Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury.
Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury.
复制标题
DOI：
10.1371/journal.pmed.0030301
复制
发表时间：
2006-08
期刊：
影响因子：
15.8
通讯作者：
Mahone EM
中科院分区：
文献类型：
--
作者：
Halbower AC;Degaonkar M;Barker PB;Earley CJ;Marcus CL;Smith PL;Prahme MC;Mahone EM
儿童阻塞性睡眠呼吸暂停（OSA）与记忆、学习和执行功能的神经心理缺陷有关。没有证据表明OSA儿童存在神经元脑损伤。我们假设儿童期OSA与神经心理功能障碍有关，并与大脑中神经元代谢物的改变有关，这表明与神经心理功能相对应的区域中的神经元损伤。我们对31名儿童（19名OSA和12名健康对照，年龄6-16岁）进行了一项横断面研究，按年龄，种族，性别和社会经济地位进行分组匹配。参与者接受了多导睡眠图和神经心理学评估。质子磁共振波谱成像进行了一个子集的儿童OSA和匹配的控制。比较两组的神经心理学测验得分和靶脑区的平均神经元代谢物比率。与对照组相比，重度OSA儿童在智商和执行功能（言语工作记忆和言语流畅性）方面存在显著缺陷。患有OSA的儿童表现出左侧海马（对照组：1.29，标准差[SD] 0.21; OSA：0.91，SD 0.05; p = 0.001）和右侧额叶皮质（对照组：2.2，SD 0.4; OSA：1.6，SD 0.4; p = 0.03）中N-乙酰天冬氨酸/胆碱的平均神经元代谢物比率降低。儿童OSA与智商和执行功能的缺陷有关，也可能与海马和额叶皮层的神经元损伤有关。我们推测，未经治疗的儿童阻塞性睡眠呼吸暂停综合症可能会永久改变发育中儿童的认知潜力。儿童阻塞性睡眠呼吸暂停与智商和执行功能的缺陷有关，也可能与海马和额叶皮质的神经元损伤有关。睡眠对健康至关重要，对儿童来说，它对正常发育至关重要。症状性儿童睡眠呼吸障碍（SDB）是一系列儿童在睡眠时呼吸困难的疾病的名称。这些情况从简单的打鼾到最严重的阻塞性睡眠呼吸暂停（OSA）。呼吸暂停意味着暂时没有呼吸，在OSA中，这是由暂时但反复阻塞流向肺部的空气引起的。在儿童中，OSA的发生有许多原因，包括扁桃体肿大，长期过敏和肥胖。每100名儿童中就有2名患有OSA。阻塞性睡眠呼吸暂停综合征的症状是夜间大声打鼾、睡眠中断、不安、过度疲劳和难以集中注意力。它的主要测试是睡眠研究（多导睡眠图）。如果不治疗，研究人员认为，它可能会导致一些长期的健康和学习问题;睡眠障碍的儿童已被证明有记忆问题，一般智力较低，执行功能较差（适应新情况的能力），并可能有类似于注意力缺陷多动障碍（ADHD）的行为问题。患有睡眠呼吸暂停的成年人已经被证明有部分大脑异常，特别是额叶皮层，小脑和海马体，但到目前为止还没有关于儿童是否有类似变化的数据。患有睡眠呼吸暂停的儿童可能有认知缺陷，但关于这一主题的研究有限。研究人员希望调查患有OSA的儿童的大脑，看看是否有任何证据表明大脑发生了变化，以及这些变化是否与任何学习问题有关。他们研究了31名儿童（19名OSA和12名健康对照，年龄6-16岁）。参与者接受了多导睡眠图和神经心理学评估，如智商测试和他们执行决策任务的能力测试。一些儿童还对他们的大脑进行了专门的扫描（称为质子磁共振光谱成像），可以测量某些代谢物的水平，这些物质是大脑活动的结果。然后，研究人员将神经心理学测试分数与代谢物水平进行了比较。他们发现，与对照组相比，患有严重阻塞性睡眠呼吸暂停综合症的儿童智商较低，执行涉及决策的任务的能力也较低。患有OSA的儿童大脑中的代谢物也发生了变化，类似于脑细胞受损的疾病。很明显，儿童OSA与学习问题有关，而这些学习问题又可能与大脑代谢物的变化有关。代谢物的变化不一定是永久性的，在其他已经发现变化的疾病中，它们可以通过治疗逆转。如果这些结果在其他患有OSA的儿童中得到证实，将强调尽快治疗儿童OSA的重要性。此外，代谢物的测量可能是衡量儿童对治疗反应如何的一种方法。请通过http://dx.doi.org/10.1371/journal.pmed.0030301上的本摘要在线版本访问这些网站。MedlinePlus的百科全书有一个关于睡眠呼吸暂停的条目美国睡眠呼吸暂停协会有关于让孩子接受睡眠呼吸暂停调查的信息国家睡眠基金会也提供关于睡眠障碍的信息
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. 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). 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. Childhood obstructive sleep apnea is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex. Sleep is essential for health, and in children it is crucial to normal development. Symptomatic childhood sleep-disordered breathing (SDB) is the name for a range of conditions in which children have difficulties with breathing when they are asleep. The conditions range from simple snoring to the most severe condition, known as obstructive sleep apnea (OSA). Apnea means a temporary absence of breathing, and in OSA this is caused by a temporary but repeated blockage of the flow of air to the lungs. In children, OSA occurs for a number of reasons including enlarged tonsils, long-term allergy, and obesity. About two in every hundred children have OSA. The symptoms of OSA are loud snoring at night, disrupted, restless sleep, undue tiredness, and difficulties in concentration. The main test for it is a sleep