Download PDF
CC BY-NC-ND 4.0 · Sleep Sci 2021; 14(S 02): 140-149
DOI: 10.5935/1984-0063.20200098
ORIGINAL ARTICLE

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

Kyriaki Astara
1   School of Medicine, University of Thessaly - Larissa - Thessaly - Greece.
,
Dimitra Siachpazidou
2   University of Thessaly, Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences - Larissa - Thessaly - Greece.
,
George D Vavougios
3   Athens Naval Hospital, Department of Neurology - Athens - Athens - Greece.
,
Dimitrios Ragias
1   School of Medicine, University of Thessaly - Larissa - Thessaly - Greece.
,
Konstantina Vatzia
1   School of Medicine, University of Thessaly - Larissa - Thessaly - Greece.
,
Georgia Rapti
4   School of Medicine and Larissa University Hospital, Sleep Disorders Laboratory, University of Thessaly - Larissa - Thessaly - Greece.
,
Emmanouil Alexopoulos
4   School of Medicine and Larissa University Hospital, Sleep Disorders Laboratory, University of Thessaly - Larissa - Thessaly - Greece.
,
Konstantinos I Gourgoulianis
2   University of Thessaly, Department of Respiratory Medicine, Faculty of Medicine, School of Health Sciences - Larissa - Thessaly - Greece.
,
Georgia Xiromerisiou
5   University of Thessaly, University Hospital of Larissa, Department of Neurology - Larissa - Thessaly - Greece.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

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.

