Numerous findings of brain structural changes in obstructive sleep apnea (OSA) give strong support to the notion that the disorder does cause brain injury. This chapter describes findings by technique, influences of factors other than the sleep disordered breathing on structural changes in OSA, and a summary of the brain regions shown across multiple studies to be affected in the disorder. Psychological symptoms of depression and anxiety are associated with neural changes in non-OSA populations, so one can hypothesize that the structural changes in OSA would be exacerbated in the presence of these symptoms. Many areas in the brain show structural impairments in OSA, including cortical, limbic, brainstem and cerebellar regions. Neuroimaging methods give numerical measures that are associated with a variety of biological pathologies, and technical limitations due to scanning and analysis issues limit the interpretability of the data.