1
|
Yanney M, Rowbotham N, Ng C, Zulkifli M, Shehata A, Chidambaram A, Tsirevelou P, Fergie N, Thakkar P, Crookes E, Dean R, Prayle A. Retrospective review of treatment outcomes and costs in children with sleep disordered breathing assessed with multi-channel studies. Sleep Med X 2024; 7:100115. [PMID: 39022329 PMCID: PMC11252078 DOI: 10.1016/j.sleepx.2024.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024] Open
Abstract
Current UK guidance on OSA management recommends only selective use of sleep studies - when there is diagnostic uncertainty, in children with comorbidities or to evaluate perioperative risk in those with suspected severe OSA. Routine use of sleep studies to confirm a diagnosis of obstructive sleep apnoea (OSA) in children before adenotonsillectomy is not currently recommended. We report the findings of a novel paediatric sleep service based on routine use of multi-channel sleep studies (MCSS) before adenotonsillectomy and present the results of a service evaluation assessing the impact of our practise on treatment outcomes and cost. We conducted a retrospective study of 264 children with sleep disordered breathing seen in our centre between July 2018-June 2019, using medical records and a sleep study database to determine treatment outcomes and costs. Using responses from a questionnaire completed by otolaryngologists for a separate prospective study, we compare our costs with estimates of those associated with a standard UK model of care i.e. with selective use of sleep studies. We estimate that our routine use of MCSS reduced the number of adenotonsillectomies by 44 % but at higher monetary costs than those estimated for the standard model of care. We note however, that reconfiguring our service to arrange a sleep study before the initial appointment, rather than after, would result in the service being cost neutral compared with the standard model. We also estimate that use of home multi-channel studies in our service would bring a significant cost saving (∼£50,000 - £80,000 per annum) compared to standard care.
Collapse
Affiliation(s)
- Michael Yanney
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Nicola Rowbotham
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christabella Ng
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Muhammad Zulkifli
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Ahmed Shehata
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Alagappan Chidambaram
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Paraskevi Tsirevelou
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Neil Fergie
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Pathik Thakkar
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Emma Crookes
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Roy Dean
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Andrew Prayle
- Nottingham Biomedical Research Centre and School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
2
|
Yanney M, Rowbotham N, Ng C, Zulkifli M, Shehata A, Chidambaram A, Tsirevelou P, Fergie N, Thakkar P, Crookes E, Dean R, Prayle A. Prospective evaluation of the impact of multi-channel studies on treatment outcomes in children with sleep disordered breathing. Sleep Med X 2024; 7:100111. [PMID: 38800098 PMCID: PMC11127274 DOI: 10.1016/j.sleepx.2024.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 05/29/2024] Open
Abstract
There are significant variations in practice regarding the use of sleep studies in children with symptoms of sleep disordered breathing (SDB) prior to adenotonsillectomy. Current UK guidance recommends the selective use of sleep studies to confirm a diagnosis of obstructive sleep apnoea (OSA) when there is diagnostic uncertainty, in children with comorbidities, or to assess perioperative risk when severe OSA is suspected. We have developed a novel paediatric sleep service over the past decade based on the routine use of multi-channel sleep studies (MCSS) before adenotonsillectomy. We present the results of a prospective evaluation assessing the impact of our service on treatment outcomes. We conducted a prospective service evaluation of 49 children with SDB seen between July 2021 and August 2022. We used medical records and a sleep study database to determine treatment outcomes. Otolaryngologists completed a questionnaire before each multi-channel sleep study to help evaluate the impact of sleep study findings on surgical decision making. Questionnaire responses before MCSS showed that clinicians thought 66 % of children were 'likely', 'very likely' or 'definitely' would require surgery but only 54 % of children underwent surgery following their sleep study. We estimate that the use of MCSS was associated with a 21 % reduction in children undergoing surgery in this small sample. We conclude that our use of MCSS facilitates conservative management, allowing a significant reduction in the number of children with SDB undergoing surgery, but further validation of MCSS against polysomnography is required.
Collapse
Affiliation(s)
- Michael Yanney
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Nicola Rowbotham
- Academic Unit of Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Christabella Ng
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Muhammad Zulkifli
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Ahmed Shehata
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Alagappan Chidambaram
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Paraskevi Tsirevelou
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Neil Fergie
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Pathik Thakkar
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Emma Crookes
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Roy Dean
- Sherwood Forest Hospitals Foundation Trust, Mansfield Road, Sutton-in-Ashfield, Nottinghamshire, UK
| | - Andrew Prayle
- Nottingham Biomedical Research Centre and School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
3
|
Chen F, Fu Y, Tang B, Tao B, Wang Y, Huang Y, Chen T, Yu C, Jiang C, Lui S, Cai X, Lu Y, Yan Z. Altered cerebral white matter network topology and cognition in children with obstructive sleep apnea. Sleep Med 2024; 118:63-70. [PMID: 38613858 DOI: 10.1016/j.sleep.2024.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVES The study aimed to explore the underlying mechanisms of OSA-related cognitive impairment by investigating the altered topology of brain white matter networks in children with OSA. METHODS Graph theory was used to examine white matter networks' network topological properties in 46 OSA and 31 non-OSA children. All participants underwent MRI, polysomnography, and cognitive testing. The effects of the obstructive apnea-hypopnea index (OAHI) on topological properties of white matter networks and network properties on cognition were studied using hierarchical linear regression. Mediation analyses were used to explore whether white matter network properties mediated the effects of OAHI on cognition. RESULTS Children with OSA had significantly higher assortativity than non-OSA children. Furthermore, OAHI was associated with the nodal properties of several brain regions, primarily in the frontal and temporal lobes. The relationship between OAHI and verbal comprehension index was mediated through clustering coefficients in the right temporal pole of the superior temporal gyrus. CONCLUSIONS OSA affects the development of white matter networks in children's brains. Besides, the mediating role of white matter network properties between the OAHI and the verbal comprehension index provided neuroimaging evidence of impaired cognitive function in children with OSA.
