{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:02:33Z","timestamp":1793383353927,"version":"4.5.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T00:00:00Z","timestamp":1576627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Ministry of Science, ICT & Future Planning, Republic of Korea","award":["2017R1A2B4003120"],"award-info":[{"award-number":["2017R1A2B4003120"]}]},{"name":"Samsung Biomedical Research Institute","award":["OTC1190671"],"award-info":[{"award-number":["OTC1190671"]}]},{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2016R1A2B4014398"],"award-info":[{"award-number":["2016R1A2B4014398"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008783","name":"National Research Council of Science & Technology","doi-asserted-by":"publisher","award":["CAP-18-01-KIST"],"award-info":[{"award-number":["CAP-18-01-KIST"]}],"id":[{"id":"10.13039\/501100008783","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P41EB015922"],"award-info":[{"award-number":["P41EB015922"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,3,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Study Objectives<\/jats:title>\n                  <jats:p>Neurocognitive impairment is one of the daytime symptoms of obstructive sleep apnea (OSA). We proposed to use tract-specific statistical analysis (TSSA) to investigate whether there are fiber tract abnormalities in OSA, which may be undiscovered using voxel-based approaches, and whether such tract-specific disruptions in brain connectivity are associated with neuropsychological deficits in patients with untreated OSA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We enrolled 38 patients with OSA diagnosed by overnight polysomnography, and 41 healthy sleepers. Fractional anisotropy (FA) and mean diffusivity (MD) maps were obtained from whole-brain diffusion tensor imaging, and TSSA were used to assess regional deficits of white matter tracts. All participants underwent a battery of neuropsychological tests. To evaluate the association between FA values and clinical, polysomnographic, and neuropsychological parameters in the OSA group, permutation-based tests for correlation were performed preceding cluster-based statistics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Compared to healthy controls, patients with OSA showed decreased values of FA in the left and right anterior thalamic radiations, and right uncinate fasciculus (UNC) (p &amp;lt; 0.001, p = 0.005, and p = 0.008, respectively). A lower score of digit span backward was associated with lower FA values of right UNC in the OSA group (p = 0.023). The Rey Complex Figure Test copy score revealed a positive correlation with FA values in the right UNC (p = 0.010).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The TSSA method indeed identified previously unrevealed tract-specific disruptions in OSA. Furthermore, reduced FA values in the frontal lobe portion of the right UNC which has been known to be involved in working memory function were significantly associated with lower cognitive performance in patients with untreated OSA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/sleep\/zsz247","type":"journal-article","created":{"date-parts":[[2019,12,18]],"date-time":"2019-12-18T08:07:25Z","timestamp":1576656445000},"source":"Crossref","is-referenced-by-count":37,"title":["White matter tract-specific alterations in male patients with untreated obstructive sleep apnea are associated with worse cognitive function"],"prefix":"10.1093","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6858-6093","authenticated-orcid":false,"given":"Dae Lim","family":"Koo","sequence":"first","affiliation":[{"name":"Department of Neurology, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye Ryun","family":"Kim","sequence":"first","affiliation":[{"name":"Global Health Technology Research Center, College of Health Science, Korea University, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hosung","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurology, USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joon-Kyung","family":"Seong","sequence":"first","affiliation":[{"name":"Global Health Technology Research Center, College of Health Science, Korea University, Seoul, South Korea"},{"name":"School of Biomedical Engineering, Korea University, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1233-959X","authenticated-orcid":false,"given":"Eun Yeon","family":"Joo","sequence":"first","affiliation":[{"name":"Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Biomedical Research Institute, Seoul, South Korea"},{"name":"Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,12,18]]},"reference":[{"issue":"1","key":"2020031204572850500_CIT0001","doi-asserted-by":"crossref","first-page":"12","DOI":"10.5853\/jos.2017.02887","article-title":"Sleep disturbances as a risk factor for stroke","volume":"20","author":"Koo","year":"2018","journal-title":"J Stroke."