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Published on: February 14, 2019
Age Effects on Cerebral Oxygenation and Behavior in Children with Sleep-disordered Breathing
Knarik Tamanyan1,2, Lisa M Walter1,2, Aidan Weichard1,2
11 The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
Insights
Children with primary snoring experience daytime deficits similar to obstructive sleep apnea, but cerebral oxygenation changes are small and not linked to cognitive issues. However, these subtle changes in oxygenation correlate with behavioral problems in older children.
Area of Science:
- Pediatric Sleep Medicine
- Neuroscience
- Respiratory Medicine
Background:
- Childhood sleep-disordered breathing (SDB) encompasses primary snoring to obstructive sleep apnea (OSA).
- SDB is linked to behavioral and neurocognitive deficits, but the reasons for similar daytime deficits in primary snoring versus OSA, and age-dependency, remain unclear.
- Investigating cerebral oxygenation may explain these deficits.
Purpose of the Study:
- To investigate cerebral tissue oxygenation and oxygen extraction in children with primary snoring.
- To determine if these physiological measures explain daytime deficits observed in children with SDB.
- To explore age-dependent effects on cerebral oxygenation in relation to SDB severity.
Main Methods:
- Overnight polysomnography with near-infrared spectroscopy was performed on children with suspected SDB and controls.
- Participants were divided into 3-6 year and 7-12 year age groups.
- Children were classified into primary snoring (≤1 event/h), mild (>1-5 events/h), and moderate/severe OSA (>5 events/h) based on the obstructive apnea-hypopnea index.
Main Results:
- No significant differences in cerebral oxygenation or extraction were found between SDB severity groups in 3-6 year olds.
- In 7-12 year olds, small but significant reductions in cerebral oxygenation were observed in controls compared to primary snoring during wakefulness and sleep.
- Cerebral oxygenation changes were not associated with cognitive performance but were linked to behavioral measures in older children.
Conclusions:
- Children with SDB can maintain cerebral oxygenation, with observed minor changes not correlating with cognitive deficits.
- Subtle alterations in cerebral oxygenation in children with SDB are associated with behavioral issues, particularly in older school-aged children.
Rationale:
Childhood sleep-disordered breathing ranges in severity from primary snoring to obstructive sleep apnea and is associated with behavioral and neurocognitive deficits. It remains unknown why children with primary snoring, who do not experience peripheral oxygen desaturation or sleep fragmentation, experience similar daytime deficits as those with obstructive sleep apnea or why effects are age-dependent.
Objectives:
To examine cerebral tissue oxygenation and oxygen extraction as an explanation for daytime deficits in children with primary snoring.
Methods:
Children referred for suspected sleep-disordered breathing and nonsnoring control subjects underwent overnight polysomnography with near-infrared spectroscopy. Children were categorized into 3- to 6-year (n = 87) and 7- to 12-year (n = 72) old groups, and according to the obstructive apnea-hypopnea index into primary snoring (≤1 event/h), mild (>1-5 events/h), and moderate/severe obstructive sleep apnea (>5 events/h). Cognitive and behavioral performance were assessed.
Measurements And Main Results:
In the 3- to 6-year group, there were no differences in cerebral oxygenation or oxygen extraction between severity groups. In the 7- to 12-year group, cerebral oxygenation was significantly lower, although these differences were small, in control subjects versus primary snoring during quiet wakefulness before sleep onset, N1, and REM. Oxygen extraction was significantly higher in control subjects versus primary snoring during N1 sleep, with no differences between primary snoring and obstructive sleep apnea groups. Cerebral oxygenation was not associated with cognitive performance in either age group or behavior in the 3- to 6-year group; however, it was associated with behavior in the school-aged children.
Conclusions:
Children with sleep-disordered breathing are able to maintain cerebral oxygenation, and the small changes observed are not related to cognitive deficits. However, in older children these differences were related to behavioral measures.
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