Is there an association between cognitive impairment and urinary adrenaline, norepinephrine, gamma-aminobutyric acid, and taurine levels in children with obstructive sleep apnea?:a case control study

Abstract

Background. The purpose of this study was to compare the urinary adrenaline (EPI), norepinephrine (NE), gamma-aminobutyric acid (GABA), and taurine levels between children with and without obstructive sleep apnea (OSA) and then analyze the predictive value of urinary neurotransmitters on cognitive impairment in these patients. Methods. Children aged 3–12 years were enrolled and underwent polysomnography (PSG) recording during the whole night. PedsQL and CBCL scales were used to evaluate the cognitive function of these children. Morning urine samples were collected and used to measure the abovementioned urinary neurotransmitter levels. Results. A total of 104 cases were recruited, including 30 primary snoring (PS) and 74 OSA cases. Compared with the PS group, the OSA group had a lower social function (Z=-2.506, P = 0.012), school function (T = 2.596,P = 0.011), and total PedsQL (T = 2.546, P = 0.012) scores; the OSA group also exhibited increased withdrawal (Z=-2.121, P = 0.034) and attention problem (Z=-2.176, P = 0.030) scores in the CBCL scale. A total of 39 cases were considered mild cognitive impairment(MIC) in the OSA group (PedsQL total score below 76.13), who had higher urinary EPI (F = 25.725, P < 0.001) and lower taurine (F = 9.515, P < 0.001) levels than both PS and OSA without MIC groups. Logistic regression results showed that the incidence of cognitive-behavioral impairment in OSA children with obesity was significantly higher than in OSA children who had a normal BMI (OR = 6.999, 95%CI: 1.302 ~ 37.617). High levels of urinary NE (OR = 1.023, 95%CI: 1.001–1.046) and low levels of taurine (OR = 0.985, 95%CI: 0.974–0.997) were significantly associated with cognitive-behavioral impairment in children with OSA, and their combination had a comparatively larger area under the curve (0.695), with a sensitivity of 64.1% and specificity of 68.6% (P = 0.004). Conclusions. Urinary taurine and EPI can contribute to the prediction of cognitive impairment in OSA children, and combining these two neurotransmitters may have relatively good sensitivity and specificity for the presence of cognitive impairment associated with OSA.