Don’t Let Childhood OSA Go Untreated!
Obstructive sleep apnea (OSA) and other sleep disturbances are common in people with Prader-Willi syndrome. Many studies in the medical literature suggest that the oxygen deprivation and fragmented sleep associated with OSA are associated with deficits in learning. A new study looks at just how damaging untreated OSA can be in children.
The authors studied the IQ of children with and without OSA (none of the kids had PWS, and the kids with OSA had severe OSA), and also used imaging techniques (magnetic resonance spectroscopy, a noninvasive way of looking at metabolism in the brain) to look directly at the brain chemistry. OSA was strongly associated with changes in the chemistry and structure in key regions of the brain (hippocampus and right frontal cortex) important in learning, memory, and higher order thinking. The changes in brain were consistent with OSA causing permanent brain injury. Children may be particularly susceptible to the damaging effects of OSA because the injury occurs at a critical time during brain development.
The key sentence here is the final sentence of their abstract: “We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential.”
The authors have not yet shown whether treating the OSA will reverse the brain metabolite changes and/or improve IQ scores, but they will be working on that next. Finally, it is interesting to note that while the children with OSA were generally well matched to controls with respect to age, socioeconomic status, etc, kids with OSA had a much higher body mass index (ie, weighed more) than the kids without OSA. Obesity is well-recognized as a significant contributor to OSA, and is also associated with decreased IQ – whether all of the decreased IQ can be attributed to OSA, or may also be due to other complications associated obesity remains to be sorted out.
A press release about the OSA article can be found here. The abstract (summary) of the article is below and the full article is available free on Public Library of Science – Medicine.
Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury
Ann C. Halbower et al.
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.
The authors studied the IQ of children with and without OSA (none of the kids had PWS, and the kids with OSA had severe OSA), and also used imaging techniques (magnetic resonance spectroscopy, a noninvasive way of looking at metabolism in the brain) to look directly at the brain chemistry. OSA was strongly associated with changes in the chemistry and structure in key regions of the brain (hippocampus and right frontal cortex) important in learning, memory, and higher order thinking. The changes in brain were consistent with OSA causing permanent brain injury. Children may be particularly susceptible to the damaging effects of OSA because the injury occurs at a critical time during brain development.
The key sentence here is the final sentence of their abstract: “We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential.”
The authors have not yet shown whether treating the OSA will reverse the brain metabolite changes and/or improve IQ scores, but they will be working on that next. Finally, it is interesting to note that while the children with OSA were generally well matched to controls with respect to age, socioeconomic status, etc, kids with OSA had a much higher body mass index (ie, weighed more) than the kids without OSA. Obesity is well-recognized as a significant contributor to OSA, and is also associated with decreased IQ – whether all of the decreased IQ can be attributed to OSA, or may also be due to other complications associated obesity remains to be sorted out.
A press release about the OSA article can be found here. The abstract (summary) of the article is below and the full article is available free on Public Library of Science – Medicine.
Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury
Ann C. Halbower et al.
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.
Submitted by Theresa Strong on Tue, 09/12/2006 - 08:58
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