Collapse
Affiliation(s)
- Fangfang Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, China; Wenzhou Key Laboratory of Structural and Functional Imaging, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yuchuan Fu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, China; Wenzhou Key Laboratory of Structural and Functional Imaging, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Biqiu Tang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610044, China
| | - Bo Tao
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610044, China
| | - Yu Wang
- Department of Radiology, Ningbo First Hospital, Ningbo, 315010, China; Wenzhou Key Laboratory of Structural and Functional Imaging, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yinyin Huang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, China; Wenzhou Key Laboratory of Structural and Functional Imaging, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Tao Chen
- Department of Radiology, The First Affiliated Hospital of Zhejiang University, Hangzhou, 310003, China; Wenzhou Key Laboratory of Structural and Functional Imaging, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Chenyi Yu
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Changcan Jiang
- Department of Otolaryngology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Su Lui
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, China; Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610044, China; Wenzhou Key Laboratory of Structural and Functional Imaging, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Xiaohong Cai
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Yi Lu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, China; Wenzhou Key Laboratory of Structural and Functional Imaging, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 325000, China; Wenzhou Key Laboratory of Structural and Functional Imaging, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
| |
Collapse
|
4
|
Tan B, Tamanyan K, Walter L, Nixon GM, Davey MJ, Ditchfield M, Horne RSC. Cortical grey matter changes, behavior and cognition in children with sleep disordered breathing. J Sleep Res 2024; 33:e14006. [PMID: 37475108 DOI: 10.1111/jsr.14006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
This paper investigated cortical thickness and volumetric changes in children to better understand the impact of obstructive sleep disordered breathing (SDB) on the neurodevelopment of specific regions of the brain. We also aimed to investigate how these changes were related to the behavioral and cognitive deficits observed in the condition. Neuroimaging, behavioral, and sleep data were obtained from 30 children (15 non-snoring controls, 15 referred for assessment of SDB) aged 7 to 17 years. Gyral-based regions of interest were identified using the Desikan-Killiany atlas. Student's t-tests were used to compare regions of interest between the controls and SDB groups. We found that the cortical thickness was significantly greater in the right caudal anterior cingulate and right cuneus regions and there were volumetric increases in the left caudal middle frontal, bilateral rostral anterior cingulate, left, right, and bilateral caudate brain regions in children with SDB compared with controls. Neither cortical thickness nor volumetric changes were associated with behavioral or cognitive measures. The findings of this study indicate disruptions to neural developmental processes occurring in structural regions of the brain; however, these changes appear unrelated to behavioural or cognitive outcomes.
Collapse
Affiliation(s)
- Brendan Tan
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
| | - Knarik Tamanyan
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
| | - Lisa Walter
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
| | - Gillian M Nixon
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Margot J Davey
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
- Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Michael Ditchfield
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
- Department of Radiology, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
5
|
Cui J, Li G, Zhang M, Xu J, Qi H, Ji W, Wu F, Zhang Y, Jiang F, Hu Y, Zhang W, Wei X, Manza P, Volkow ND, Gao X, Wang GJ, Zhang Y. Associations between body mass index, sleep-disordered breathing, brain structure, and behavior in healthy children. Cereb Cortex 2023; 33:10087-10097. [PMID: 37522299 PMCID: PMC10656948 DOI: 10.1093/cercor/bhad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 08/01/2023] Open
Abstract
Pediatric overweight/obesity can lead to sleep-disordered breathing (SDB), abnormal neurological and cognitive development, and psychiatric problems, but the associations and interactions between these factors have not been fully explored. Therefore, we investigated the associations between body mass index (BMI), SDB, psychiatric and cognitive measures, and brain morphometry in 8484 children 9-11 years old using the Adolescent Brain Cognitive Development dataset. BMI was positively associated with SDB, and both were negatively correlated with cortical thickness in lingual gyrus and lateral orbitofrontal cortex, and cortical volumes in postcentral gyrus, precentral gyrus, precuneus, superior parietal lobule, and insula. Mediation analysis showed that SDB partially mediated the effect of overweight/obesity on these brain regions. Dimensional psychopathology (including aggressive behavior and externalizing problem) and cognitive function were correlated with BMI and SDB. SDB and cortical volumes in precentral gyrus and insula mediated the correlations between BMI and externalizing problem and matrix reasoning ability. Comparisons by sex showed that obesity and SDB had a greater impact on brain measures, cognitive function, and mental health in girls than in boys. These findings suggest that preventing childhood obesity will help decrease SDB symptom burden, abnormal neurological and cognitive development, and psychiatric problems.
