Kennedy J D, Blunden S, Hirte C, Parsons D W, Martin A J, Crowe E, Williams D, Pamula Y, Lushington K
Department of Pulmonary Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.
Pediatr Pulmonol. 2004 Apr;37(4):330-7. doi: 10.1002/ppul.10453.
Obstructive sleep apnea syndrome (OSAS) has been associated with reduced neurocognitive performance in children, but the underlying etiology is unclear. The aim of this study was to evaluate the relationship between hypoxemia, respiratory arousals, and neurocognitive performance in snoring children referred for adenotonsillectomy. Thirteen snoring children who were referred for evaluation regarding the need for adenotonsillectomy to a children's hospital otolaryngology/respiratory department underwent detailed neurocognitive and polysomnographic (PSG) evaluation. PSGs were evaluated for respiratory abnormalities and compared with 13 nonsnoring control children of similar age who were studied in the same manner. The snoring children had an obstructive respiratory disturbance index within normal range (mean obstructive apnea/hypopnea index, 0.6/hr). Despite this, several domains of neurocognitive function were reduced in the snoring group. These included mean verbal IQ scores (snorers 92.6 vs. nonsnorers 110.2, P < 0.001), mean global IQ scores (snorers 96.7 vs. nonsnorers 110.2, P < 0.005), mean selective attention scores (snorers 46.4 vs. nonsnorers 11.8, P < 0.001), mean sustained attention scores (snorers 8.0 vs. nonsnorers 2.2, P = 0.001), and mean memory index (snorers 95.2 vs. nonsnorers 112.1, P = 0.001). There was a direct relationship between number of mild oxygen desaturations of > or = 3%, obstructive hypopneas with > or = 3% oxygen desaturations, and respiratory arousals and severity of neurocognitive deficits, with the greatest effect being on memory scores. The disruption of sleep in snoring children produced by relatively mild changes in oxygen saturation or by increases in respiratory arousals may have a greater effect on neurocognitive function than hitherto appreciated. A possible explanation for these neurocognitive deficits may be the combination of the chronicity of sleep disruption secondary to snoring which is occurring at a time of rapid neurological development in the first decade of life. Future studies need to confirm the reversal of these relatively mild neurocognitive decrements post adenotonsillectomy.
阻塞性睡眠呼吸暂停综合征（OSAS）与儿童神经认知功能下降有关，但其潜在病因尚不清楚。本研究的目的是评估因打鼾而转诊至医院进行腺样体扁桃体切除术的儿童低氧血症、呼吸唤醒与神经认知功能之间的关系。13名因打鼾而转诊至儿童医院耳鼻喉科/呼吸科评估是否需要进行腺样体扁桃体切除术的儿童接受了详细的神经认知和多导睡眠图（PSG）评估。对PSG进行呼吸异常评估，并与13名以同样方式进行研究的年龄相仿的非打鼾对照儿童进行比较。打鼾儿童的阻塞性呼吸紊乱指数在正常范围内（平均阻塞性呼吸暂停/低通气指数为0.6/小时）。尽管如此，打鼾组的几个神经认知功能领域仍有所下降。这些领域包括平均语言智商得分（打鼾儿童为92.6，非打鼾儿童为110.2，P<0.001）、平均总体智商得分（打鼾儿童为96.7，非打鼾儿童为110.2，P<0.005）、平均选择性注意力得分（打鼾儿童为46.4，非打鼾儿童为11.8，P<0.001）、平均持续性注意力得分（打鼾儿童为8.0，非打鼾儿童为2.2，P=0.001）以及平均记忆指数（打鼾儿童为95.2，非打鼾儿童为112.1，P=0.001）。轻度氧饱和度下降≥3%的次数、伴有≥3%氧饱和度下降的阻塞性低通气以及呼吸唤醒与神经认知缺陷的严重程度之间存在直接关系，对记忆得分的影响最大。打鼾儿童因氧饱和度相对轻微变化或呼吸唤醒增加而导致的睡眠中断，对神经认知功能的影响可能比以往认为的更大。这些神经认知缺陷的一个可能解释可能是，在生命的第一个十年神经快速发育时期，打鼾导致的睡眠中断的长期性。未来的研究需要证实腺样体扁桃体切除术后这些相对轻微的神经认知减退是否会逆转。
