Childhood Obstructive Sleep Apnea Is Associated With Neuropsychological Deficits

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Childhood Obstructive Sleep Apnea Is Associated With

Neuropsychological Deficits And Neuronal Brain Injury

http://www.medicalnewstoday.com/medicalnews.php?newsid=50174

In this study, Ann Halbower and colleagues from s Hopkins

University School of Medicine looked at 19 children aged 6-16 y with

OSA and compared them with 12 healthy controls. The children

underwent sleep tests, a battery of neuropsychological assessments,

including IQ tests, and tests of executive function, and a group of

children were assessed by magnetic resonance spectroscopy, a special

form of brain imaging.

Children with OSA had significantly lower scores than matched

controls on full scale IQ tests and significantly lower performance

on measures of executive function, including verbal working memory

(sentence span) and word fluency. The special brain imaging (proton

magnetic resonance spectroscopic imaging) showed decreases in the

mean neuronal metabolite ratio of N-acetyl aspartate/choline in the

left hippocampus and right frontal cortex, indicating possible

neuronal injury in these areas.

Symptomatic childhood sleep-disordered breathing includes a range of

conditions in which children have difficulties with breathing when

they are asleep. The conditions range from simple snoring to the most

severe condition, obstructive sleep apnea (OSA). In children, OSA may

be associated with enlarged tonsils, long-term allergy, or obesity.

About two in every hundred children have OSA. The symptoms of OSA are

loud snoring at night, disrupted, restless sleep, undue tiredness,

and difficulties in concentration. If untreated, researchers believe

that it may lead to a number of long-term problems with health and

learning. Children with disorders of sleep have previously been shown

to have memory problems, lower general intelligence, and worse

executive function (the ability to adapt to new situations), and may

have behavioral problems similar to those of attention deficit

hyperactivity disorder.

Previous work has shown that adults with sleep apnea have

abnormalities of parts of their brain, specifically the frontal

cortex, cerebellum, and hippocampus, but this is the first study to

investigate similar changes in children. The authors speculate that

untreated childhood OSA could permanently alter a developing child's

cognitive potential, but that the changes in metabolites are not

necessarily permanent--in other diseases where changes have been

found they can be reversed with treatment.

If these results are confirmed in other children with OSA, and if

these results are reversible with treatment, it will highlight the

importance of treating children for OSA as soon as possible. In

addition, the measurement of metabolites may be a way of measuring

how well children are responding to treatment.

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Citation: Halbower AC, Degaonkar M, Barker PB, Earley CJ, Marcus CL,

et al. (2006) Childhood obstructive sleep apnea associates with

neuropsychological deficits and neuronal brain injury. PLoS Med 3(8):

e301

http://dx.doi.org/10.1371/journal.pmed.0030301