Collapse
Affiliation(s)
- Jianqi Cui
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Guanya Li
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Minmin Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Jiayu Xu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Haowen Qi
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Weibin Ji
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Feifei Wu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Yaqi Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Fukun Jiang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Yang Hu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Wenchao Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| | - Xiaorong Wei
- Kindergarten, Air Force Medical University, Xi'an, Shaanxi 710032, China
| | - Peter Manza
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Nora D Volkow
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Xinbo Gao
- Chongqing Key Laboratory of Image Cognition, Chongqing University of Posts and Telecommunications, Chongqing 400065, China
- Chongqing Institute for Brain, Guangyang Bay Laboratory, Chongqing 400064, China
| | - Gene-Jack Wang
- Laboratory of Neuroimaging, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA
| | - Yi Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China
| |
Collapse
|
6
|
Lee MH, Sin S, Lee S, Park H, Wagshul ME, Zimmerman ME, Arens R. Altered cortical structure network in children with obstructive sleep apnea. Sleep 2022; 45:zsac030. [PMID: 35554588 PMCID: PMC9113011 DOI: 10.1093/sleep/zsac030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/10/2022] [Indexed: 02/07/2023] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is characterized by recurrent airway collapse during sleep, resulting in intermittent hypoxia and sleep fragmentation that may contribute to alternations in brain structure and function. We hypothesized that OSA in children reorganizes and alters cortical structure, which can cause changes in cortical thickness correlation between brain regions across subjects. METHODS We constructed cortical structure networks based on cortical thickness measurements from 41 controls (age 15.54 ± 1.66 years, male 19) and 50 children with OSA (age 15.32 ± 1.65 years, male 29). The global (clustering coefficient [CC], path length, and small-worldness) and regional (nodal betweenness centrality, NBC) network properties and hub region distributions were examined between groups. RESULTS We found increased CCs in OSA compared to controls across a wide range of network densities (p-value < .05) and lower NBC area under the curve in left caudal anterior cingulate, left caudal middle frontal, left fusiform, left transverse temporal, right pars opercularis, and right precentral gyri (p-value < .05). In addition, while most of the hub regions were the same between groups, the OSA group had fewer hub regions and a different hub distribution compared to controls. CONCLUSIONS Our findings suggest that children with OSA exhibit altered global and regional network characteristics compared to healthy controls. Our approach to the investigation of cortical structure in children with OSA could prove useful in understanding the etiology of OSA-related brain functional disorders.
Collapse
Affiliation(s)
- Min-Hee Lee
- Institute of Human Genomic Study, College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Sanghun Sin
- Division of Respiratory and Sleep Medicine, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Seonjoo Lee
- Department of Biostatistics and Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Hyunbin Park
- Division of Respiratory and Sleep Medicine, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mark E Wagshul
- Department of Radiology, Albert Einstein College of Medicine, Gruss MRRC, Bronx, NY, USA
| | | | - Raanan Arens
- Division of Respiratory and Sleep Medicine, Children’s Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
7
|
Yu PK, Radcliffe J, Gerry Taylor H, Amin RS, Baldassari CM, Boswick T, Chervin RD, Elden LM, Furth SL, Garetz SL, George A, Ishman SL, Kirkham EM, Liu C, Mitchell RB, Kamal Naqvi S, Rosen CL, Ross KR, Shah JR, Tapia IE, Young LR, Zopf DA, Wang R, Redline S. Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea. Sleep 2022; 45:zsac035. [PMID: 35554583 PMCID: PMC9113015 DOI: 10.1093/sleep/zsac035] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea is associated with neurobehavioral dysfunction, but the relationship between disease severity as measured by the apnea-hypopnea index and neurobehavioral morbidity is unclear. The objective of our study is to compare the neurobehavioral morbidity of mild sleep-disordered breathing versus obstructive sleep apnea. METHODS Children 3-12 years old recruited for mild sleep-disordered breathing (snoring with obstructive apnea-hypopnea index < 3) into the Pediatric Adenotonsillectomy Trial for Snoring were compared to children 5-9 years old recruited for obstructive sleep apnea (obstructive apnea-hypopnea 2-30) into the Childhood Adenotonsillectomy Trial. Baseline demographic, polysomnographic, and neurobehavioral outcomes were compared using univariable and multivariable analysis. RESULTS The sample included 453 participants with obstructive sleep apnea (median obstructive apnea-hypopnea index 5.7) and 459 participants with mild sleep-disordered breathing (median obstructive apnea-hypopnea index 0.5). By polysomnography, participants with obstructive sleep apnea had poorer sleep efficiency and more arousals. Children with mild sleep-disordered breathing had more abnormal executive function scores (adjusted odds ratio 1.96, 95% CI 1.30-2.94) compared to children with obstructive sleep apnea. There were also elevated Conners scores for inattention (adjusted odds ratio 3.16, CI 1.98-5.02) and hyperactivity (adjusted odds ratio 2.82, CI 1.83-4.34) in children recruited for mild sleep-disordered breathing. CONCLUSIONS Abnormal executive function, inattention, and hyperactivity were more common in symptomatic children recruited into a trial for mild sleep-disordered breathing compared to children recruited into a trial for obstructive sleep apnea. Young, snoring children with only minimally elevated apnea-hypopnea levels may still be at risk for deficits in executive function and attention. TRIAL REGISTRATION Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040; Childhood Adenotonsillectomy Trial (CHAT), NCT00560859.
