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Updated: Feb 9, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Regional brain tissue integrity in pediatric obstructive sleep apnea
Leila Kheirandish-Gozal1, Ashish K Sahib2, Paul M Macey3
1Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA.
Insights
Pediatric obstructive sleep apnea (OSA) is linked to brain tissue changes, particularly in areas controlling cognition and behavior. These findings suggest acute injury in children with OSA, impacting brain function.
Area of Science:
- Neuroscience
- Pediatric Medicine
- Radiology
Background:
- Obstructive sleep apnea (OSA) in children is associated with neural injury and cognitive deficits.
- Previous research indicated structural brain changes like reduced gray matter volume in pediatric OSA.
- Understanding the underlying pathology of these structural changes is crucial.
Purpose of the Study:
- To assess brain tissue integrity in children with OSA using entropy tissue texture analysis.
- To identify specific brain regions affected by tissue changes in pediatric OSA.
- To correlate these tissue changes with potential pathological processes.
Main Methods:
- High-resolution T1-weighted MRI scans were acquired from 10 children with OSA and 8 healthy controls.
- Entropy maps were calculated from MRI images to measure local signal intensity patterns.
- Statistical comparison (ANCOVA) was performed between groups, controlling for age and gender.
Main Results:
- Children with OSA exhibited reduced entropy values in key brain regions, including the pre-frontal cortex, corpus callosum, thalamus, hippocampus, and cerebellum.
- These reduced entropy values suggest acute tissue injury in these areas.
- No brain regions showed increased entropy in the OSA group.
Conclusions:
- Pediatric OSA is associated with acute brain tissue injury, predominantly in regions regulating autonomic, respiratory, cognitive, and neuropsychological functions.
- Hypoxia/re-oxygenation, repeated arousals, and hypercarbia are potential contributors to these observed brain tissue integrity changes.
- These findings highlight the impact of OSA on brain health in children.
Abstract:
Children with long-standing obstructive sleep apnea (OSA) show evidence of neural injury and functional deficits in behavioral and cognitive regulatory brain regions that are reflected in symptoms of altered cognitive performance and behaviors. While we earlier showed reduced gray matter volume and increased and reduced regional cortical thicknesses, such structural changes give little indication of the underlying pathology. Brain tissue integrity in pediatric OSA subjects can reflect the nature and extent of injury or structural adaptation, and can be assessed by entropy tissue texture, a measure of local changes in signal intensity patterns from high-resolution magnetic resonance images. We collected high-resolution T1-weighted magnetic resonance images from 10 pediatric OSA (age, 7.9 ± 1.1 years; apnea-hypopnea-index, 8.8 ± 3.0 events/hour; body-mass-index, 20 ± 6.7 kg/m2; 7 male) and 8 healthy controls (age, 8.8 ± 1.6 years; body-mass-index, 19.6 ± 5.9 kg/m2; 5 female). Images were bias-corrected and entropy maps calculated, individual maps were normalized to a common space, smoothed, and compared between groups (ANCOVA; covariates: age, gender; SPM12, uncorrected-threshold p < 0.005). No significant differences in age (p = .48), gender (p = .59), or body-mass-index (p = .63) emerged between groups. In OSA children, several brain sites including the pre-frontal cortex, middle and posterior corpus callosum, thalamus, hippocampus, and cerebellar areas showed reduced entropy values, indicating tissue changes suggestive of acute insults. No regions showed higher entropy values in OSA. Children suffering from OSA display predominantly acute tissue injury in neural regions principally localized within autonomic, respiratory, cognitive, and neuropsychologic control, functions that correspond to previously-reported comorbidities associated with OSA. A range of acute processes, including hypoxia/re-oxygenation, repeated arousals, and episodic hypercarbia, may have contributed to regional brain tissue integrity changes in pediatric OSA.
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