Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury

Ann C Halbower, Mahaveer Degaonkar, Peter B Barker, Christopher J Earley, Carole L Marcus, Philip L Smith, M Cristine Prahme, E Mark Mahone, Ann C Halbower, Mahaveer Degaonkar, Peter B Barker, Christopher J Earley, Carole L Marcus, Philip L Smith, M Cristine Prahme, E Mark Mahone

Abstract

Background: 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 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).

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Single Voxel Image from the…
Figure 1. Single Voxel Image from the Left Hippocampus in an 11-y-Old Normal Male Child
Blue areas are outer volume suppression bands that improve the accuracy of the hippocampal signal by suppressing surrounding lipid signal. On the right is a spectroscopy signal from a 11 year old male child, the spectrum demonstrating peaks from NAA, Cho, and Cr.
Figure 2. Hippocampal Neuronal NAA/Cho Metabolites Are…
Figure 2. Hippocampal Neuronal NAA/Cho Metabolites Are Decreased in Children with OSA aged 9–16 y
The ratio of NAA to Cho is decreased in the hippocampus of OSA patients compared to normal children.

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