Sleep disordered breathing from preschool to early adult age and its neurocognitive complications: A preliminary report

Objective The onset and development of sleep disordered breathing (SDB) remains unclear in an age - dependent manner. Despite treatment, persistent symptoms such as snoring and excessive daytime sleepiness, as well as cognitive impairment may be present. The aim of the research was to determine the prevalence of residual symptoms of SDB in adolescence and early adulthood, the predisposing factors and its neurocognitive complications. Methods In the present pilot study-cohort, a questionnaire was utilized to 154 people (average age: 17.9 ± 3), who as children (mean age: 5.3 ± 1.4) had AHI ≥2.5 episodes/h. They were divided into two groups based on AHI = 5 episodes/h. Depending on the results, they were invited to undergo a repeated polysomnography (PSG) and complete the Montreal Cognitive Assessment (MoCA) test. Statistical analysis was made with IBM SPSS software. Results Out of the total, 35.7% claimed to still snore. AHI was negatively correlated to the severity of residual symptoms (Mann-Witney U test, p <0.005). According to repeated PSGs, 9/17 met the criteria for OSAS, while high BMI was associated with the severity of new AHI (chi squared test, p<0.005). Additionally, 7/16 scored below the MoCA baseline (<26/30). The characteristics of cognitive declines were mapped, with most prominent having been visuospatial, short - term memory and naming/language deficits. Discussion A significant percentage of children with sleep breathing disorder present with residual symptoms during their transition to early adulthood, as well as undiagnosed neurocognitive complications. Clinicians suspicion for the underlying neurocognitive complications is required, even in young adults, while guidelines on monitoring pediatric OSAS patients after treatment should be addressed.

[1]  S. Mitra,et al.  Anti-inflammatory medications for obstructive sleep apnoea in children. , 2020, The Cochrane database of systematic reviews.

[2]  L. Hui,et al.  How OSA Evolves From Childhood to Young Adulthood: Natural History From a 10-Year Follow-up Study. , 2019, Chest.

[3]  Ken K. P. Chan,et al.  Use of Berlin questionnaire in comparison to polysomnography and home sleep study in patients with obstructive sleep apnea , 2019, Respiratory Research.

[4]  E. Sougey,et al.  Is the Montreal Cognitive Assessment (MoCA) screening superior to the Mini-Mental State Examination (MMSE) in the detection of mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) in the elderly? , 2018, International Psychogeriatrics.

[5]  T. Kasai,et al.  Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea. , 2018, Journal of thoracic disease.

[6]  Soowon Park,et al.  Montreal cognitive assessment reflects cognitive reserve , 2018, BMC Geriatrics.

[7]  R. Bucks,et al.  Cognitive deficits in obstructive sleep apnea: Insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. , 2017, Sleep medicine reviews.

[8]  G. Parati,et al.  Obstructive Sleep Apnea Syndrome (OSAS) and Cardiovascular System. , 2017, La Medicina del lavoro.

[9]  R. Arens,et al.  Sleep and Breathing the First Night After Adenotonsillectomy in Obese Children With Obstructive Sleep Apnea. , 2017, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[10]  Bahn Agha,et al.  Facial phenotype in obstructive sleep apnea–hypopnea syndrome: a systematic review and meta‐analysis , 2017, Journal of sleep research.

[11]  L. Lux,et al.  Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force , 2017, JAMA.

[12]  M. Villa,et al.  Adenotonsillectomy to treat obstructive sleep apnea: Is it enough? , 2017, Pediatric pulmonology.

[13]  Haya S Alsubie,et al.  Obstructive Sleep Apnoea: Children are not little Adults. , 2017, Paediatric respiratory reviews.

[14]  S. Tsai,et al.  Managing Comorbid Illness in Obstructive Sleep Apnea: What Can We Learn from Other Diseases? , 2016, Sleep medicine clinics.

[15]  N. Marshall,et al.  Residual Daytime Sleepiness in Obstructive Sleep Apnea After Continuous Positive Airway Pressure Optimization: Causes and Management. , 2016, Sleep medicine clinics.

[16]  C. Kushida,et al.  A review of neurocognitive function and obstructive sleep apnea with or without daytime sleepiness. , 2016, Sleep medicine.

[17]  Y. Fu,et al.  Relationship between C-reactive protein levels and obstructive sleep apnea syndrome. , 2016, Genetics and molecular research : GMR.

[18]  S. Ulualp,et al.  Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children , 2016, The Laryngoscope.

[19]  K. Gourgoulianis,et al.  Phenotypes of comorbidity in OSAS patients: combining categorical principal component analysis with cluster analysis , 2016, Journal of sleep research.

[20]  L. Delrosso Epidemiology and Diagnosis of Pediatric Obstructive Sleep Apnea. , 2016, Current problems in pediatric and adolescent health care.

[21]  M. Villa,et al.  Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management , 2015, European Respiratory Journal.

[22]  J. Barthélémy,et al.  Protective Effect of Long-Term CPAP Therapy on Cognitive Performance in Elderly Patients with Severe OSA: The PROOF Study. , 2015, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[23]  J. Hedner,et al.  Attention deficits detected in cognitive tests differentiate between sleep apnea patients with or without a motor vehicle accident. , 2015, Sleep medicine.

[24]  T. Hendler,et al.  The Montreal Cognitive Assessment in cognitively-intact elderly: a case for age-adjusted cutoffs. , 2014, Journal of Alzheimer's disease : JAD.

[25]  S. Redline,et al.  Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence. , 2015, Sleep.