Collapse
Affiliation(s)
- Phoebe K Yu
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
- Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA
| | - Jerilynn Radcliffe
- Division of Developmental and Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - H Gerry Taylor
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH, USA
| | - Raouf S Amin
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA
| | - Cristina M Baldassari
- Eastern Virginia Medical School, Department of Otolaryngology Head and Neck Surgery, Children’s Hospitals of The King’s Daughters Department of Pediatric Sleep Medicine, Norfolk, VA, USA
| | - Thomas Boswick
- Eastern Virginia Medical School, Department of Otolaryngology Head and Neck Surgery, Children’s Hospitals of The King’s Daughters Department of Pediatric Sleep Medicine, Norfolk, VA, USA
| | - Ronald D Chervin
- University of Michigan, Department of Neurology, Ann Arbor, MI, USA
| | - Lisa M Elden
- Children’s Hospital of Philadelphia, Division of Otolaryngology, Philadelphia, PA, USA
| | - Susan L Furth
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - Susan L Garetz
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Alisha George
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA
| | - Stacey L Ishman
- University of Cincinnati College of Medicine, Department of Otolaryngology – Head and Neck Surgery, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Division of Otolaryngology – Head & Neck Surgery, Cincinnati, OH, USA
| | - Erin M Kirkham
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Christopher Liu
- University of Texas Southwestern, Department of Otolaryngology, Dallas, TX, USA
| | - Ron B Mitchell
- University of Texas Southwestern, Department of Otolaryngology, Dallas, TX, USA
- University of Texas Southwestern, Department of Pediatrics, Dallas, TX, USA
| | - S Kamal Naqvi
- University of Texas Southwestern, Department of Pediatrics, Dallas, TX, USA
| | - Carol L Rosen
- Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH, USA
| | - Kristie R Ross
- University Hospitals Rainbow Babies & Children’s Hospital, Department of Pediatrics, Cleveland, OH, USA
| | - Jay R Shah
- University Hospitals Rainbow Babies & Children’s Hospital, Department of Otolaryngology, Cleveland, OH, USA
| | - Ignacio E Tapia
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - Lisa R Young
- Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA
| | - David A Zopf
- University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA
| | - Rui Wang
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
| | - Susan Redline
- Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA
| |
Collapse
|
8
|
Li X, Ying H, Zhang Z, Yang Z, You C, Cai X, Lin Z, Xiao Y. Sulforaphane Attenuates Chronic Intermittent Hypoxia-Induced Brain Damage in Mice via Augmenting Nrf2 Nuclear Translocation and Autophagy. Front Cell Neurosci 2022; 16:827527. [PMID: 35401114 PMCID: PMC8986999 DOI: 10.3389/fncel.2022.827527] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Obstructive sleep apnea–hypopnea syndrome (OSAHS), typically characterized by chronic intermittent hypoxia (CIH), is associated with neurocognitive dysfunction in children. Sulforaphane (SFN), an activator of nuclear factor E2-related factor 2 (Nrf2), has been demonstrated to protect against oxidative stress in various diseases. However, the effect of SFN on OSAHS remains elusive. In this research, we investigated the neuroprotective role of SFN in CIH-induced cognitive dysfunction and underlying mechanisms of regulation of Nrf2 signaling pathway and autophagy. CIH exposures for 4 weeks in mice, modeling OSAHS, contributed to neurocognitive dysfunction, manifested as increased working memory errors (WMEs), reference memory errors (RMEs) and total memory errors (TEs) in the 8-arm radial maze test. The mice were intraperitoneally injected with SFN (0.5 mg/kg) 30 min before CIH exposure everyday. SFN treatment ameliorated neurocognitive dysfunction in CIH mice, which demonstrates less RME, WME, and TE. Also, SFN effectively alleviated apoptosis of hippocampal neurons following CIH by decreased TUNEL-positive cells, downregulated cleaved PARP, cleaved caspase 3, and upregulated Bcl-2. SFN protects hippocampal tissue from CIH-induced oxidative stress as evidenced by elevated superoxide dismutase (SOD) activities and reduced malondialdehyde (MDA). In addition, we found that SFN enhanced Nrf2 nuclear translocation to hold an antioxidative function on CIH-induced neuronal apoptosis in hippocampus. Meanwhile, SFN promoted autophagy activation, as shown by increased Beclin1, ATG5, and LC3II/LC3I. Overall, our findings indicated that SFN reduced the apoptosis of hippocampal neurons through antioxidant effect of Nrf2 and autophagy in CIH-induced brain damage, which highlights the potential of SFN as a novel therapy for OSAHS-related neurocognitive dysfunction.
Collapse
Affiliation(s)
- Xiucui Li
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huiya Ying
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zilong Zhang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Zijing Yang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Cancan You
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xiaohong Cai
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongdong Lin
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yanfeng Xiao
- Department of Pediatrics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
9
|
Menzies B, Teng A, Burns M, Lah S. Neurocognitive outcomes of children with sleep disordered breathing: a systematic review with meta-analysis. Sleep Med Rev 2022; 63:101629. [DOI: 10.1016/j.smrv.2022.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
|
10
|
Turner EM, Koskela-Staples MSN, Evans BSC, Black LV, Heaton SC, Fedele DA. The Role of Sleep-Disordered Breathing Symptoms in Neurocognitive Function Among Youth With Sickle Cell Disease1. Dev Neuropsychol 2022; 47:93-104. [PMID: 35157528 DOI: 10.1080/87565641.2022.2038601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine associations between sleep-disordered breathing (SDB) and executive/attentional function in pediatric sickle cell disease (SCD). METHODS Sixty youth with SCD ages 8-18 years and caregivers completed the Pediatric Sleep Questionnaire (PSQ), Delis Kaplan Executive Function System Trail Making Test (DKEFS TMT), Psychomotor Vigilance Test (PVT), and the Behavior Rating Inventory Of Executive Function, Second Edition (BRIEF-2) Parent Report. RESULTS The PSQ significantly predicted the BRIEF-2 Parent Report, F(1, 58) = 44.64, p < .001, R2 = 0.44, f2 = 0.77. CONCLUSIONS Sleep-disordered breathing symptoms may predict informant-rated executive dysfunction in pediatric SCD, but not performance-based executive function.