},{"issue":"3","key":"2020031204572850500_CIT0002","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1093\/sleep\/23.3.1d","article-title":"Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsychological test battery","volume":"23","author":"D\u00e9cary","year":"2000","journal-title":"Sleep."},{"issue":"7","key":"2020031204572850500_CIT0003","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1111\/resp.13140","article-title":"Reviewing the relationship between OSA and cognition: where do we go from here?","volume":"22","author":"Bucks","year":"2017","journal-title":"Respirology."},{"issue":"2","key":"2020031204572850500_CIT0004","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.neuroimage.2010.09.065","article-title":"Cognitive profile and brain morphological changes in obstructive sleep apnea","volume":"54","author":"Torelli","year":"2011","journal-title":"Neuroimage."},{"issue":"3","key":"2020031204572850500_CIT0005","doi-asserted-by":"crossref","first-page":"361","DOI":"10.5665\/sleep.4490","article-title":"White matter damage and systemic inflammation in obstructive sleep apnea","volume":"38","author":"Chen","year":"2015","journal-title":"Sleep."},{"issue":"7","key":"2020031204572850500_CIT0006","first-page":"967","article-title":"Brain structural changes in obstructive sleep apnea","volume":"31","author":"Macey","year":"2008","journal-title":"Sleep."},{"issue":"10","key":"2020031204572850500_CIT0007","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1002\/jnr.23083","article-title":"Altered global and regional brain mean diffusivity in patients with obstructive sleep apnea","volume":"90","author":"Kumar","year":"2012","journal-title":"J Neurosci Res."},{"issue":"1","key":"2020031204572850500_CIT0008","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1586\/17476348.2.1.75","article-title":"Intermittent hypoxia: the culprit of oxidative stress, vascular inflammation and dyslipidemia in obstructive sleep apnea","volume":"2","author":"Lavie","year":"2008","journal-title":"Expert Rev Respir Med."},{"issue":"4","key":"2020031204572850500_CIT0009","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1016\/j.neuroimage.2006.02.024","article-title":"Tract-based spatial statistics: voxelwise analysis of multi-subject diffusion data","volume":"31","author":"Smith","year":"2006","journal-title":"Neuroimage."},{"issue":"3","key":"2020031204572850500_CIT0010","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1016\/j.neuroimage.2008.12.023","article-title":"Tract-based morphometry for white matter group analysis","volume":"45","author":"O\u2019Donnell","year":"2009","journal-title":"Neuroimage."},{"issue":"4","key":"2020031204572850500_CIT0011","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.3233\/JAD-150841","article-title":"Tract-specific correlates of neuropsychological deficits in patients with subcortical vascular cognitive impairment","volume":"50","author":"Jung","year":"2016","journal-title":"J Alzheimers Dis."},{"key":"2020031204572850500_CIT0012","volume-title":"The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications","author":"Iber","year":"2007","edition":"1"},{"issue":"2","key":"2020031204572850500_CIT0013","doi-asserted-by":"crossref","first-page":"130","DOI":"10.3988\/jcn.2012.8.2.130","article-title":"The relationship between hippocampal volume and cognition in patients with chronic primary insomnia","volume":"8","author":"Noh","year":"2012","journal-title":"J Clin Neurol."},{"key":"2020031204572850500_CIT0014","article-title":"Diffusion toolkit: a software package for diffusion imaging data processing and tractography","volume":"15","author":"Wang","year":"2007","journal-title":"Proc Intl Soc Mag Reson Med."},{"issue":"2","key":"2020031204572850500_CIT0015","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1002\/1531-8249(199902)45:2<265::AID-ANA21>3.0.CO;2-3","article-title":"Three-dimensional tracking of axonal projections in the brain by magnetic resonance imaging","volume":"45","author":"Mori","year":"1999","journal-title":"Ann Neurol."},{"issue":"7","key":"2020031204572850500_CIT0016","doi-asserted-by":"crossref","first-page":"e0133337","DOI":"10.1371\/journal.pone.0133337","article-title":"An example-based multi-atlas approach to automatic labeling of white matter tracts","volume":"10","author":"Yoo","year":"2015","journal-title":"PLoS One."},{"issue":"11","key":"2020031204572850500_CIT0017","doi-asserted-by":"crossref","first-page":"e49790","DOI":"10.1371\/journal.pone.0049790","article-title":"Tract profiles of white matter properties: automating fiber-tract quantification","volume":"7","author":"Yeatman","year":"2012","journal-title":"PLoS One."},{"issue":"1","key":"2020031204572850500_CIT0018","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1109\/42.750253","article-title":"Global, voxel, and cluster tests, by theory and permutation, for a difference between two groups of structural MR images of the brain","volume":"18","author":"Bullmore","year":"1999","journal-title":"IEEE Trans Med Imaging."