Determinants of Regional Cerebral Oxygenation in Children with Sleep-disordered Breathing

Abstract

Rationale: An association between neurocognitive deficits and pediatric sleep-disordered breathing has been suggested; however, weak correlations between disease severity and functional outcomes underscore the lack of knowledge regarding factors modulating cognitive morbidity of sleep-disordered breathing. Objectives: To identify the parameters affected by sleep-disordered breathing that modulate cerebral oxygenation, an important determinant of cognition. A further objective was to use these parameters with demographic data to develop a predictive statistical model of pediatric cerebral oxygenation. Methods: Ninety-two children (14 control subjects, 32 with primary snoring, and 46 with obstructive sleep apnea) underwent polysomnography with continuous monitoring of cerebral oxygenation and blood pressure. Analysis of covariance was used to relate the blood pressure, sleep diagnostic parameters, and demographic characteristics to regional cerebral oxygenation. Measurements and Main Results: To account for anatomic variability, an index of cerebral oxygenation during sleep was derived by referencing the measurement obtained during sleep to that obtained during wakefulness. In a repeated measures model predicting the index of cerebral oxygenation, mean arterial pressure, rapid eye movement (REM) sleep, female sex, age, and oxygen saturation had a positive effect on cerebral oxygenation levels, whereas arousal index and non-REM (NREM) sleep had a negative effect. Conclusions: Increasing mean arterial pressure, age, oxygen saturation, and REM sleep augment cerebral oxygenation, while sleepdisordered breathing, male sex, arousal index, and NREM sleep diminish it. The proposed model may explain the sources of variability in cognitive function of children with sleep-disordered breathing.Keywords: children; sleep-disordered breathing; cerebral oxygenationThe pediatric syndrome of sleep-disordered breathing (SDB), which encompasses both primary snoring and obstructive sleep apnea (OSA), affects more than 12% of children (1, 2). Whereas children with primary snoring have only a limited number of obstructive airway events during sleep, those with OSA characteristically experience varying, but more frequent episodes of airway obstruction. Although cognitive deficits have been described in children with SDB, evidence of a causal relationship between SDB and these deficits has not been firmly established (3-9). The absence of a dose-dependent association of cognitive deficits with increasing severity of OSA, coupled with findings of cognitive deficits in children with primary snoring, has challenged the notion of an adverse effect of SDB on cognition (10, 11). To the contrary, however, SDB may indeed be causally related to the development of cognitive deficits, with the biological factors that modify its effect on cognition not yet identified.There is strong evidence that a sustained decrease of regional cerebral oxygen saturation (rS O 2 ) during cardiopulmonary bypass surgery in adults is related to postoperative decline in...

Sleep-disordered breathing, behavior, and academic performance in Taiwan schoolchildren

“…In addition, an association between increased arousal index and SDB severity was observed among our tested children, with results that were similar to previous studies [35,36]. The differences in polysomnographic parameters observed in the current study were similar to other children research including sleep efficiency and sleep stages, although AHI classification was different [35,36].…”

“…The differences in polysomnographic parameters observed in the current study were similar to other children research including sleep efficiency and sleep stages, although AHI classification was different [35,36]. We also observed an oxygen deficit in children with severe SDB, AHI>15 group.…”

“…It has been proposed that, when breathing pauses, oxygen is blocked before entering into the lungs [37]. Decreasing regional cerebral oxygen has been found in children with increasing SDB status and is related to mean arterial blood pressure and oxygen saturation during sleep [35]. These findings explained children with severe AHI having the highest DI values and lowest LOS.…”

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

“…Khadra et al 62 reported that male gender, arousal index, and amount of non-rapid eye movement sleep were associated with diminished cerebral oxygenation, whereas increasing mean arterial pressure, age, oxygen saturation (SpO 2 ), and amount of rapid eye movement sleep were associated with augmented cerebral oxygenation (level III). Hogan et al 48 found a decrease in middle cerebral artery velocity postoperatively in patients treated for OSAS, whereas control subjects showed a slight increase over time (level IV).…”

Cerebral Oxygenation in Preterm Infants

“…50,51 In the mature brain, CBF usually overshoots the metabolic demands of AS resulting in an increase in oxygenated Hb relative to deoxygenated Hb and therefore increased cerebral TOI. 52 At 2 to 4 weeks CA, the CBF-metabolism coupling response appears to be relatively immature with inadequate increases in CBF 22 during AS resulting in increased oxygen extraction, increased deoxygenated Hb, and decreased cerebral TOI. The reversal of this observation at 5 to 6 months CA suggests that maturation of CBF-metabolism coupling is occurring during this period.…”