Collapse
Affiliation(s)
- Elise M Turner
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | | | - B S Corinne Evans
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - L Vandy Black
- Division of Pediatric Hematology and Oncology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Shelley C Heaton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| | - David A Fedele
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
11
|
Torres-Lopez LV, Cadenas-Sanchez C, Migueles JH, Esteban-Cornejo I, Molina-Garcia P, H. Hillman C, Catena A, Ortega FB. Does sleep-disordered breathing add to impairments in academic performance and brain structure usually observed in children with overweight/obesity? Eur J Pediatr 2022; 181:2055-2065. [PMID: 35142932 PMCID: PMC9056447 DOI: 10.1007/s00431-022-04403-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED Approximately 4-11% of children suffer from sleep-disordered breathing (SDB), and children with obesity are at increased risk. Both obesity and SDB have been separately associated with poorer brain health, yet whether SDB severity affects brain health in children with obesity remains unanswered. This study aimed to examine associations of SDB severity with academic performance and brain structure (i.e., total brain and gray and white matter volumes and gray matter volume in the hippocampus) in children with overweight/obesity. One hundred nine children aged 8-12 years with overweight/obesity were included. SDB severity and its subscales (i.e., snoring, daytime sleepiness, and inattention/hyperactivity) were evaluated via the Pediatric Sleep Questionnaire (PSQ), and academic performance was evaluated with the Woodcock-Muñoz standardized test and school grades. Brain structure was assessed by magnetic resonance imaging. SDB severity was not associated with academic performance measured by the standardized test (all |β|> 0.160, P > 0.076), yet it was associated with the school grade point average (β = -0.226, P = 0.007) and natural and social science grades (β = -0.269, P = 0.024). Intention/hyperactivity seemed to drive these associations. No associations were found between SDB severity and the remaining school grades (all β < -0.188, P > 0.065) or brain volumes (all P > 0.05). CONCLUSION Our study shows that SDB severity was associated with lower school grades, yet it was not associated with the standardized measurement of academic performance or with brain volumes in children with overweight/obesity. SDB severity may add to academic problems in children beyond the effects contributed by overweight/obesity status alone. WHAT IS KNOWN • Sleep-disordered breathing (SDB) may affect brain structure and academic performance in children. • Children with overweight/obesity are at higher risk for the development of SDB, yet the comorbid obesity-SDB relationship with brain health has not been investigated thus far. WHAT IS NEW • To our knowledge, this is the first study examining the associations of comorbid obesity-SDB severity with brain volumes and academic performance in children. • SDB symptoms may adversely affect academic performance at school in children with overweight/obesity, beyond the effects of weight status alone.
Collapse
Affiliation(s)
- Lucia V. Torres-Lopez
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Cristina Cadenas-Sanchez
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Institute for Innovation and Sustainable Development in the Food Chain (IS-FOOD), Public University of Navarra, Pamplona, Spain
| | - Jairo H. Migueles
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden ,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, 14183 Sweden
| | - Irene Esteban-Cornejo
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Pablo Molina-Garcia
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain
| | - Charles H. Hillman
- Center for Cognitive and Brain Health, Department of Psychology, Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA USA
| | - Andres Catena
- School of Psychology, University of Granada, Granada, Spain
| | - Francisco B. Ortega
- PROFITH “PROmoting FITness and Health Through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, 18011 Spain ,Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, 14183 Sweden ,Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| |
Collapse
|
12
|
Lovos A, Bottrill K, Sakhon S, Nyhuis C, Egleson E, Luongo A, Murphy M, Thurman AJ, Abbeduto L, Lee NR, Hughes K, Edgin J. Circadian Sleep-Activity Rhythm across Ages in Down Syndrome. Brain Sci 2021; 11:brainsci11111403. [PMID: 34827402 PMCID: PMC8615672 DOI: 10.3390/brainsci11111403] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/05/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022] Open
Abstract
Across all ages, individuals with Down syndrome (DS) experience high rates of sleep problems as well as cognitive impairments. This study sought to investigate whether circadian rhythm disruption was also experienced by people with DS and whether this kind of sleep disorder may be correlated with cognitive performance. A cross-sectional study of 101 participants (58 with DS, 43 with typical development) included individuals in middle childhood (6–10 years old), adolescence (11–18 years old), and young adulthood (19–26 years old). Sleep and markers of circadian timing and robustness were calculated using actigraphy. Cognitive and behavioral data were gathered via a novel touchscreen battery (A-MAPTM, Arizona Memory Assessment for Preschoolers and Special Populations) and parent questionnaire. Results indicated that children and adolescents with DS slept the same amount as peers with typical development, but significant group differences were seen in phase timing. The circadian robustness markers, interdaily stability and intradaily variability of sleep-wake rhythms, were healthiest for children regardless of diagnostic group and worst for adults with DS. Amplitude of the 24-h activity profile was elevated for all individuals with DS. In analyses of the correlations between sleep quality, rhythms, and cognition in people with DS, interdaily stability was positively correlated with reaction time and negatively correlated with verbal and scene recall, a finding that indicates increased stability may paradoxically correlate with poorer cognitive outcomes. Further, we found no relations with sleep efficiency previously found in preschool and adult samples. Therefore, the current findings suggest that a thorough examination of sleep disorders in DS must take into account age as well as circadian robustness to better understand sleep-cognitive correlations in this group.
Collapse
Affiliation(s)
- Annalysa Lovos
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
- Correspondence:
| | - Kenneth Bottrill
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
| | - Stella Sakhon
- Statistics Department, Los Angeles Valley College, Van Nuys, Los Angeles, CA 91401, USA;
| | - Casandra Nyhuis
- College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA;
| | - Elizabeth Egleson
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
| | - Alison Luongo
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
| | - Melanie Murphy
- Department of Physiology and Buiphysics, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Angela John Thurman
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, Sacramento, CA 95817, USA; (A.J.T.); (L.A.)
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California Davis Health, Sacramento, CA 95817, USA; (A.J.T.); (L.A.)
| | - Nancy Raitano Lee
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA 19104, USA;
| | | | - Jamie Edgin
- Department of Psychology, School of Mind, Brain and Behavior, College of Science, The University of Arizona, Tucson, AZ 85721, USA; (K.B.); (E.E.); (A.L.); (J.E.)