Sleep Apnea Syndromes - Cognitive Dysfunction - Adolescent - C-Reactive Protein

Supplementary



Publication History

Received: 19 June 2020

Accepted: 15 January 2021

Article published online:
30 November 2023

© 2023. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • REFERENCES

  • 1 Tsara V, Amfilochiou A, Papagrigorakis JM, Georgopoulos D, Liolios E, Kadiths A, 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). Hippokratia. 2010 Jan/ Mar;14(1):57-62.
  • 2 Foldvary-Schaefer NR, Waters TE. Sleep-disordered breathing. Continuum (Minneap Minn). 2017 Aug;23(4):1093-116.
  • 3 Chang SJ, Chae KY. Obstructive sleep apnea syndrome in children: epidemiology, pathophysiology, diagnosis and sequelae. Korean J Pediatr. 2010 Oct;53(10):863-71.
  • 4 Kaditis AG, Gozal D, Khalyfa A, Kheirandish-Gozal L, Capdevila OS, Gourgoulianis K, et al. Variants in C-reactive protein and IL-6 genes and susceptibility to obstructive sleep apnea in children: a candidategene association study in European American and Southeast European populations. Sleep Med. 2014 Feb;15(2):228-35.
  • 5 Goldbart AD, Tal A. Inflammation and sleep disordered breathing in children: a state-of-the-art review. Pediatr Pulmonol. 2008;43(12):1151-60.
  • 6 De A, Waltuch T, Gonik NJ, Nguyen-Famulare N, Muzumdar H, Bent JP, et al. Sleep and breathing the first night after adenotonsillectomy in obese children with obstructive sleep apnea syndrome. J Clin Sleep Med. 2017 Jun;13(6):805-11.
  • 7 Boudewyns A, Abel F, Alexopoulos E, Evangelisti M, Kaditis A, Miano S, et al. Adenotonsillectomy to treat obstructive sleep apnea: is it enough?. Pediatr Pulmonol. 2017 May;52(5):699-709.
  • 8 Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor G, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368:2366-76.
  • 9 Santamaria J, Iranzo A, Ma Montserrat J, Pablo J. Persistent sleepiness in CPAP treated obstructive sleep apnea patients: evaluation and treatment. Sleep Med Rev. 2007 Jun;11(3):195-207.
  • 10 Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, Mitchell RB, Promchiarak J, Simakajornboon N, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010 Sep;182(5):676-83.
  • 11 Chapman J, Serinel Y, Marshall NS, Grunstein RR. Residual daytime sleepiness in obstructive sleep apnea after continuous positive airway pressure optimization: causes and management. Sleep Med Clin. 2016 Sep;11(3):353-63.
  • 12 Deary V, Ellis JG, Wilson JA, Coulter C, Barclay NL. Simple snoring: not quite so simple after all?. Sleep Med Rev. 2014 Dec;18(6):453-62.
  • 13 Zhou J, Camacho M, Tang X, Kushida CA. A review of neurocognitive function and obstructive sleep apnea with or without daytime sleepiness. Sleep Med. 2016 Jul;23:99-108.
  • 14 Crawford-Achour E, Dauphinot V, Martin MS, Tardy M, Gonthier R, Barthelemy JC, et al. Protective effect of long-term CPAP therapy on cognitive performance in elderly patients with severe OSA: the PROOF study. J Clin Sleep Med. 2015 May;11(5):519-24.
  • 15 Slater G, Steier J. Excessive daytime sleepiness in sleep disorders. J Thorac Dis. 2012 Dec;4(6):608-16.
  • 16 Pan W, Abba JK. Can sleep apnea cause Alzheimer’s disease?. Neurosci Biobehav Rev. 2014 Nov;47:656-69.
  • 17 Torelli F, Moscufo N, Garreffa G, Placidi F, Romigi A, Zannino S, et al. Cognitive profile and brain morphological changes in obstructive sleep apnea. Neuroimage. 2011;54(2):787-93.
  • 18 Yuan HC, Sohn EY, Abouezzeddine T, Mahrer NE, Barber BA, Keens TG, et al. Neurocognitive functioning in children with obstructive sleep apnea syndrome: a pilot study of positive airway pressure therapy. J Pediatr Nurs. 2012 Dec;27(6):607-13.
  • 19 Marcus CL, Carroll JL. Obstructive sleep apnea syndrome. In: Loughlin GM, Eigen H, eds. Respiratory disease in children: diagnosis and management. Baltimore: Williams & Wilkins; 1994. p. 475-99.
  • 20 Praud JP, D’Allest AM, Nedelcoux H, Curzi-Dascalova L, Guilleminault C, Gaultier C. Sleep-related abdominal muscle behavior during partial or complete obstructed breathing in prepubertal children. Pediatr Res. 1989;26(4):347-50.
  • 21 Gozal D. Obstructive sleep apnea in children: implications for the developing central nervous system. Semin Pediatr Neurol. 2008 Jun;15(2):100-6.
  • 22 Chan KC, Au CT, Hui LL, Ng SK, Wing YK, Li AM. How OSA evolves from childhood to young adulthood. Chest. 2019 Jul;156(1):120-30.
  • 23 Kurnatowski P, Puty.ski L, Lapienis M, Kowalska B. Neurocognitive abilities in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2006 Mar;70(3):419-24.
  • 24 Katz ES, D’Ambrosio CM. Pathophysiology of pediatric obstructive sleep apnea. Proc Am Thorac Soc. 2008 Feb;5(2):253-62.
  • 25 Spilsbury JC, Storfer-Isser A, Rosen CL, Redline S. Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence. Sleep. 2015 Jan;38(1):23-9.
  • 26 Imanguli M, Ulualp SO. Risk factors for residual obstructive sleep apnea after adenotonsillectomy in children. Laryngoscope. 2016 Nov;126(11):2624-9.
  • 27 Leclerc G, Lacasse Y, Page D, Series F. Do obstructive sleep apnea syndrome patients underestimate their daytime symptoms before continuous positive airway pressure treatment?. Can Respir J. 2014 Jul/Aug;21(4):216-20.
  • 28 Alexopoulos EI, Kaditis AG, Kalampouka E, Kostadima E, Angelopoulos NV, Mikraki V, et al. Nasal corticosteroids for children with snoring. Pediatr Pulmonol. 2004 Aug;38(2):161-7.