study (polysomnography). If untreated, researchers believe that it may lead to a number of long-term problems with health and learning; children with disorders of sleep have been shown to have memory problems, lower general intelligence, and worse executive function (the ability to adapt to new situations), and may have behavioral problems similar to those of attention deficit hyperactivity disorder (ADHD). Adults with sleep apnea have been shown to have abnormalities of parts of their brain, specifically the frontal cortex, cerebellum, and hippocampus, but so far there are no data on whether there are similar changes in children. Children with sleep apnea may have cognitive deficits, but the research on this topic is limited. The researchers wanted to investigate the brains of children with OSA to see if there was any evidence of changes in the brain and if these changes were associated with any learning problems. They studied 31 children (19 with OSA and 12 healthy controls, aged 6–16 y). Participants underwent polysomnography and neuropsychological assessments, such as IQ tests and tests of their ability to perform tasks involving decision making. Some of the children also had specialized scans of their brains (known as proton magnetic resonance spectroscopic imaging) that can measure the levels of certain metabolites—substances that are produced as a result of brain activity. The researchers then compared the neuropsychological test scores with the levels of the metabolites. They found that relative to controls, children with severe OSA had lower IQ and ability to perform tasks involving decision making. Children with OSA also had changes in metabolites in the brain similar to those seen in diseases in which there is damage to brain cells. It seems clear that OSA in children is associated with learning problems, and that these learning problems may in turn be associated with changes in brain metabolites. The changes in metabolites are not necessarily permanent—in other diseases where changes have been found they can be reversed with treatment. If these results are confirmed in other children with OSA, it will highlight the importance of treating children for OSA as soon as possible. In addition, the measurement of metabolites may be a way of measuring how well children are responding to treatment. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030301. MedlinePlus's encyclopedia has an entry on sleep apnea The American Sleep Apnea Association has information about having a child investigated for sleep apnea The National Sleep Foundation also provides information about sleep disorders
登录
查看更多内容
影响因子：
4.8
作者：
Bartlett, DJ;Rae, C;Grunstein, RR
通讯作者：
Grunstein, RR
影响因子：
2.3
作者：
Costa, MOR;Lacerda, MTC;Leite, CD
通讯作者：
Leite, CD
影响因子：
1.5
作者：
Denckla, MB
通讯作者：
Denckla, MB
影响因子：
14.5
作者：
DAVIE, CA;HAWKINS, CP;MCDONALD, WI
通讯作者：
MCDONALD, WI
DOI：
10.1080/01688639108405110
发表时间：
1991-11-01
影响因子：
2.2
作者：
BEDARD, MA;MONTPLAISIR, J;MALO, J
通讯作者：
MALO, J