- Sonoran University Center for Excellence in Developmental Disabilities (UCEDD), University of Arizona, Farmington, CT 06032, USA
| |
Collapse
|
13
|
Isaiah A, Ernst T, Cloak CC, Clark DB, Chang L. Associations between frontal lobe structure, parent-reported obstructive sleep disordered breathing and childhood behavior in the ABCD dataset. Nat Commun 2021; 12:2205. [PMID: 33850154 PMCID: PMC8044120 DOI: 10.1038/s41467-021-22534-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/16/2021] [Indexed: 02/03/2023] Open
Abstract
Parents frequently report behavioral problems among children who snore. Our understanding of the relationship between symptoms of obstructive sleep disordered breathing (oSDB) and childhood behavioral problems associated with brain structural alterations is limited. Here, we examine the associations between oSDB symptoms, behavioral measures such as inattention, and brain morphometry in the Adolescent Brain Cognitive Development (ABCD) study comprising 10,140 preadolescents. We observe that parent-reported symptoms of oSDB are associated with composite and domain-specific problem behaviors measured by parent responses to the Child Behavior Checklist. Alterations of brain structure demonstrating the strongest negative associations with oSDB symptoms are within the frontal lobe. The relationships between oSDB symptoms and behavioral measures are mediated by significantly smaller volumes of multiple frontal lobe regions. These results provide population-level evidence for an association between regional structural alterations in cortical gray matter and problem behaviors reported in children with oSDB.
Collapse
Grants
- U01 DA041174 NIDA NIH HHS
- U01 DA041048 NIDA NIH HHS
- U01 DA041156 NIDA NIH HHS
- U01 DA041093 NIDA NIH HHS
- U01 DA041106 NIDA NIH HHS
- U01 DA050989 NIDA NIH HHS
- U01 DA041089 NIDA NIH HHS
- U01 DA050988 NIDA NIH HHS
- U01 DA041028 NIDA NIH HHS
- U01 DA041134 NIDA NIH HHS
- U24 DA041147 NIDA NIH HHS
- U01 DA050987 NIDA NIH HHS
- P50 DA046346 NIDA NIH HHS
- U01 DA041022 NIDA NIH HHS
- U01 DA041025 NIDA NIH HHS
- U01 DA051037 NIDA NIH HHS
- U01 DA051016 NIDA NIH HHS
- U01 DA041148 NIDA NIH HHS
- U24 DA041123 NIDA NIH HHS
- U01 DA041120 NIDA NIH HHS
- U01 DA051039 NIDA NIH HHS
- U01 DA051018 NIDA NIH HHS
- U01 DA051038 NIDA NIH HHS
- U.S. Department of Health & Human Services | National Institutes of Health (NIH)
- The ABCD Study is supported by the National Institutes of Health (NIH) and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, U24DA041147, U01DA041093, and U01DA041025. A full list of supporters is available at https://abcdstudy.org/federal-partners.html. A listing of participating sites and a complete listing of the study investigators can be found at https://abcdstudy.org/Consortium_Members.pdf.
Collapse
Affiliation(s)
- Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Thomas Ernst
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine C Cloak
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Linda Chang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
14
|
Horne RSC. Consequences of paediatric sleep disordered breathing: contributions from Australian and New Zealand investigators. Sleep Med 2020; 77:147-160. [PMID: 33373901 DOI: 10.1016/j.sleep.2020.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/23/2020] [Accepted: 11/29/2020] [Indexed: 12/13/2022]
Abstract
AIMS To highlight the contributions of Australian and New Zealand researchers to the identification of the consequences of paediatric sleep disordered breathing (SDB). METHODS A search was conducted in PubMed using the terms "sleep disordered breathing" "child" and "Australia or New Zealand". All abstracts were reviewed and those which focused on the consequences of SDB have been included. RESULTS Australasian research into the consequences of SDB has grown exponentially over the last 35 years. SDB has significant adverse consequences for quality of life, behaviour, neurocognition and the cardiovascular system and the Australasian research studies investigating these are summarised. CONCLUSIONS Australian and New Zealand researchers have played a significant role in understanding the consequences of paediatric SDB and the mechanisms which underpin these. The research conducted "Downunder" has led the world in this field of research and will continue to provide evidence to improve the lives of children not only in Australasia but around the world.
Collapse
Affiliation(s)
- Rosemary S C Horne
- Department of Paediatrics, Monash University, Level 5, Monash Children's Hospital, 246 Clayton Rd, Melbourne, 3168, Victoria, Australia.
| |
Collapse
|
15
|
Mei L, Li X, Zhou G, Ji T, Chen J, Xu Z, Peng Y, Liu Y, Li H, Zhang J, Wang S, Zhang Y, Ge W, Guo Y, Qiu Y, Jia X, Tian J, Zheng L, Liu J, Tai J, Ni X. Effects of obstructive sleep apnoea severity on neurocognitive and brain white matter alterations in children according to sex: a tract-based spatial statistics study. Sleep Med 2020; 82:134-143. [PMID: 33915429 DOI: 10.1016/j.sleep.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate alterations in neurocognitive, attention, paediatric sleep questionnaire (PSQ) scores and whole brain white matter (WM) integrity between children with mild and severe obstructive sleep apnoea (OSA) according to sex and whether these changes are associated with OSA severity. METHODS Fifty-seven children (36 males and 21 females) diagnosed with OSA were recruited for this study. Children of both sexes were divided into mild (male-MG, female-MG) and severe (male-SG, female-SG) groups according to OSA severity. Polysomnography (PSG), neurocognitive, attention and PSQ tests were compared between groups by one-way samples analysis of variance (ANOVA) F test. Diffusion tensor imaging (DTI) was scanned using a 3T GE MRI scanner and analysed by Tract-based Spatial Statistics (TBSS). Spearman correlation was calculated between DTI Eigenvalues and clinical characteristics. RESULTS Compared to mild OSA patients, severe OSA patients presented greater severity of obstructive apnoea hypopnea index (OAHI), neurocognition, PSQ and attention tests in both male and female patients. Brain WM integrity in the male-SG, compared to the male-MG, demonstrated significantly reduced fractional anisotropy (FA) values in the right middle frontal gyrus and the right frontal sub-gyral regions and increased axial diffusivity (AD) values in the right inferior frontal gyrus, left parietal angular gyrus and sub-gyral regions, while no differences were found between the female-MG and female-SG. Alterations in male-SG brain regions were observably correlated with severity in male OSA patients. CONCLUSIONS The integrity of WM, which regulates autonomic, cognitive, and attention functions, is impaired in male, but not female, children with severe OSA.
