SLEEPBrain MRI Changes Following Continuous Positive Airway Pressure Therapy in Adults with Obstructive Sleep Apnea: A Systematic Review 

⚠️ Evidence Review

Researchers reviewed longitudinal MRI studies evaluating brain changes before and after CPAP therapy in adults with OSA. While multiple studies reported imaging changes following treatment, findings varied substantially across MRI modalities, brain regions studied, CPAP adherence definitions, and analytic approaches.

Clinical Considerations

• Studies reported changes in gray matter, white matter, functional connectivity, perfusion, and cerebrovascular measures after CPAP therapy.
• Evidence was highly heterogeneous across imaging methods and study designs.
• Most studies were small and nonrandomized, limiting confidence in reproducibility.
• The review did not identify consistent MRI findings that could serve as reliable markers of treatment response.
• Current evidence does not support routine brain MRI monitoring in patients receiving CPAP.

Practice Applications

• CPAP remains the standard treatment for OSA, but MRI should not be used routinely to assess treatment response.
• Reported brain imaging changes should be viewed as hypothesis-generating rather than clinically actionable.
• Larger, harmonized longitudinal studies are needed before MRI biomarkers can inform individual patient management.