diseases. White matter lesions and asymptomatic lacunar infarction are early indicators of cerebral small vessel disease and are associated with an increased risk of stroke and cognitive decline. While a link between OSAHS and these brain changes has been suggested, the role of specific inflammatory mediators is not fully understood. This study retrospectively analyzed data from 119 individuals who visited the sleep breathing monitoring clinic between May 2022 and May 2023. Participants were divided into three groups: a simple OSAHS group (n=60), an OSAHS group with concomitant asymptomatic lacunar infarction (combined group, n=29), and a non-OSAHS control group (n=30). The severity of OSAHS was categorized as mild, moderate, or severe based on the Apnea-Hypopnea Index (AHI). The study measured serum levels of Serum Amyloid A (SAA), Tumor Necrosis Factor-alpha (TNF-α), and Interleukin-6 (IL-6). The severity of white matter lesions was assessed using brain MRI and the Age-Related White Matter Change (ARWMC) scoring system. The primary hypothesis is that elevated levels of these OSAHS-related inflammatory markers are associated with the presence and severity of both white matter lesions and asymptomatic lacunar infarction.

Inclusion Criteria (for OSAHS and Combined Groups):

• Compliance with the diagnostic criteria for OSAHS (AHI > 5 times/h).
• For Combined Group: Brain MRI or CT evidence of lacunar infarction (diameter ≥3 mm) without a history of acute stroke or neurological deficits.
• No prior OSAHS-related surgery or CPAP treatment.
• Availability of complete clinical data.
• Age > 18 years old.

Inclusion Criteria (for Control Group):

• Did not meet the diagnostic criteria for OSAHS (AHI < 5 times/h).
• No evidence of asymptomatic or symptomatic cerebral infarction.
• Age > 18 years old.

Exclusion Criteria (for all groups):

• Symptomatic cerebral infarction, cerebral hemorrhage, brain injury, or brain tumors.
• Severe anxiety, depression, or other mental illness.
• Severe liver, kidney, heart, or lung dysfunction.
• Acute or chronic infections.
• Other severe respiratory diseases (e.g., COPD, interstitial lung disease).
• Central sleep apnea.
• Coexisting tumor or immune disorders.
• Claustrophobia.
• Pregnant women.

The study population was sourced from individuals who visited The First Affiliated Hospital of Hebei North University between May 2022 and May 2023. Case participants (patients with OSAHS) were enrolled from the sleep breathing monitoring clinic of the Otolaryngology Department. Control participants were non-OSAHS individuals who underwent health examinations at the same hospital during the same period. All participants were over 18 years old and met detailed inclusion/exclusion criteria.