Collapse
Affiliation(s)
- Lin Mei
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaodan Li
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Guifei Zhou
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China
| | - Tingting Ji
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jun Chen
- Big Data and Engineering Research Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Zhifei Xu
- Department of Respiration, Beijing Children's Hospital, Capital Medical University,National Center for Children's Health, Beijing, 100045, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yue Liu
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hongbin Li
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jie Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shengcai Wang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yamei Zhang
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wentong Ge
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yongli Guo
- Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Paediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Yue Qiu
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xinbei Jia
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jinghong Tian
- Department of Neurorehabilitation, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Li Zheng
- Department of Respiration, Beijing Children's Hospital, Capital Medical University,National Center for Children's Health, Beijing, 100045, China
| | - Jiangang Liu
- School of Computer and Information Technology, Beijing Jiaotong University, Beijing, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, 100191, China
| | - Jun Tai
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China; Department of Otorhinolaryngology, Children's Hospital, Capital Institute of Paediatrics, Beijing, 100020, China.
| | - Xin Ni
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
| |
Collapse
|
16
|
Yanney MP, Prayle AP, Rowbotham NJ, Kurc M, Tilbrook S, Ali N. Observational Study of Pulse Transit Time in Children With Sleep Disordered Breathing. Front Neurol 2020; 11:316. [PMID: 32457689 PMCID: PMC7225317 DOI: 10.3389/fneur.2020.00316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 03/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Pulse transit time (PTT) is a non-invasive measure of arousals and respiratory effort for which we aim to identify threshold values that detect sleep disordered breathing (SDB) in children. We also compare the sensitivity and specificity of oximetry with the findings of a multi-channel study. Methods: We performed a cross-sectional observational study of 521 children with SDB admitted for multi-channel sleep studies (pulse oximetry, ECG, video, sound, movement, PTT) in a secondary care centre. PTT data was available in 368 children. Studies were categorised as normal; primary snoring; upper airway resistance syndrome (UARS); obstructive sleep apnoea (OSA), and "abnormal other." Receiver operator characteristic curves were constructed for different PTT (Respiratory swing; Arousal index) thresholds using a random sample of 50% of children studied (training set); calculated thresholds of interest were validated against the other 50% (test set). Study findings were compared with oximetry categories (normal, inconclusive, abnormal) using data (mean and minimum oxygen saturations; oxygen desaturations > 4%) obtained during the study. Results: Respiratory swing of 17.92 ms identified SDB (OSA/UARS) with sensitivity: 0.80 (C.I. 0.62-0.90) and specificity 0.79 (C.I. 0.49-0.87). PTT arousal index of 16.06/ hour identified SDB (OSA/UARS) with sensitivity: 0.85 (95% C.I. 0.67-0.92) and specificity 0.37 (95% C.I. 0.17-0.48). Oximetry identified SDB (OSA) with sensitivity: 0.38 (C.I. 0.31-0.46) and specificity 0.98 (C.I. 0.97-1.00). Conclusions: PTT is more sensitive but less specific than oximetry at detecting SDB in children. The additional use of video and sound enabled detection of SDB in twice as many children as oximetry alone.
Collapse
Affiliation(s)
- Michael P Yanney
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Andrew P Prayle
- Division of Child Health, Obstetrics and Gynaecology, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom.,NIHR Nottingham Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Nicola J Rowbotham
- Division of Child Health, Obstetrics and Gynaecology, Queens Medical Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Miguel Kurc
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Sean Tilbrook
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| | - Nabeel Ali
- Sherwood Forest Hospitals Foundation Trust, Mansfield, United Kingdom
| |
Collapse
|
17
|
Walter LM, Shepherd KL, Yee A, Horne RS. Insights into the effects of sleep disordered breathing on the brain in infants and children: Imaging and cerebral oxygenation measurements. Sleep Med Rev 2020; 50:101251. [DOI: 10.1016/j.smrv.2019.101251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 01/13/2023]
|
18
|
Tabone L, Khirani S, Olmo Arroyo J, Amaddeo A, Sabil A, Fauroux B. Cerebral Oxygenation During Respiratory Events in Children with Sleep-Disordered Breathing and Associated Disorders. J Pediatr 2019; 214:134-140.e7. [PMID: 31540763 DOI: 10.1016/j.jpeds.2019.07.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/12/2019] [Accepted: 07/12/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate changes in cerebral oxygenation by means of near-infrared spectroscopy during respiratory events in children with sleep-disordered breathing (SDB) and associated disorders. STUDY DESIGN Sixty-five children suspected of having SDB underwent a respiratory polygraphy with simultaneous recording of cerebral oxygenation indices. Respiratory events were analyzed by type of event, duration, variations of pulse oximetry (oxygen saturation [SpO2]), cerebral tissue oxygenation index (TOI), and heart rate. Data were categorized according to the severity of SDB and age. RESULTS There were 540 obstructive and mixed apneas, 172 central apneas, and 393 obstructive hypopneas analyzed. The mean decreases in SpO2 and TOI were 4.1 ± 3.1% and 3.4 ± 2.8%, respectively. The mean TOI decrease was significantly smaller for obstructive hypopnea compared with apneas. The TOI decrease was significantly less in children with mild SDB as compared with those with moderate-to-severe SDB and in children >7 years as compared with those <7 years old. TOI decreases correlated significantly with SpO2 decreases, duration of event, and age, regardless of the type of event. In a multivariable regression model, predictive factors of TOI decreases were the type of respiratory event, SpO2 decrease, apnea-hypopnea index, and age. CONCLUSIONS In children with SDB and associated disorders, cerebral oxygenation variations depend on the type of respiratory event, severity of SDB, and age.
