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Brain Damage Seen in Adults with Obstructive Sleep Apnea

By MedImaging staff writers
Posted on 04 Aug 2008

Image: Colored scanning electron micrograph of myelinated nerve fibers, showing the myelin sheath (pink), the axoplasm (dark brown), and the endoneurium (yellow) (Photo courtesy of Steve Gschmeissner / SPL).

A new study provides visual evidence of the severe structural damage that occurs in many regions of the brain in individuals with obstructive sleep apnea (OSA).

Results from the study, published in the July 1, 2008, issue of the journal Sleep, revealed that OSA patients have extensive alterations in "white matter,” nerve tissue in the brain containing fibers that are insulated with myelin--a white, fatty sheath. These structural changes appear both in brain regions that have functional importance for characteristics such as mood, memory, and cardiovascular regulation; and in fiber pathways interconnecting these regions.

"Showing that the fibers are damaged means that many areas that work together to make one feel happy, to adjust blood pressure correctly to circumstances, and to remember properly can affect each other,” said lead investigator Ronald Harper, Ph.D., a professor of neurobiology at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA; USA). "That possibility, that we are now contending with an entire system of structures that serve memory, mood, and blood pressure, rather than individual structures, was surprising.”

The study involved 41 patients with moderate to severe OSA and 69 control participants matched by age. Diffusion tensor imaging (DTI), a newer modality of magnetic resonance imaging (MRI), was performed to examine the microstructure of the brain tissue. From this data, fractional anisotropy (FA) was derived to measure fiber integrity, resulting in a whole brain FA "map.”

Study participants with OSA had lower FA in multiple areas of the brain including regions of the cerebellum, thalamus, and prefrontal cortex. According to the investigators, lower FA primarily represents damage, shrinking, or loss of myelin in groups of axons--nerve fibers that transmit impulses away from the body of nerve cells. Such damage may affect the function of these brain regions, while similar changes to the fiber pathways may compromise the relaying of information between regions.

The investigators speculate that at least some of these changes result from the fluctuation of oxygen levels caused by pauses in breathing during OSA. In this study, the subjects with OSA averaged 15 to 101 partial or complete pauses in breathing per hour of sleep during one night of monitoring at the UCLA Sleep Disorders Laboratory. Blood flow in the brain is reduced during these pauses, the investigators also noted, and high blood pressure is associated with OSA; both of these conditions also create a potential for tissue damage.

In a related study published in the June 27, 2008, issue of the journal Neuroscience Letters, the same UCLA research group reported finding that people with sleep apnea also have tissue loss in the mammillary bodies, brain regions that help store memory. "The findings make it all the more imperative that OSA be treated as soon as possible to prevent further injury,” said Dr. Harper. "The long-term effects of OSA are terribly damaging to memory and thinking processes. Moreover, control of blood pressure is heavily impacted by the breathing condition, and if multiple areas, each connected with one another, are affected, regulation of blood pressure will be all the more difficult if OSA continues.”

The scientists concluded that the structural alterations found in the study probably represent injury that accumulated over time; it is uncertain if these changes are permanent, or if they can be reversed by treating OSA. "The changes in the brain connections we see with this technique may be to some degree reversible,” said lead author Paul Macey, Ph.D., an assistant professor in residence in the UCLA School of Nursing and Brain Research Institute. "However, some of the changes are probably due to fibers and cells having died.”

The most common treatment for OSA is continuous positive airway pressure (CPAP), which provides a steady stream of air through a mask that is worn during sleep. This airflow keeps the airway open to prevent pauses in breathing and restore normal oxygen levels.

According to the American Academy of Sleep Medicine, most individuals with OSA snore loudly and frequently, with periods of silence when airflow is reduced or blocked. They then make choking, snorting, or gasping sounds when their airway reopens. Approximately 80- 90% of adults with OSA remain undiagnosed.

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58 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

59 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

60 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

61 (101.08947753906): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (567.91305541992): SELECT fid FROM jos_deeppockets WHERE id=293970000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=293970000 AND published='1' LIMIT 1

63 (314.95094299316): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (46.968460083008): select jos_twitters.link from jos_twitters where cat=10

65 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

66 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

67 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

68 (39.100646972656): SELECT fid FROM jos_deeppockets WHERE id=293970000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=293970000 AND published='1' LIMIT 1

69 (39.815902709961): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (375.98609924316): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=293970000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (297.06954956055): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=293970000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (99.897384643555): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (75.101852416992): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (82.015991210938): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=293970000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (41.961669921875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=293970000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.968460083008): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

105 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

106 (54.836273193359): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=293970000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=293970000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

109 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

110 (72.002410888672): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=293970000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (684.02290344238): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=293970000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (544.07119750977): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (386.95335388184): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

115 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

116 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

117 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

118 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

119 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

120 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

121 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

122 (233.88862609863): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 29930.830001831): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (602.96058654785): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=293970000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=293970000 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9721.040725708): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (192.16537475586): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (245.80955505371): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (47.922134399414): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (225.06713867188): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (42.915344238281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (133.99124145508): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (128.03077697754): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (118.97087097168): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (453.94897460938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (339.03121948242): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (181.91337585449): SELECT name FROM jos_deeppockets WHERE id=212

138 (35.04753112793): SELECT name FROM jos_deeppockets WHERE id=212

139 (699.04327392578): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (761.98577880859): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

142 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

143 (!!!!! 19189.834594727): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1485.1093292236): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=293970000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (111.10305786133): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=293970000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1331.8061828613): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (158.07151794434): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (843.04809570312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

149 (!!!!! 1322.0310211182): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

150 (!!!!! 1503.9443969727): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (422.00088500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

152 (197.8874206543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

153 (464.91622924805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=293970000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=293970000 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (45.061111450195): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (37.193298339844): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (!!!!! 4465.1031494141): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 1056.9095611572): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

158 (!!!!! 3255.1288604736): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=293970000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=293970000 AND published='1' LIMIT 1

159 (142.81272888184): select jos_twitters.link from jos_twitters where cat=10

160 (39.100646972656): select jos_facebook.link from jos_facebook where cat=10

161 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

162 (78.916549682617): select jos_linkedin.link from jos_linkedin where cat=10

163 (325.91819763184): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 3067.9702758789): insert into jos_banners_delta values (14615,'2025-06-30 05:29:58','216.73.216.249','view'),(14202,'2025-06-30 05:29:58','216.73.216.249','view'),(14203,'2025-06-30 05:29:58','216.73.216.249','view')

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