  • 29 Kuhle S, Hoffmann DU, Mitra S, Urschitz MS. Anti-inflammatory medications for obstructive sleep apnoea in children. Cochrane Database Syst Rev. 2020 Jan;1(1):CD007074.
  • 30 Choi JH, Kim EJ, Choi J, Kwon SY, Kim TH, Lee SH, et al. Obstructive sleep apnea syndrome: a child is not just a small adult. Ann Otol Rhinol Laryngol. 2010 Oct;119(10):656-61.
  • 31 Alsubie HS, BaHammam AS. Review obstructive sleep apnoea: children are not little adults. Paediatr Respir Rev. 2017 Jan;21:72-9.
  • 32 Apostolidou MT, Alexopoulos EI, Chaidas K, Ntamagka G, Karathanasi A, Apostolidis TI, et al. Obesity and persisting sleep apnea after adenotonsillectomy in Greek children. Chest. 2008 Dec;134(6):1149-55.
  • 33 Romero-Corral A, Caples SM, Lopez-Jimenez F, Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010 Mar;137(3):711-9.
  • 34 Agha B, Johal A. Facial phenotype in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis. J Sleep Res. 2017 Apr;26(2):122-31.
  • 35 Kim AM, Keenan BT, Jackson N, Chan EL, Staley B, Poptani H, et al. Tongue fat and its relationship to obstructive sleep apnea. Sleep. 2014 Oct;37(10):1639-48.
  • 36 Davies RJ, Ali NJ, Stradling JR. Neck circumference and other clinical features in the diagnosis of the obstructive sleep apnoea syndrome. Thorax. 1992 Feb;47(2):101-5.
  • 37 Eckert DJ, Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008 Feb;5(2):144-53.
  • 38 Kaditis AG, Alvarez MLA, Boudewyns A, Alexopoulos EI, Ersu R, Joosten K, et al. Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management. Eur Respir J. 2016 Jan;47(1):69-94.
  • 39 Mohsenin V. Gender differences in the expression of sleep-disordered breathing. Role of upper airway dimensions. Chest. 2001;120(5):1442-7.
  • 40 Inoshita A, Kasai T, Matsuoka R, Sata N, Shiroshita N, Kawana F, et al. Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea. J Thorac Dis. 2018 Dec;10(12):6702-10.
  • 41 DelRosso LM. Epidemiology and diagnosis of pediatric obstructive sleep apnea. Curr Probl Pediatr Adolesc Health Care. 2016 Jan;46(1):2-6.
  • 42 Lombardi C, Tobaldini E, Montano N, Losurdo A, Parati G. Obstructive sleep apnea syndrome (OSAS) and cardiovascular system. Med Lav. 2017 Aug;108(4):276-82.
  • 43 Tie YX, Fu YY, Xu Z, Peng Y. Relationship between C-reactive protein levels and obstructive sleep apnea syndrome. Genet Mol Res. 2016 May;15(2).
  • 44 Kaditis AG, Alexopoulos EI, Kalampouka E, Kostadima E, Germenis A, Zintzaras E, et al. Morning levels of C-reactive protein in children with obstructive sleep-disordered breathing. Am J Respir Crit Care Med. 2005 Feb;171(3):282-6.
  • 45 Nehring SM, Goyal A, Bansal P, Patel BC. C reactive protein (CRP) [Internet]. Treasure Island: StatPearls Publishing; 2020; [access in ANO Mês dia]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441843/
  • 46 Conwell WD, Tsai SC. Managing comorbid illness in obstructive sleep apnea: what can we learn from other diseases?. Sleep Med Clin. 2016 Sep;11(3):313-21.
  • 47 Pinto TCC, Machado L, Bulgacov TM, Rodrigues-Júnior AL, Costa MLG, Ximenes RCC, 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?. Int Psychogeriatr. 2019 Apr;31(4):491-504.
  • 48 Kang JM, Cho YS, Park S, Lee BH, Sohn BK, Choi CH, et al. Montreal cognitive assessment reflects cognitive reserve. BMC Geriatr. 2018 Oct;18(1):261.
  • 49 Stern Y. Cognitive reserve. Neuropsychologia. 2009 Aug;47(10):2015-28.
  • 50 Oren N, Yogev-Seligmann G, Ash E, Hendler T, Giladi N, Lerner Y. The Montreal cognitive assessment in cognitively-intact elderly: a case for age-adjusted cutoffs. J Alzheimers Dis. 2015;43(1):19-22.
  • 51 Olaithe M, Bucks RS, Hillman DR, Eastwood PR. Cognitive deficits in obstructive sleep apnea: Insights from a meta-review and comparison with deficits observed in COPD, insomnia, and sleep deprivation. Sleep Med Rev. 2018 Apr;38:39-49.
  • 52 Feinberg I, Bie E, Davis NM, Campbell IG. Topographic differences in the adolescent maturation of the slow wave EEG during NREM sleep. Sleep. 2011 Mar;34(3):325-33.
  • 53 Lal C, Strange C, Bachman D. Neurocognitive impairment in obstructive sleep apnea. Chest. 2012 Jun;141(6):1601-10.
  • 54 Beebe DW, Groesz L, Wells C, Nichols A, McGee K. The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data. Sleep. 2003 May;26(3):298-307.
  • 55 Vavougios GD, George DG, Pastaka C, Zarogiannis SG, Gourgoulianis KI. Phenotypes of comorbidity in OSAS patients: combining categorical principal component analysis with cluster analysis. J Sleep Res. 2016 Feb;25(1):31-8.
  • 56 Karimi M, Hedner J, Zou D, Eskandari D, Lundquist AC, Grote L. Attention deficits detected in cognitive tests differentiate between sleep apnea patients with or without a motor vehicle accident. Sleep Med. 2015 Apr;16(4):528-33.
  • 57 Jonas DE, Amick HR, Feltner C, Weber RP, Arvanitis M, Stine A, et al. Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017 Jan;317(4):415-33.
  • 58 Ng SS, Tam W, Chan TO, To KW, Ngai J, Chan KKP, et al. Use of Berlin questionnaire in comparison to polysomnography and home sleep study in patients with obstructive sleep apnea. Respir Res. 2019 Feb;20(1):40.
  • 59 Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01600.
  • 60 Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012 Jul;9(3):490-9.