Collapse
Affiliation(s)
- Laurence Tabone
- Research Unit French Institute of Health and Medical Research U 955, team 13, Créteil, France.
| | - Sonia Khirani
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France; ASV Santé, Gennevilliers, France
| | - Jorge Olmo Arroyo
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France
| | - Alessandro Amaddeo
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France
| | | | - Brigitte Fauroux
- Pediatric noninvasive ventilation and sleep unit, AP-HP, Necker Hospital, Paris, France; EA 7330 VIFASOM (Vigilance, Fatigue, Sleep and Public Health), Paris Descartes University, Paris, France
| |
Collapse
|
19
|
Jamieson K, Davey MJ, Nixon GM. Oximetry knowledge in neonatal units in Victoria, Australia: can we do better? Acta Paediatr 2019; 108:468-472. [PMID: 30043414 DOI: 10.1111/apa.14512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/01/2018] [Accepted: 07/23/2018] [Indexed: 12/01/2022]
Abstract
AIM Pulse oximetry has become a widely used technology in medicine and is a standard part of monitoring in neonatal medicine. Knowledge of basic principles, clinical and technical considerations is important to optimise clinical benefit of use, but have been shown to be insufficient in paediatric staff. We aimed to assess knowledge of pulse oximetry in neonatal medical staff, a population not previously studied. METHODS A 21-item questionnaire (seven demographic, 14 knowledge) was devised and then administered to neonatal medical staff at all postgraduate levels working in the major public neonatal services in the state of Victoria, Australia. RESULTS Average test score was 64.4% (range 30.8-92.3%) with no correlation between years of experience and score. All respondents reported experience with oximetry, but only 57% reported adequate training in practical oximetry skills and only 28% in interpretation of downloaded oximetry data. About 45% reported knowing what an averaging time was but only 29% were able to provide an acceptable definition and only 10% knew what averaging time was used on devices in their units. CONCLUSION Significant knowledge deficits regarding oximetry are evident in neonatal staff, supporting the need for targeted and continuous training in oximetry.
Collapse
Affiliation(s)
- Katharine Jamieson
- Melbourne Children's Sleep Centre Monash Children's Hospital Melbourne Victoria Australia
- Neonatal Intensive Care Unit Homerton University Hospital NHS Foundation Trust London UK
| | - Margot J. Davey
- Melbourne Children's Sleep Centre Monash Children's Hospital Melbourne Victoria Australia
- Department of Paediatrics Monash University Melbourne Victoria Australia
| | - Gillian M. Nixon
- Melbourne Children's Sleep Centre Monash Children's Hospital Melbourne Victoria Australia
- Department of Paediatrics Monash University Melbourne Victoria Australia
| |
Collapse
|
20
|
Tamanyan K, Weichard A, Biggs SN, Davey MJ, Nixon GM, Walter LM, Horne RSC. The impact of central and obstructive respiratory events on cerebral oxygenation in children with sleep disordered breathing. Sleep 2019; 42:5352806. [DOI: 10.1093/sleep/zsz044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/09/2019] [Indexed: 02/02/2023] Open
Affiliation(s)
- Knarik Tamanyan
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Aidan Weichard
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Sarah N Biggs
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Margot J Davey
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Gillian M Nixon
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
- Melbourne Children’s Sleep Centre, Monash Children’s Hospital, Melbourne, Australia
| | - Lisa M Walter
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Paediatrics, Monash University, Melbourne, Australia
| |
Collapse
|
21
|
Kheirandish-Gozal L, Sahib AK, Macey PM, Philby MF, Gozal D, Kumar R. Regional brain tissue integrity in pediatric obstructive sleep apnea. Neurosci Lett 2018; 682:118-123. [PMID: 29883682 DOI: 10.1016/j.neulet.2018.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/02/2018] [Accepted: 06/03/2018] [Indexed: 12/14/2022]
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.
Collapse
Affiliation(s)
- Leila Kheirandish-Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Ashish K Sahib
- Departments of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Paul M Macey
- UCLA School of Nursing, University of California Los Angeles, Los Angeles, CA 90095, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Mona F Philby
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - David Gozal
- Section of Pediatric Sleep Medicine, Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Rajesh Kumar
- Departments of Anesthesiology, University of California Los Angeles, Los Angeles, CA 90095, USA; Radiological Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA; Bioengineering, University of California Los Angeles, Los Angeles, CA 90095, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA 90095, USA.
| |
Collapse
|
22
|
Bennet L, Walker DW, Horne RSC. Waking up too early - the consequences of preterm birth on sleep development. J Physiol 2018; 596:5687-5708. [PMID: 29691876 DOI: 10.1113/jp274950] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 03/16/2017] [Indexed: 12/12/2022] Open
Abstract
Good quality sleep of sufficient duration is vital for optimal physiological function and our health. Sleep deprivation is associated with impaired neurocognitive function and emotional control, and increases the risk for cardiometabolic diseases, obesity and cancer. Sleep develops during fetal life with the emergence of a recognisable pattern of sleep states in the preterm fetus associated with the development, maturation and connectivity within neural networks in the brain. Despite the physiological importance of sleep, surprisingly little is known about how sleep develops in individuals born preterm. Globally, an estimated 15 million babies are born preterm (<37 weeks gestation) each year, and these babies are at significant risk of neural injury and impaired brain development. This review discusses how sleep develops during fetal and neonatal life, how preterm birth impacts on sleep development to adulthood, and the factors which may contribute to impaired brain and sleep development, leading to altered neurocognitive, behavioural and motor capabilities in the infant and child. Going forward, the challenge is to identify specific risk factors for impaired sleep development in preterm babies to allow for the design of interventions that will improve the quality and quantity of sleep throughout life.
Collapse
Affiliation(s)
- Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - David W Walker
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| |
Collapse
|