New Light on Link between Snoring and Cognitive Deficits in Children

Tuesday, October 07, 2008

About two-thirds of children with sleep-disordered breathing (SDB)— snoring or obstructive sleep apnea (OSA)— have some degree of cognitive deficit, but the severity of the cognitive deficit has been notoriously difficult to correlate to the severity of the SDB. This suggests that other important issues may be at play, or that the right factors were simply not being measured.

A new study that will be published in the first issue for November of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine opens the door to understanding the complex relationship between sleep, breathing and brain function in a whole new way.

"A history of snoring is a predictor for cognitive deficit in children with SDB," said principle investigator Raouf Amin, MD, professor of pediatrics and the director of the Division of Pulmonary Medicineat Cincinnati Children's Hospital Medical Center. "However, the frequency of apnea events not predict cognitive deficit and does not correlate with the degree of cognitive deficit. Such a paradox raised the question of whether there are some variables that we do not traditionally measure in the sleep laboratory that might modify the effect of SDB on cognition."

Dr. Amin and colleagues measured a new parameter to determine whether it could explain the variability in cognitive dysfunction better than the severity of SDB: the degree to which the brain's blood remains oxygenated during sleep. Using a technology called near infrared spectroscopy, which is able to penetrate the skull with high-powered light beams to assess oxygen saturation, they measured the "regional cerebral oxygen concentration" (SrO2) in children 7 to 13 years old with SDB to varying degrees. They also measured blood pressure (BP) during sleep.
As expected, they found that children with snoring had lower regional cerebral oxygen concentration than healthy children. But, paradoxically, they found that children with sleep apnea, which is usually considered a more severe degree of sleep-disordered breathing, have higher regional cerebral oxygen concentration than children with just snoring.

"During normal sleep, when breathing appears to be stable, there seems to be higher oxygen in the brain among children with sleep apnea compared even to normal children," said Dr. Amin, who attributes the unexpected finding to the sleep apnea raises blood pressure. "Children with sleep apnea have higher BP compared to children with snoring. This may explain why paradoxically we find higher oxygen levels in children with OSA."

This study opens the door to a new area of study, said David Gozal, MD, professor of pediatrics and director of the Kosair Children's Hospital Research Institute at the University of Louisville, who wrote the accompanying editorial in the journal. "It shows us that what is happening in children with OSA and that neurocognitive deficits are not just in the brain matter but involve the cardiovascular system as well."

More than anything, the study opens up avenues of inquiry for investigating the perplexing link between SDB and cognitive deficits in children. Understanding the source of that association will be key in future efforts to treat or prevent it.

"By taking into account the role of blood pressure in regulating the amount of oxygen concentration in the brain, we might have a better understanding of the relationship between sleep-disordered breathing and cognitive deficit," concluded Dr. Amin.

*It should be noted the American Thoracic Society published this press release.

Contact for study: Raouf Amin

Director of the Division of Pulmonary Medicine
Cincinnati Children’s Hospital Medical Center
3333 Burnet Avenue
Cincinnati, OH 45229

Please contact via: Nick Miller, media relations department

Contact for Editorial: David Gozal, MD
Professor, Division of Sleep Medicine
Department of Pediatrics
University of Louisville
School of Medicine
570 S. Preston St. Ste. 204
Louisville, KY 40202

Phone: 502-852-4070

E-mail: david.gozal@louisville.edu

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Founded in 1905, the American Thoracic Society is the world’s leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society has more than 15,000 members who prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy.

About Cincinnati Children’s Hospital Medical Center

Cincinnati Children's Hospital Medical Center is one of America’s top three children’s hospitals for general pediatrics and is highly ranked for its expertise in digestive diseases, respiratory diseases, cancer, neonatal care, heart care and neurosurgery, according to the annual ranking of best children's hospitals by U.S. News & World Report. One of the three largest children’s hospitals in the U.S., Cincinnati Children’s is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health.

For its achievements in transforming healthcare, Cincinnati Children's is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize ® for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases, so that children with the most difficult-to-treat diseases and conditions receive the most advanced care leading to better outcomes.