},{"issue":"12","key":"2020031204572850500_CIT0019","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1111\/j.1469-8986.2011.01273.x","article-title":"Mass univariate analysis of event-related brain potentials\/fields I: a critical tutorial review","volume":"48","author":"Groppe","year":"2011","journal-title":"Psychophysiology."},{"issue":"8","key":"2020031204572850500_CIT0020","doi-asserted-by":"crossref","first-page":"e72332","DOI":"10.1371\/journal.pone.0072332","article-title":"Cluster-based statistics for brain connectivity in correlation with behavioral measures","volume":"8","author":"Han","year":"2013","journal-title":"PLoS One."},{"issue":"2","key":"2020031204572850500_CIT0021","first-page":"127","article-title":"Why permutation tests are superior totandftests in biomedical research","volume":"52","author":"Ludbrook","year":"1998","journal-title":"Am Statist"},{"issue":"1","key":"2020031204572850500_CIT0022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/hbm.1058","article-title":"Nonparametric permutation tests for functional neuroimaging: a primer with examples","volume":"15","author":"Nichols","year":"2002","journal-title":"Hum Brain Mapp."},{"key":"2020031204572850500_CIT0023","volume-title":"Numerical ecology","author":"Legendre","year":"1998","edition":"2"},{"key":"2020031204572850500_CIT0024","doi-asserted-by":"crossref","first-page":"1764837","DOI":"10.1155\/2016\/1764837","article-title":"Obstructive sleep apnea in women: specific issues and interventions","volume":"2016","author":"Wimms","year":"2016","journal-title":"Biomed Res Int."},{"key":"2020031204572850500_CIT0025","volume-title":"Pirko I. Multiple Sclerosis 3: Advances in Multiple Sclerosis Imaging","year":"2009","edition":"1"},{"key":"2020031204572850500_CIT0026","doi-asserted-by":"crossref","first-page":"99","DOI":"10.2147\/HP.S103091","article-title":"Chronic intermittent hypoxia and obstructive sleep apnea: an experimental and clinical approach","volume":"4","author":"Sforza","year":"2016","journal-title":"Hypoxia (Auckl)."},{"key":"2020031204572850500_CIT0027","doi-asserted-by":"crossref","first-page":"251096","DOI":"10.1155\/2012\/251096","article-title":"Pathogenesis of cognitive dysfunction in patients with obstructive sleep apnea: a hypothesis with emphasis on the nucleus tractus solitarius","volume":"2012","author":"Daulatzai","year":"2012","journal-title":"Sleep Disord."},{"issue":"12","key":"2020031204572850500_CIT0028","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.5664\/jcsm.5278","article-title":"Nocturnal hypoxemia is associated with white matter hyperintensities in patients with a minor stroke or transient ischemic attack","volume":"11","author":"Patel","year":"2015","journal-title":"J Clin Sleep Med."},{"issue":"9","key":"2020031204572850500_CIT0029","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.5665\/sleep.3994","article-title":"White matter integrity in obstructive sleep apnea before and after treatment","volume":"37","author":"Castronovo","year":"2014","journal-title":"Sleep."},{"issue":"2","key":"2020031204572850500_CIT0030","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1055\/s-2002-24985","article-title":"The neuroanatomy of attention","volume":"23","author":"Filley","year":"2002","journal-title":"Semin Speech Lang."},{"issue":"4","key":"2020031204572850500_CIT0031","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1002\/hipo.1048","article-title":"Medial temporal and prefrontal contributions to working memory tasks with novel and familiar stimuli","volume":"11","author":"Stern","year":"2001","journal-title":"Hippocampus."},{"issue":"1","key":"2020031204572850500_CIT0032","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1006\/nimg.2002.1136","article-title":"Virtual in vivo interactive dissection of white matter fasciculi in the human brain","volume":"17","author":"Catani","year":"2002","journal-title":"Neuroimage."},{"issue":"Pt 3","key":"2020031204572850500_CIT0033","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1093\/brain\/awl359","article-title":"Association fibre pathways of the brain: parallel observations from diffusion spectrum imaging and autoradiography","volume":"130","author":"Schmahmann","year":"2007","journal-title":"Brain."},{"issue":"11","key":"2020031204572850500_CIT0034","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1093\/cercor\/12.11.1218","article-title":"Asymmetry of the uncinate fasciculus: a post-mortem study of normal subjects and patients with schizophrenia","volume":"12","author":"Highley","year":"2002","journal-title":"Cereb Cortex."},{"issue":"4","key":"2020031204572850500_CIT0035","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.cortex.2009.07.005","article-title":"White matter pathways associated with working memory in normal aging","volume":"46","author":"Charlton","year":"2010","journal-title":"Cortex."