Reduced Regional Grey Matter Volumes in Pediatric Obstructive Sleep Apnea

Abstract

Pediatric OSA is associated with cognitive risk. Since adult OSA manifests MRI evidence of brain injury, and animal models lead to regional neuronal losses, pediatric OSA patients may also be affected. We assessed the presence of neuronal injury, measured as regional grey matter volume, in 16 OSA children (8 male, 8.1 ± 2.2 years, AHI:11.1 ± 5.9 events/hr), and 200 control subjects (84 male, 8.2 ± 2.0 years), 191 of whom were from the NIH-Pediatric MRI database. High resolution T1-weighted whole-brain images were assessed between groups with voxel-based morphometry, using ANCOVA (covariates, age and gender; family-wise error correction, P < 0.01). Significant grey matter volume reductions appeared in OSA throughout areas of the superior frontal and prefrontal, and superior and lateral parietal cortices. Other affected sites included the brainstem, ventral medial prefrontal cortex, and superior temporal lobe, mostly on the left side. Thus, pediatric OSA subjects show extensive regionally-demarcated grey matter volume reductions in areas that control cognition and mood functions, even if such losses are apparently independent of cognitive deficits. Since OSA disease duration in our subjects is unknown, these findings may result from either delayed neuronal development, neuronal damaging processes, or a combination thereof, and could either reflect neuronal atrophy or reductions in cellular volume (neurons and glia).

Waking up too early – the consequences of preterm birth on sleep development

“…; Philby et al . ). fMRI studies suggest that children with OSA had greater neuronal recruitment in brain regions associated with cognitive control, conflict monitoring, and attentional allocation (Kheirandish‐Gozal et al .…”

“…; Philby et al . ). Diffusion tensor imaging studies have identified that both chronic and acute changes occur, indicating that both short‐term and long‐lasting processes are operating in children with OSA, probably resulting from a combination of ischaemic and hypoxic mechanisms associated with the syndrome (Horne et al .…”

Temporal trajectories of novel object recognition performance in mice exposed to intermittent hypoxia

“…Obstructive sleep apnoea (OSA) is a highly prevalent clinical condition characterised by repeated episodes of upper airway obstruction during sleep, which imposes not only substantial cardiovascular and metabolic morbidity, but is also implicated in deleterious consequences on cognitive and behavioural functioning [1,2]. Evidence pointing to structural brain changes in neural sites underlying cognitive functioning may ultimately account to the neuropsychological impairments [3][4][5][6][7][8][9][10][11][12]. However, the reversibility of such functional deficits has been highly variable, with studies showing major improvements while others were unable to detect any functional changes [13,14].…”

Plasma Extracellular Vesicles in Children with OSA Disrupt Blood–Brain Barrier Integrity and Endothelial Cell Wound Healing In Vitro

“…Pediatric obstructive sleep apnea (P-OSA) may affect up to 3%-4% of all school-aged children, and is characterized by recurrent episodes of upper airway collapsibility during sleep that leads to disruption of alveolar ventilation, episodic hypoxemia, and sleep fragmentation. A large body of evidence has reported the presence of associations between childhood OSA and behavioral and cognitive problems, including impulsivity, hyperactivity, and decreased attention and academic performance [7][8][9][10][11][12][13][14]. The biological plausibility of these associations has been corroborated by extensive studies in rodent models [15][16][17].…”