PLoS Medicine August 2006 | Volume 3 | Issue 8 | e301

 

Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury

Ann C. Halbower 1 , Mahaveer Degaonkar 2 , Peter B. Barker 2, Christopher J. Earley 3 ,Carole L. Marcus 4 ,

Philip L. Smith 5 , M. Cristine Prahme 6 , E. Mark Mahone 6 , 7

  1. Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
  2. Department of Radiology, Johns Hopkins University School of Medicine, and FM Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, United States of America
  3. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
  4. Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
  5. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
  6. Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, Maryland, United States of America
  7. Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
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Methods and Findings: We conducted a cross-sectional study of 31 children (19 with OSA and 12 healthy controls, aged 6–16 y) group-matched by age, ethnicity, gender, and socioeconomic status. Participants underwent polysomnography and neuropsychological assessments. Proton magnetic resonance spectroscopic imaging was performed on a subset of children with OSA and on matched controls. Neuropsychological test scores and mean neuronal metabolite ratios of target brain areas were compared. Relative to controls, children with severe OSA had significant deficits in IQ and executive functions (verbal working memory and verbal fluency). Children with OSA demonstrated decreases of the mean neuronal metabolite ratio N-acetyl aspartate/choline in the left hippocampus (controls: 1.29, standard deviation [SD] 0.21; OSA: 0.91, SD 0.05; p = 0.001) and right frontal cortex (controls: 2.2, SD 0.4; OSA: 1.6, SD 0.4; p = 0.03). Conclusions: Childhood OSA is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex. We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential.