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However, no studies have investigated the full extent of the brain WM, and its associations with cognitive deficits in OSA remain unclear. We thus applied diffusion tensor imaging (DTI) tractography with multi\u2010fiber models and used atlas\u2010based bundle\u2010specific approach to investigate the WM abnormalities for various tracts of the cerebral cortex, thalamus, brainstem, and cerebellum in patients with untreated OSA. We enrolled 100 OSA patients and 63 healthy controls. Fractional anisotropy (FA) and mean diffusivity (MD) values mapped on 33 regions of interest including WM tracts of cortex, thalamus, brainstem, and cerebellum were obtained from tractography\u2010based reconstructions. We compared FA\/MD values between groups and correlated FA\/MD with clinical data in the OSA group after controlling for age and body mass index. OSA patients showed significantly lower FA values in multiple WM fibers including corpus callosum, inferior fronto\u2010occipital fasciculus, middle\/superior longitudinal fasciculi, thalamic radiations, and uncinate (FDR\u2009&lt;0.05). Higher FA values were found in medial lemniscus of patients compared to controls (FDR\u2009&lt;0.05). Lower FA values of rostrum of corpus callosum correlated with lower visual memory performance in OSA group (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.005). Our quantitative DTI analysis demonstrated that untreated OSA could negatively impact the integrity of pathways more broadly, including brainstem structures such as medial lemniscus, in comparison to previous findings. Fiber tract abnormalities of the rostral corpus callosum were associated with impaired visual memory in untreated OSA may provide insights into the related pathomechanism.<\/jats:p>","DOI":"10.1002\/hbm.26261","type":"journal-article","created":{"date-parts":[[2023,3,10]],"date-time":"2023-03-10T09:53:31Z","timestamp":1678442011000},"page":"3045-3056","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["More extensive white matter disruptions present in untreated obstructive sleep apnea than we thought: A large sample diffusion imaging study"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6858-6093","authenticated-orcid":false,"given":"Dae Lim","family":"Koo","sequence":"first","affiliation":[{"name":"Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center Seoul National University College of Medicine  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan P.","family":"Cabeen","sequence":"additional","affiliation":[{"name":"Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soon Hyun","family":"Yook","sequence":"additional","affiliation":[{"name":"Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven Yong","family":"Cen","sequence":"additional","affiliation":[{"name":"Department of Radiology, USC Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Yeon","family":"Joo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Samsung Medical Center Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hosung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nurt.2007.05.011"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2020.0311"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201606-1271OC"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.24971"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-021-01094-2"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.10609"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000006537"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/med\/9780190209407.001.0001"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0166-4328(01)00297-2"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2013.11.026"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.2172"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1843.2012.02255.x"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/resp.13140"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2015.11.061"},{"key":"e_1_2_8_16_1","unstructured":"Cabeen R. 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