Title: Sleep Apnea in Children May Affect Brain Development
Authors: Dr Sujit Kumar, Dr Pradeep Kumar, Dr Alka Singh
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.217
Abstract
Childhood 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 Findings: We conducted a cross-sectional study of 11 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.
Conclusions: Childhood 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.
Keywords: Children, Sleep, Apnea.
References
1. Gastaut H, Duron B, Tassinari CA, Lyagoubi S, Saier J (1969) Mechanism of the respiratory pauses accompanying slumber in the Pickwickian syndrome. Act Nerv Super (Praha) 11: 2095.
2. Guilleminault C, Rosekind M (1981) The arousal threshold: Sleep deprivation, sleep fragmentation, and obstructive sleep apnea syndrome. Bull Eur Physiopathol Respir 17: 111–119.
3. Reuveni H, Simon T, Tal A, Elhayany A, Tarasiuk A (2002) Health care services utilization in children with obstructive sleep apnea syndrome. Pediatrics 110: 68–72.
4. Salorio CF, White DA, Piccirillo J, Duntley SP, Uhles ML (2002) Learning, memory, and executive control in individuals with obstructive sleep apnea syndrome. J Clin Exp Neuropsychol 21: 91–100.
5. Bedard MA, Montplaisir J, Richer F, Rouleau I, Malo J (1991) Obstructive sleep apnea syndrome: Pathogenesis of neuropsychological deficits. J Clin Exp Neuropsychol 11: 950–961.
6. Gozal D (1998) Sleep-disordered breathing and school performance in children. Pediatrics 102: 616–620.
7. Beebe DW, Groesz L, Wells C, Nichols A, McGee K (2001) The neuropsychological effects of obstructive sleep apnea: A meta-analysis of normreferenced and case-controlled data. Sleep 26: 298–107.
8. Levin HS, Culhane KA, Hartmann J, Evankovich K, Mattson AJ, et al. (1991) Developmental changes in performance on tests of purported frontal lobe functioning. Dev Neuropsychol 7: 177–195.
9. Welch MC, Pennington BF, Groisser DB (1991) A normative-developmental study of executive function. A window on prefrontal function in children. Dev Neuropsychol 7: 111–119.
10. Denckla MB (1996) Research on executive function in a neurodevelopmental context: Application of clinical measures. Dev Neuropsychol 12: 5– 15.
11. Jones K, Harrison Y (2001) Frontal lobe function, sleep loss and fragmented sleep. Sleep Med Rev 5: 161–175.
12. Bao G, Guilleminault C (2001) Upper airway resistance syndrome—One decade later. Curr Opin Pulm Med 10: 161–167.
13. Gottlieb DJ, Vezina RM, Chase C, Lesko SM, Heeren TC, et al. (2001) Symptoms of sleep-disordered breathing in 5-year-old children are associated with sleepiness and problem behaviors. Pediatrics 112: 870–877.
14. Archbold KH, Pituch KJ, Panahi P, Chervin RD (2002) Symptoms of sleep disturbances among children at two general pediatric clinics. J Pediatr 110: 97–102.
15. Ali NJ, Pitson D, Stradling JR (1996) Sleep disordered breathing: Effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr 155: 56–62.
16. Goldstein NA, Fatima M, Campbell TF, Rosenfeld RM (2002) Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg 128: 770–775.
17. Owens J, Opipari L, Nobile C, Spirito A (1998) Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders. Pediatrics 102: 1178–1181.
18. Stradling JR, Thomas G, Warley AR, Williams P, Freeland A (1990) Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet 115: 219–251.
19. Guilleminault C, Winkle R, Korobkin R, Simmons B (1982) Children and nocturnal snoring: Evaluation of the effects of sleep related respiratory resistive load and daytime functioning. Eur J Pediatr 119: 165–171.
20. Brouillette RT, Fernbach SK, Hunt CE (1982) Obstructive sleep-apnea in infants and children. J Pediatr 100: 11–10.