Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury

Abstract

BackgroundChildhood obstructive sleep apnea (OSA) is associated with neuropsychological deficits of memory, learning, and executive function. There is no evidence of neuronal brain injury in children with OSA. We hypothesized that childhood OSA is associated with neuropsychological performance dysfunction, and with neuronal metabolite alterations in the brain, indicative of neuronal injury in areas corresponding to neuropsychological function.Methods and FindingsWe conducted a cross-sectional study of 31 children (19 with OSA and 12 healthy controls, aged 6–16 y) group-matched by age, ethnicity, gender, and socioeconomic status. Participants underwent polysomnography and neuropsychological assessments. Proton magnetic resonance spectroscopic imaging was performed on a subset of children with OSA and on matched controls. Neuropsychological test scores and mean neuronal metabolite ratios of target brain areas were compared.Relative to controls, children with severe OSA had significant deficits in IQ and executive functions (verbal working memory and verbal fluency). Children with OSA demonstrated decreases of the mean neuronal metabolite ratio N-acetyl aspartate/choline in the left hippocampus (controls: 1.29, standard deviation [SD] 0.21; OSA: 0.91, SD 0.05; p = 0.001) and right frontal cortex (controls: 2.2, SD 0.4; OSA: 1.6, SD 0.4; p = 0.03).ConclusionsChildhood OSA is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex. We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential.

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

“…[22][23][24][25][26][27][28][29][30] The plausibility of the obstructive sleep apnea syndrome contributing to cognitive deficits is supported by research showing impaired learning in juvenile rats exposed to intermittent hypoxemia 3 and by imaging studies showing cerebral neuronal injury in children with the syndrome. 30 Previous studies have shown differences in the cognitive function of children with the obstructive sleep apnea syndrome, as compared with controls. 19,27,31 However, baseline cognitive scores of children with the obstructive sleep apnea syndrome fell within the normal range, a finding similar to that in the current study.…”

“…19,27,31 However, baseline cognitive scores of children with the obstructive sleep apnea syndrome fell within the normal range, a finding similar to that in the current study. Cognitive and behavioral abnormalities have been shown to be reduced after adenotonsillectomy in some, [24][25][26][27]29 but not all, 30 nonrandomized studies, with inconsistency in the reported effect after treatment. 25,29,32 Previous studies have been limited by small samples, lack of randomization or appropriate controls, heterogeneous study groups, and sole reliance on parent questionnaires rather than including neuropsychological testing.…”

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

“…(1) SDB has been linked to hypertension,(2) growth failure,(3) enuresis, (4,5) and impairment of cognition, attention, and executive functions. (6)(7)(8)(9)(10)(11)(12) Identification of children at high risk for SDB and its associated morbidities is particularly important given the growing body of evidence that treatment with adenotonsillectomy may improve quality of life and neurocognitive function. (5,(13)(14)(15)(16)(17) Preterm infants are especially vulnerable both to SDB and its sequelae.…”

Etiological treatment of OSA

“…Similarly, a recent study has shown metabolic alterations at the level of the hippocampus and the frontal cortex in children suffering from OSA in association with neuropsychic deficits that suggest a possible neural lesion related to OSA 5 .…”

“…Accordingly, electromyography analyses show that chronic partial enervation of the palatopharyngeal muscle can occur during episodes of OSA 5,14 . In short, structural changes, side effects of the vibration trauma related to snoring, can affect every component of the pharyngeal complex, and contribute to collapse of this segment of the airways.…”