Advertisement

Current Anesthesiology Reports

, Volume 9, Issue 2, pp 110–115 | Cite as

Pediatric Obstructive Sleep Apnea: Neurocognitive Consequences

  • Arvind ChandrakantanEmail author
  • Adam Adler
Pediatric Anesthesia (J Lerman, Section Editor)
  • 26 Downloads
Part of the following topical collections:
  1. Pediatric Anesthesia

Abstract

Purpose of Review

This review seeks to highlight the issue of when the best time to operate is given the neurocognitive consequences of pediatric OSA.

Recent Findings

Learning and memory deficits persist after adenotonsillectomy in school age children with the disease at 9-month follow-up, suggesting short-term damage to the hippocampus in young children with OSA.

Summary

Larger trials with younger children with pediatric OSA are currently ongoing to evaluate the impact of adenotonsillectomy on learning and memory recovery.

Keywords

Obstructive sleep apnea Hypoxia ADHD Neurogenesis Hippocampus 

Notes

Acknowledgments

The authors thank Dr. B. Lee Ligon, Center for Research, Innovation and Scholarship, Department of Pediatrics, BCM, for editorial assistance.

Compliance with Ethical Standards

Conflict of Interest

Arvind Chandrakantan and Adam Adler declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Kheirandish L, Gozal D. Neurocognitive dysfunction in children with sleep disorders. Dev Sci. 2006;9(4):388–99.Google Scholar
  2. 2.
    • Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368(25):2366–76 This study demonstrated that in young children with mild OSA, adenotonsillectomy provided no benefit over watchful waiting with regards to executive function.Google Scholar
  3. 3.
    Lavin JM, Smith C, Harris ZL, Thompson DM. Critical care resources utilized in high-risk adenotonsillectomy patients. Laryngoscope. 2018.Google Scholar
  4. 4.
    De Luca Canto G, et al. Adenotonsillectomy complications: a meta-analysis. Pediatrics. 2015;136(4):702–18.Google Scholar
  5. 5.
    • Waters KA, Chawla J, Harris MA, Dakin C, Heussler H, Black R, et al. Rationale for and design of the “POSTA” study: evaluation of neurocognitive outcomes after immediate adenotonsillectomy compared to watchful waiting in preschool children. BMC Pediatr. 2017;17(1):47 This ongoing study seeks to study mild OSA and its effect on neurocognitive outcomes with regards to surgery or watchful waiting.Google Scholar
  6. 6.
    Jahn HM, Bergami M. Critical periods regulating the circuit integration of adult-born hippocampal neurons. Cell Tissue Res. 2018;371(1):23–32.Google Scholar
  7. 7.
    Lavie L. Obstructive sleep apnoea syndrome--an oxidative stress disorder. Sleep Med Rev. 2003;7(1):35–51.Google Scholar
  8. 8.
    Macey PM, Henderson LA, Macey KE, Alger JR, Frysinger RC, Woo MA, et al. Brain morphology associated with obstructive sleep apnea. Am J Respir Crit Care Med. 2002;166(10):1382–7.Google Scholar
  9. 9.
    Row BW, Liu R, Xu W, Kheirandish L, Gozal D. Intermittent hypoxia is associated with oxidative stress and spatial learning deficits in the rat. Am J Respir Crit Care Med. 2003;167(11):1548–53.Google Scholar
  10. 10.
    Baril AA, Gagnon K, Arbour C, Soucy JP, Montplaisir J, Gagnon JF, et al. Regional cerebral blood flow during wakeful rest in older subjects with mild to severe obstructive sleep apnea. Sleep. 2015;38(9):1439–49.Google Scholar
  11. 11.
    Punjabi NM, Beamer BA. C-reactive protein is associated with sleep disordered breathing independent of adiposity. Sleep. 2007;30(1):29–34.Google Scholar
  12. 12.
    Li T, Chen Y, Gua C, Wu B. Elevated oxidative stress and inflammation in hypothalamic paraventricular nucleus are associated with sympathetic excitation and hypertension in rats exposed to chronic intermittent hypoxia. Front Physiol. 2018;9:840.Google Scholar