[26]  N. Barclay,et al.  Simple snoring: not quite so simple after all? , 2014, Sleep medicine reviews.

[27]  W. Pan,et al.  Can sleep apnea cause Alzheimer's disease? , 2014, Neuroscience & Biobehavioral Reviews.

[28]  D. Torigian,et al.  Tongue fat and its relationship to obstructive sleep apnea. , 2014, Sleep.

[29]  Javier Quintero,et al.  Underdiagnosis of Attention-Deficit/Hyperactivity Disorder in Adult Patients: A Review of the Literature , 2014, The primary care companion for CNS disorders.

[30]  Y. Lacasse,et al.  Do obstructive sleep apnea syndrome patients underestimate their daytime symptoms before continuous positive airway pressure treatment? , 2014, Canadian respiratory journal.

[31]  L. Kheirandish-Gozal,et al.  Variants in C-reactive protein and IL-6 genes and susceptibility to obstructive sleep apnea in children: a candidate-gene association study in European American and Southeast European populations. , 2014, Sleep medicine.

[32]  Raanan Arens,et al.  A randomized trial of adenotonsillectomy for childhood sleep apnea. , 2013, The New England journal of medicine.

[33]  B. Caldwell Anti‐inflammatory medications for obstructive sleep apnoea in children , 2012 .

[34]  S. D. Davidson Ward,et al.  Neurocognitive functioning in children with obstructive sleep apnea syndrome: a pilot study of positive airway pressure therapy. , 2012, Journal of pediatric nursing.

[35]  J. Steier,et al.  Excessive daytime sleepiness in sleep disorders. , 2012, Journal of thoracic disease.

[36]  E. Willcutt The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review , 2012, Neurotherapeutics.

[37]  C. Strange,et al.  Neurocognitive impairment in obstructive sleep apnea. , 2012, Chest.

[38]  Irwin Feinberg,et al.  Topographic differences in the adolescent maturation of the slow wave EEG during NREM sleep. , 2011, Sleep.

[39]  Maria Grazia Marciani,et al.  Cognitive profile and brain morphological changes in obstructive sleep apnea , 2011, NeuroImage.

[40]  J. Choi,et al.  Obstructive Sleep Apnea Syndrome: A Child is not Just a Small Adult , 2010, The Annals of otology, rhinology, and laryngology.

[41]  Sun Jung Chang,et al.  Review article DOI: 10.3345/kjp.2010.53.10.863 , 2010 .

[42]  L. Kheirandish-Gozal,et al.  Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. , 2010, American journal of respiratory and critical care medicine.

[43]  Francisco Lopez-Jimenez,et al.  Interactions between obesity and obstructive sleep apnea: implications for treatment. , 2010, Chest.

[44]  D. Georgopoulos,et al.  Guidelines for diagnosing and treating sleep related breathing disorders in adults and children (Part 3: obstructive sleep apnea in children, diagnosis and treatment). , 2010, Hippokratia.

[45]  Paschos Kahippokratia Guidelines for Diagnosing and Treating Sleep related Breathing Disorders in Adults and Children ( Part 3 : Obstructive Sleep Apnea in Children , Diagnosis and Treatment ) , 2009 .

[46]  K. Gourgoulianis,et al.  Obesity and persisting sleep apnea after adenotonsillectomy in Greek children. , 2008, Chest.

[47]  A. Tal,et al.  Inflammation and Sleep Disordered Breathing in Children: A State‐of‐the‐Art Review , 2008, Pediatric pulmonology.

[48]  David Gozal,et al.  Obstructive sleep apnea in children: implications for the developing central nervous system. , 2008, Seminars in pediatric neurology.

[49]  E. Katz,et al.  Pathophysiology of pediatric obstructive sleep apnea. , 2008, Proceedings of the American Thoracic Society.

[50]  Atul Malhotra,et al.  Pathophysiology of adult obstructive sleep apnea. , 2008, Proceedings of the American Thoracic Society.

[51]  J. Santamaria,et al.  Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment. , 2007, Sleep medicine reviews.

[52]  P. Kurnatowski,et al.  Neurocognitive abilities in children with adenotonsillar hypertrophy. , 2006, International journal of pediatric otorhinolaryngology.

[53]  Yaakov Stern,et al.  Cognitive Reserve: Implications for Assessment and Intervention , 2013, Folia Phoniatrica et Logopaedica.

[54]  K. Gourgoulianis,et al.  Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing. , 2005, American journal of respiratory and critical care medicine.

[55]  K. Gourgoulianis,et al.  Nasal corticosteroids for children with snoring , 2004, Pediatric pulmonology.

[56]  D. Beebe,et al.  The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data. , 2003, Sleep.

[57]  V. Mohsenin,et al.  Gender differences in the expression of sleep-disordered breathing : role of upper airway dimensions. , 2001, Chest.

[58]  C. Zwillich,et al.  Obstructive Sleep-Disordered Breathing , 1999 .

[59]  H. Ohtani [C-reactive protein (CRP)]. , 1995, Nihon rinsho. Japanese journal of clinical medicine.

[60]  J. Stradling,et al.  Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. , 1992, Thorax.

[61]  B A Staats,et al.  Obstructive sleep apnea syndrome. , 1990, Mayo Clinic proceedings.

[62]  C. Guilleminault,et al.  Sleep-Related Abdominal Muscle Behavior during Partial or Complete Obstructed Breathing in Prepubertal Children1 , 1989, Pediatric Research.

[63]  M C Apps,et al.  Sleep-disordered Breathing , 2022 .