{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T06:07:09Z","timestamp":1789106829971,"version":"build-2803163510"},"reference-count":81,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The roles of cortical glymphatic dysfunction and excitation-inhibition imbalance in cognitive impairment associated with obstructive sleep apnea (OSA) require further study. This study aimed to investigate sleep-related glymphatic function and neurotransmitter changes in OSA and their relationships with cognition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighty seven participants (50 OSA, 37 controls) completed a pre-sleep MRI, followed by an overnight PSG recording, and a post-sleep MRI to assess sleep-dependent glymphatic and neurotransmitter changes. Resting-state blood-oxygen-level-dependent (BOLD) signals and cerebrospinal fluid (CSF) signals (BOLD-CSF coupling), an indirect glymphatic-related imaging proxy, were assessed in the global cortex, anterior cingulate cortex (ACC), posterior cingulate cortex (PCC), and default mode network (DMN) cortex. MRS-derived gamma-aminobutyric acid (GABA) and glutamate\/glutamine (Glx) levels were measured in the ACC and PCC as indirect neurochemical measures of excitation-inhibition (E\/I) balance. General linear models, linear mixed-effects models, correlation analyses, and moderation analyses were employed to examine group differences, overnight changes in BOLD-CSF coupling and neurotransmitters, and their relationships with cognitive performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the moderate-to-severe OSA group, pre-sleep global and ACC-BOLD-CSF coupling were weaker than in controls, and ACC-GABA showed a group \u00d7 time interaction (\u03b7\n                      <jats:sub>p<\/jats:sub>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0.105,\n                      <jats:italic>p<\/jats:italic>\n                      -FDR\u202f=\u202f0.049), with a significant overnight decrease observed only in controls (Cohen\u2019s d\u202f=\u202f0.75,\n                      <jats:italic>p<\/jats:italic>\n                      -FDR\u202f=\u202f0.007). Greater magnitudes of overnight change in both ACC-BOLD-CSF coupling and ACC-E\/I were independently associated with worse cognition. ACC-E\/I change also moderated the coupling-cognition relationship (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.590,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.015), with a significant negative association only at smaller magnitudes of E\/I change (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.729,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that OSA severity is associated with ACC-specific BOLD-CSF decoupling and a disrupted overnight decline in ACC-GABA. The magnitude of overnight E\/I variation moderated the association between BOLD-CSF coupling variation and cognitive performance. These preliminary findings highlight the potential relevance of ACC-BOLD-CSF coupling and neurochemical alterations to OSA-related cognitive impairment. Future studies with larger sample sizes are needed to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2026.1932223","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:28:58Z","timestamp":1789104538000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep-dependent alterations in anterior cingulate cortex excitation\u2013inhibition balance link alterations in BOLD-CSF coupling to cognitive performance in obstructive sleep apnea"],"prefix":"10.3389","volume":"18","author":[{"given":"Youquan","family":"Ning","sequence":"first","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenliang","family":"Xiong","sequence":"additional","affiliation":[{"name":"College of Computer Science and Technology, Guizhou University","place":["Guiyang, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehu","family":"Sheng","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Laboratory of Research and Translation for Geriatric Diseases, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"He","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoxin","family":"Xiang","sequence":"additional","affiliation":[{"name":"MR Scientific Collaboration, United Imaging Healthcare","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yida","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fajin","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Radiology, The First Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2111","DOI":"10.1007\/s11325-023-02783-7","article-title":"Sleep apnea pathophysiology","volume":"27","author":"Andrisani","year":"2023","journal-title":"Sleep Breath."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1186\/s12888-026-08102-0","article-title":"Ultra-high field magnetic resonance spectroscopy study of transcranial magnetic stimulation treatment in adolescents with depression","volume":"26","author":"Bakir","year":"2026","journal-title":"BMC Psychiatry"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"609485","DOI":"10.3389\/fnins.2021.609485","article-title":"Effect of ketamine on human neurochemistry in posterior cingulate cortex: a pilot magnetic resonance spectroscopy study at 3 tesla","volume":"15","author":"Bednarik","year":"2021","journal-title":"Front. 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