  13. 13.
    Lavie L. Oxidative stress in obstructive sleep apnea and intermittent hypoxia--revisited--the bad ugly and good: implications to the heart and brain. Sleep Med Rev. 2015;20:27–45.Google Scholar
  14. 14.
    Lovett-Barr MR, Satriotomo I, Muir GD, Wilkerson JER, Hoffman MS, Vinit S, et al. Repetitive intermittent hypoxia induces respiratory and somatic motor recovery after chronic cervical spinal injury. J Neurosci. 2012;32(11):3591–600.Google Scholar
  15. 15.
    Dore-Duffy P, et al. Chronic mild hypoxia ameliorates chronic inflammatory activity in myelin oligodendrocyte glycoprotein (MOG) peptide induced experimental autoimmune encephalomyelitis (EAE). Adv Exp Med Biol. 2011;701:165–73.Google Scholar
  16. 16.
    Gozal D, Daniel JM, Dohanich GP. Behavioral and anatomical correlates of chronic episodic hypoxia during sleep in the rat. J Neurosci. 2001;21(7):2442–50.Google Scholar
  17. 17.
    Zhang J, Veasey S. Making sense of oxidative stress in obstructive sleep apnea: mediator or distracter? Front Neurol. 2012;3:179.Google Scholar
  18. 18.
    Floyd RA, Hensley K. Oxidative stress in brain aging. Implications for therapeutics of neurodegenerative diseases. Neurobiol Aging. 2002;23(5):795–807.Google Scholar
  19. 19.
    Xu W, Chi L, Row BW, Xu R, Ke Y, Xu B, et al. Increased oxidative stress is associated with chronic intermittent hypoxia-mediated brain cortical neuronal cell apoptosis in a mouse model of sleep apnea. Neuroscience. 2004;126(2):313–23.Google Scholar
  20. 20.
    Beebe DW, Wells CT, Jeffries J, Chini B, Kalra M, Amin R. Neuropsychological effects of pediatric obstructive sleep apnea. J Int Neuropsychol Soc. 2004;10(7):962–75.Google Scholar
  21. 21.
    O’Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, et al. Neurobehavioral implications of habitual snoring in children. Pediatrics. 2004;114(1):44–9.Google Scholar
  22. 22.
    O’Brien LM, Mervis CB, Holbrook CR, Bruner JL, Smith NH, McNally N, et al. Neurobehavioral correlates of sleep-disordered breathing in children. J Sleep Res. 2004;13(2):165–72.Google Scholar
  23. 23.
    O’Brien LM. The neurocognitive effects of sleep disruption in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18(4):813–23.Google Scholar
  24. 24.
    Gozal D. Congenital central hypoventilation syndrome: an update. Pediatr Pulmonol. 1998;26(4):273–82.Google Scholar
  25. 25.
    Urschitz MS, Guenther A, Eggebrecht E, Wolff J, Urschitz-Duprat PM, Schlaud M, et al. Snoring, intermittent hypoxia and academic performance in primary school children. Am J Respir Crit Care Med. 2003;168(4):464–8.Google Scholar
  26. 26.
    Hadden SM, Burke CN, Skotcher S, Voepel-Lewis T. Early postoperative outcomes in children after adenotonsillectomy. J Perianesth Nurs. 2011;26(2):89–95.Google Scholar
  27. 27.
    da Silva Gusmao Cardoso T, Pompeia S, Miranda MC. Cognitive and behavioral effects of obstructive sleep apnea syndrome in children: a systematic literature review. Sleep Med. 2018;46:46–55.Google Scholar
  28. 28.
    Song SA, Tolisano AM, Cable BB, Camacho M. Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: a systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol. 2016;83:205–10.Google Scholar
  29. 29.
    Schmidt-Kastner R. Genomic approach to selective vulnerability of the hippocampus in brain ischemia-hypoxia. Neuroscience. 2015;309:259–79.Google Scholar
  30. 30.
    Taupin P. Adult neural stem cells, neurogenic niches, and cellular therapy. Stem Cell Rev. 2006;2(3):213–9.Google Scholar
  31. 31.
    Kempermann G. Why new neurons? Possible functions for adult hippocampal neurogenesis. J Neurosci. 2002;22(3):635–8.Google Scholar
  32. 32.