},{"issue":"8","key":"2020031204572850500_CIT0036","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1111\/j.1528-1167.2008.01596.x","article-title":"Abnormalities in diffusion tensor imaging of the uncinate fasciculus relate to reduced memory in temporal lobe epilepsy","volume":"49","author":"Diehl","year":"2008","journal-title":"Epilepsia."},{"issue":"10","key":"2020031204572850500_CIT0037","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1111\/j.1469-8986.2012.01448.x","article-title":"Frontotemporal anatomical connectivity and working-relational memory performance predict everyday functioning in schizophrenia","volume":"49","author":"Hanlon","year":"2012","journal-title":"Psychophysiology."},{"issue":"5","key":"2020031204572850500_CIT0038","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1017\/S1355617715000314","article-title":"Fusing functional MRI and diffusion tensor imaging measures of brain function and structure to predict working memory and processing speed performance among inter-episode bipolar patients","volume":"21","author":"McKenna","year":"2015","journal-title":"J Int Neuropsychol Soc."},{"issue":"1","key":"2020031204572850500_CIT0039","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1523\/JNEUROSCI.3862-09.2010","article-title":"Mechanisms of spatial attention control in frontal and parietal cortex","volume":"30","author":"Szczepanski","year":"2010","journal-title":"J Neurosci."},{"key":"2020031204572850500_CIT0040","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.neuroimage.2014.06.021","article-title":"Methodological considerations on tract-based spatial statistics (TBSS)","volume":"100","author":"Bach","year":"2014","journal-title":"Neuroimage."},{"key":"2020031204572850500_CIT0041","first-page":"448","article-title":"Structure-specific statistical mapping of white matter tracts","volume-title":"Neuroimage","author":"Yushkevich","year":"2008"},{"issue":"5","key":"2020031204572850500_CIT0042","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.media.2010.05.002","article-title":"A tract-specific framework for white matter morphometry combining macroscopic and microscopic tract features","volume":"14","author":"Zhang","year":"2010","journal-title":"Med Image Anal."},{"key":"2020031204572850500_CIT0043","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/j.neuroimage.2013.11.025","article-title":"Diffusion properties of major white matter tracts in young, typically developing children","volume":"88","author":"Johnson","year":"2014","journal-title":"Neuroimage."},{"issue":"Pt 1","key":"2020031204572850500_CIT0044","first-page":"917","article-title":"Findings in schizophrenia by tract-oriented DT-MRI analysis","volume":"11","author":"Maddah","year":"2008","journal-title":"Med Image Comput Comput Assist Interv."},{"issue":"12","key":"2020031204572850500_CIT0045","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1038\/nm.3390","article-title":"Quantifying the local tissue volume and composition in individual brains with magnetic resonance imaging","volume":"19","author":"Mezer","year":"2013","journal-title":"Nat Med."},{"issue":"1-2","key":"2020031204572850500_CIT0046","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.drugalcdep.2012.09.013","article-title":"Heavy smokers show abnormal microstructural integrity in the anterior corpus callosum: a diffusion tensor imaging study with tract-based spatial statistics","volume":"129","author":"Lin","year":"2013","journal-title":"Drug Alcohol Depend."},{"issue":"1","key":"2020031204572850500_CIT0047","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1002\/hbm.23038","article-title":"Effects of long-term treatment on brain volume in patients with obstructive sleep apnea syndrome","volume":"37","author":"Kim","year":"2016","journal-title":"Hum Brain Mapp."}],"container-title":["Sleep"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/sleep\/advance-article-pdf\/doi\/10.1093\/sleep\/zsz247\/31559136\/zsz247.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/sleep\/article-pdf\/43\/3\/zsz247\/32849227\/zsz247.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/sleep\/article-pdf\/43\/3\/zsz247\/32849227\/zsz247.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,3,12]],"date-time":"2020-03-12T08:59:06Z","timestamp":1584003546000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/sleep\/article\/doi\/10.1093\/sleep\/zsz247\/5680176"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,18]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,12,18]]},"published-print":{"date-parts":[[2020,3,12]]}},"URL":"https:\/\/doi.org\/10.1093\/sleep\/zsz247","relation":{},"ISSN":["0161-8105","1550-9109"],"issn-type":[{"value":"0161-8105","type":"print"},{"value":"1550-9109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,3]]},"published":{"date-parts":[[2019,12,18]]},"article-number":"zsz247"}}