Increased Cerebral Blood Flow Velocity in Children With Mild Sleep-Disordered Breathing: A Possible Association With Abnormal Neuropsychological Function

Abstract

Objective-Sleep-disordered breathing describes a spectrum of upper airway obstruction in sleep from simple primary snoring, estimated to affect 10% of preschool children, to the syndrome of obstructive sleep apnea. Emerging evidence has challenged previous assumptions that primary snoring is benign. A recent report identified reduced attention and higher levels of social problems and anxiety/depressive symptoms in snoring children compared with controls. Uncertainty persists regarding clinical thresholds for medical or surgical intervention in sleep-disordered breathing, underlining the need to better understand the pathophysiology of this condition. Adults with sleepdisordered breathing have an increased risk of cerebrovascular disease independent of atherosclerotic risk factors. There has been little focus on cerebrovascular function in children with sleep-disordered breathing, although this would seem an important line of investigation, because studies have identified abnormalities of the systemic vasculature. Raised cerebral blood flow velocities on transcranial Doppler, compatible with raised blood flow and/or vascular narrowing, are associated with neuropsychological deficits in children with sickle cell disease, a condition in which sleepdisordered breathing is common. We hypothesized that there would be cerebral blood flow velocity differences in sleep-disordered breathing children without sickle cell disease that might contribute to the association with neuropsychological deficits.Design-Thirty-one snoring children aged 3 to 7 years were recruited from adenotonsillectomy waiting lists, and 17 control children were identified through a local Sunday school or as siblings of cases. Children with craniofacial abnormalities, neuromuscular disorders, moderate or severe learning disabilities, chronic respiratory/cardiac conditions, or allergic rhinitis were excluded. Severity of sleep-disordered breathing in snoring children was categorized by attended polysomnography. Weight, height, and head circumference were measured in all of the children. BMI and occipitofrontal circumference z scores were computed. Resting systolic and diastolic blood Address correspondence to Catherine M. Hill, BM, MSc, MRCP, FRCPCH, University of Southampton-Child Health, Mail Point 803, Southampton General Hospital, Southampton, Hampshire SO16 6YD, United Kingdom. Email: cmh2@soton.ac.uk The authors have indicated they have no financial relationships relevant to this article to disclose.Drs Hill and Hogan contributed equally to this work and share first authorship. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2007 October 1. Published in final edited form as:Pediatrics. 2006 October ; 118(4): e1100-e1108. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript pressure were obtained. Both sleep-disordered breathing children and the age-and BMI-similar controls were assessed using the Behavior Rating Inventory of Executive Function (BRIEF), Neuropsychological Test Battery...

Hemoglobinopathies and sleep – The road less traveled

“…An interesting association between executive dysfunction and SDB can be inferred from studies on cerebral blood flow in children with SDB e a study by Hill et al [152] found that in healthy children with mild SDB (AHI < 5/hTST), increased cerebral blood flow velocities were strongly correlated with decreased executive function as compared to healthy controls. The marked overlap between the presence of endothelial dysfunction and cognitive deficits in children with SDB is not only striking but further suggests that altered endothelial function may adversely affect the survival of neurons in highly susceptible regions such as the frontal cortex [153,154].…”

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

“…(1) SDB has been linked to hypertension,(2) growth failure,(3) enuresis, (4,5) and impairment of cognition, attention, and executive functions. (6)(7)(8)(9)(10)(11)(12) Identification of children at high risk for SDB and its associated morbidities is particularly important given the growing body of evidence that treatment with adenotonsillectomy may improve quality of life and neurocognitive function. (5,(13)(14)(15)(16)(17) Preterm infants are especially vulnerable both to SDB and its sequelae.…”

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

“…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)(4)(5)(6)(7)(8)(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).…”