Effect of Sleep-disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-aged Children
Effect of Sleep-disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-aged Children
复制标题
DOI：
10.1164/rccm.201510-2099oc
复制
发表时间：
2016-09-15
影响因子：
24.7
通讯作者：
Kheirandish-Gozal, Leila
中科院分区：
文献类型：
--
作者：
Hunter, Scott J.;Gozal, David;Kheirandish-Gozal, Leila
原理：儿童睡眠呼吸障碍（SDB）与认知挑战相关。然而，SDB严重程度和神经认知功能之间的潜在关联，以及SDB临界值的存在，尚未得到充分的研究。目的：确定SDB相关的神经认知功能不良变化是否与严重程度相关。共1、010打鼾和不打鼾的5岁儿童-从公立学校前瞻性招募7岁儿童，并进行多导睡眠图和智力、注意力、记忆力、语言和执行功能发育的神经认知评估。根据呼吸暂停低通气指数（AHI）将儿童分为四个严重组，然后比较认知功能，特别关注智力、语言、注意力、记忆力和执行功能的标准化子测试。测量和主要结果：言语能力差异量表（P < 0.001）和非语言（P = 0.002）的表现，以及整体概念能力（IQ）（P < 0.001）得分，在各组之间存在显著差异，具有较高AHI的个体表现较差。此外，特定的NEPSY（一种发育神经心理学评估）子分数集中在注意力和执行技能上，各组之间存在差异，表明参与和解决问题的水平存在差异。儿童较高的AHI（>5每小时的总睡眠时间）显着受损比所有三个较低的AHI组，表明剂量反应的影响SDB.Conclusions：这个大的社区为基础的样本的儿童突出了SDB的显着有害影响，特别是在中度至重度阻塞性睡眠呼吸暂停的儿童，而且，即使打鼾单独影响神经认知功能。通过影响发展能力，如以严重程度分级的方式进行的认知测量所示，SDB可能对儿童实现学业和适应目标的能力产生不利影响，最终阻碍他们实现独立的能力。我们的研究结果支持需要提高对SDB的认识，特别强调患有更严重阻塞性睡眠呼吸暂停的儿童。
Rationale: Sleep-disordered breathing (SDB) in children is associated with cognitive challenges. However, potential associations between SDB severity and neurocognitive function, as well as the presence of an SDB cutoff, have not been fully explored.Objectives: To determine whether SDB-associated adverse changes in neurocognitive functioning are severity dependent.Methods: A total of 1,010 snoring and nonsnoring children ages 5-7 years were prospectively recruited from public schools and underwent polysomnography and neurocognitive assessments of intellectual, attention, memory, language, and executive function development. The children were subdivided into four severity groups on the basis of apnea hypopnea index (AHI), followed by comparisons of cognitive function, with a particular focus on standardized subtests of intellectual, language, attention, memory, and executive function.Measurement and Main Results: Differential Ability Scales Verbal (P < 0.001) and Nonverbal (P = 0.002) performance, as well as global conceptual ability (IQ) (P < 0.001) scores, differed significantly across the groups, with individuals with higher AHI showing worse performance. Additionally, specific NEPSY (a Developmental Neuropsychological Assessment) subscores focused on attention and executive skills differed across the groups, indicating differences in levels of engagement and problem solving. Children with higher AHI (>5 per hour of total sleep time) were significantly more impaired than all three lower AHI groups, indicating a dose response impact of SDB.Conclusions: This large community-based sample of children highlights the significant deleterious impact of SDB, particularly in children with moderate to severe obstructive sleep apnea, and also that even snoring alone affects neurocognitive function. By affecting developing capabilities, as illustrated by cognitive measures in a severity-graded manner, SDB could adversely impact children's capacity to attain academic and adaptive goals, ultimately hampering their ability to reach independence. Our findings support the need for increased awareness of SDB, with particular emphasis on children with more severe obstructive sleep apnea.