{"doi":"10.1001/jamanetworkopen.2025.39874","title":"Obstructive Sleep Apnea and Cerebral Microbleeds in Middle-Aged and Older Adults","abstract":"Importance: The association of obstructive sleep apnea (OSA) with risk of incident cerebral microbleeds (CMBs) is unknown. Objective: To investigate the association between OSA severity and risk of incident CMBs in the late middle-aged general population. Design, Setting, and Participants: This cohort study included eligible participants who had in-home overnight polysomnography data and brain magnetic resonance imaging done at baseline (2011-2014) and 4-year follow-ups (first follow-up, 2015-2018, and second follow-up, 2019-2022) from an ongoing longitudinal cohort study of a Korean community of adults. Data were analyzed from March 2024 through January 2025. Exposures: OSA severity was categorized by apnea-hypopnea index levels as no OSA (0-4.9 events/h), mild OSA (5.0-14.9 events/h), and moderate to severe OSA (≥15.0 events/h). Main Outcomes and Measures: CMBs were defined as well-defined focal areas (<10 mm in diameter) of very low signal intensity on gradient echo T2*-weighted images. Modified Poisson regression (robust error variance) was used to estimate relative risk (RR), with 95% CIs, of incident CMBs by OSA group; adjustment was done for age, sex, education level, body mass index, physical activity level, smoking and drinking status, total and low-density lipoprotein cholesterol level, hypertension, diabetes, age-related white matter changes, change in apnea-hypopnea index level, change in body mass index, and mean arterial pressure of the corresponding follow-up. Results: Of 1441 study participants (mean [SD] age, 57.75 [5.53] years; 759 female [52.67%]), 436 participants (30.25%) and 193 participants (13.39%) had mild and moderate to severe OSA at baseline, respectively; 812 participants had no OSA. The cumulative incidence rate of CMBs in non-OSA, mild OSA, and moderate to severe OSA groups was 15 participants (1.85%), 7 participants (1.61%), and 9 participants (4.66%), respectively, at 4 years and 27 participants (3.33%), 14 participants (3.21%), and 14 participants (7.25%), respectively, at 8 years. In multivariable modified Poisson models, participants with moderate to severe OSA compared with the non-OSA group had an increased risk of developing CMBs at 8 years (RR, 2.14; 95% CI, 1.08-4.23; P = .02). These results were unaffected by the presence or absence of APOE-ε4 carrier status. No significantly increased risks were observed at 4 years or in the mild OSA group at any time. Conclusions and Relevance: In this study, moderate to severe OSA was independently associated with an increased risk of incident CMBs over an 8-year follow-up. These results add to the evidence for the importance of sleep apnea to brain health.","journal":"JAMA Network Open","year":2025,"id":535202,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7512,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1418778,"name":"Yoon Ho Hwang","orcid":"0000-0003-0636-7084","position":1,"is_corresponding":false},{"id":531587,"name":"Soriul Kim","orcid":"0000-0002-6161-1636","position":2,"is_corresponding":false},{"id":1376159,"name":"Seung Ku Lee","orcid":"0000-0001-5120-5557","position":3,"is_corresponding":false},{"id":311338,"name":"Min‐Hee Lee","orcid":"0000-0002-1932-9557","position":4,"is_corresponding":false},{"id":785613,"name":"Hyeon Jin Kim","orcid":"0000-0003-1401-9258","position":5,"is_corresponding":false},{"id":544041,"name":"Young Jin Kim","orcid":"0000-0002-6235-6550","position":6,"is_corresponding":false},{"id":52739,"name":"Bong‐Jo Kim","orcid":"0000-0002-3722-2032","position":7,"is_corresponding":false},{"id":772466,"name":"Peter Hadar","orcid":"0000-0002-1681-4717","position":8,"is_corresponding":false},{"id":280809,"name":"M. Brandon Westover","orcid":"0000-0003-4803-312X","position":9,"is_corresponding":false},{"id":992542,"name":"Robert J. Thomas","orcid":"0000-0003-3216-7203","position":10,"is_corresponding":false},{"id":1376160,"name":"Nan Hee Kim","orcid":"0000-0003-4378-520X","position":11,"is_corresponding":false},{"id":390681,"name":"Chol Shin","orcid":"0000-0002-2928-8576","position":12,"is_corresponding":false},{"id":1418777,"name":"Ali Tanweer Siddiquee","orcid":"0000-0002-3583-094X","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-19T02:51:56.297114Z","pmid":"41148136","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}