    Li B, Sierra A, Deudero JJ, Semerci F, Laitman A, Kimmel M, et al. Multitype Bellman-Harris branching model provides biological predictors of early stages of adult hippocampal neurogenesis. BMC Syst Biol. 2017;11(Suppl 5):90.Google Scholar
  33. 33.
    Toni N, Teng EM, Bushong EA, Aimone JB, Zhao C, Consiglio A, et al. Synapse formation on neurons born in the adult hippocampus. Nat Neurosci. 2007;10(6):727–34.Google Scholar
  34. 34.
    Dayer AG, Ford AA, Cleaver KM, Yassaee M, Cameron HA. Short-term and long-term survival of new neurons in the rat dentate gyrus. J Comp Neurol. 2003;460(4):563–72.Google Scholar
  35. 35.
    Kempermann G, Gast D, Kronenberg G, Yamaguchi M, Gage FH. Early determination and long-term persistence of adult-generated new neurons in the hippocampus of mice. Development. 2003;130(2):391–9.Google Scholar
  36. 36.
    Sierra A, Encinas JM, Deudero JJP, Chancey JH, Enikolopov G, Overstreet-Wadiche LS, et al. Microglia shape adult hippocampal neurogenesis through apoptosis-coupled phagocytosis. Cell Stem Cell. 2010;7(4):483–95.Google Scholar
  37. 37.
    Boldrini M, Fulmore CA, Tartt AN, Simeon LR, Pavlova I, Poposka V, et al. Human hippocampal neurogenesis persists throughout aging. Cell Stem Cell. 2018;22(4):589–599 e5.Google Scholar
  38. 38.
    Sorrells SF, Paredes MF, Cebrian-Silla A, Sandoval K, Qi D, Kelley KW, et al. Human hippocampal neurogenesis drops sharply in children to undetectable levels in adults. Nature. 2018;555(7696):377–81.Google Scholar
  39. 39.
    Kesner RP. A behavioral analysis of dentate gyrus function. Prog Brain Res. 2007;163:567–76.Google Scholar
  40. 40.
    Deng W, Aimone JB, Gage FH. New neurons and new memories: how does adult hippocampal neurogenesis affect learning and memory? Nat Rev Neurosci. 2010;11(5):339–50.Google Scholar
  41. 41.
    Sahay A, Scobie KN, Hill AS, O’Carroll CM, Kheirbek MA, Burghardt NS, et al. Increasing adult hippocampal neurogenesis is sufficient to improve pattern separation. Nature. 2011;472(7344):466–70.Google Scholar
  42. 42.
    Miller BR, Hen R. The current state of the neurogenic theory of depression and anxiety. Curr Opin Neurobiol. 2015;30:51–8.Google Scholar
  43. 43.
    Wu J, Gu M, Chen S, Chen W, Ni K, Xu H, et al. Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups. Medicine (Baltimore). 2017;96(42):e8281.Google Scholar
  44. 44.
    Plessen KJ, Bansal R, Zhu H, Whiteman R, Amat J, Quackenbush GA, et al. Hippocampus and amygdala morphology in attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2006;63(7):795–807.Google Scholar
  45. 45.
    • Miano S, Esposito M, Foderaro G, Ramelli GP, Pezzoli V, Manconi M. Sleep-related disorders in children with attention-deficit hyperactivity disorder: preliminary results of a full sleep assessment study. CNS Neurosci Ther. 2016;22(11):906–14 This study sought to create a relationship between sleep disorders and ADHD.Google Scholar
  46. 46.
    Rubia K. Cognitive neuroscience of attention deficit hyperactivity disorder (ADHD) and its clinical translation. Front Hum Neurosci. 2018;12:100.Google Scholar
  47. 47.
    Bin-Hasan S, Katz S, Nugent Z, Nehme J, Lu Z, Khayat A, et al. Prevalence of obstructive sleep apnea among obese toddlers and preschool children. Sleep Breath. 2018;22(2):511–5.Google Scholar
  48. 48.
    • Alsubie HS, BaHammam AS. Obstructive sleep apnoea: children are not little adults. Paediatr Respir Rev. 2017;21:72–9 This paper demonstrates that adult and pediatric OSA are two different disorders.Google Scholar
  49. 49.
    Nieminen P, Tolonen U, Löppönen H, Löppönen T, Luotonen J, Jokinen K. Snoring children: factors predicting sleep apnea. Acta Otolaryngol Suppl. 1997;529:190–4.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Anesthesiology & PediatricsTexas Children’s Hospital/Baylor College of MedicineHoustonUSA

Personalised recommendations