Sleep Clinic for Developmental Age, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Naples, Italy.
Neuropsychiatr Dis Treat. 2013;9:1087-94. doi: 10.2147/NDT.S47287. Epub 2013 Aug 9.
The role of sleep in cognitive processes can be considered clear and well established. Different reports have disclosed the association between sleep and cognition in adults and in children, as well as the impact of disturbed sleep on various aspects of neuropsychological functioning and behavior in children and adolescents. Behavioral and cognitive dysfunctions can also be considered as related to alterations in the executive functions (EF) system. In particular, the EF concept refers to self-regulatory cognitive processes that are associated with monitoring and controlling both thought and goal directed behaviors. The aim of the present study is to assess the impact of the obstructive sleep apnea syndrome (OSAS) on EF in a large sample of school aged children.
The study population comprised 79 children (51 males and 28 females) aged 7-12 years (mean 9.14 ± 2.36 years) with OSAS and 92 healthy children (63 males and 29 females, mean age 9.08 ± 2.44 years). To identify the severity of OSAS, an overnight respiratory evaluation was performed. All subjects filled out the Italian version of the Modified Card Sorting Test to screen EFs. Moreover, to check the degree of subjective perceived daytime sleepiness, all subjects were administered the Pediatric Daytime Sleepiness Scale (PDSS).
No significant differences between the two study groups were found for age (P = 0.871), gender (P = 0.704), z-score of body mass index (P = 0.656), total intelligence quotient (P = 0.358), and PDSS scores (P = 0.232). The OSAS children showed a significantly higher rate of total errors (P < 0.001), perseverative errors (P < 0.001), nonperseverative errors (P < 0.001), percentage of total errors (P < 0.001), percentage of perseverative errors (P < 0.001), and percentage of nonperseverative errors (P < 0.001). On the other hand, OSAS children showed a significant reduction in the number of completed categories (P = 0.036), total correct sorts (P = 0.001), and categorizing efficiency (P < 0.001). The Pearson's correlation analysis revealed a significant positive relationship between all error parameters and apnea-hypopnea index, oxygen desaturation index, and percentage of mean desaturation of O2 with a specular negative relationship between the error parameters and the mean oxygen saturation values, such as a significant negative relationship between apnea-hypopnea index, oxygen desaturation index, percent of mean desaturation of O2, and the number of completed categories.
Our study identified differences in the executive functioning of children affected by OSAS and is the first to identify a correlation between alteration in respiratory nocturnal parameters and EF that has not yet been reported in developmental age. These findings can be considered as the strength and novelty of the present report in a large pediatric population.
睡眠在认知过程中的作用可以说是明确且已得到充分证实的。不同的报告揭示了睡眠与成人和儿童认知之间的关联，以及睡眠紊乱对儿童和青少年神经心理功能和行为的各个方面的影响。行为和认知功能障碍也可以被认为与执行功能（EF）系统的改变有关。特别是，EF 概念是指与自我调节认知过程相关的，这些过程与监测和控制思维和目标导向行为有关。本研究的目的是评估阻塞性睡眠呼吸暂停综合征（OSAS）对大量学龄儿童 EF 的影响。
研究人群包括 79 名儿童（51 名男性和 28 名女性），年龄 7-12 岁（平均 9.14±2.36 岁），患有 OSAS 和 92 名健康儿童（63 名男性和 29 名女性，平均年龄 9.08±2.44 岁）。为了确定 OSAS 的严重程度，进行了一整夜的呼吸评估。所有受试者都填写了意大利语改良卡片分类测试来筛选 EF。此外，为了检查主观日间嗜睡的程度，所有受试者都接受了小儿日间嗜睡量表（PDSS）的评估。
两组研究对象在年龄（P=0.871）、性别（P=0.704）、体重指数 z 分数（P=0.656）、总智商（P=0.358）和 PDSS 评分（P=0.232）方面均无显著差异。OSAS 儿童的总错误率（P＜0.001）、持续错误率（P＜0.001）、非持续错误率（P＜0.001）、总错误率百分比（P＜0.001）、持续错误率百分比（P＜0.001）和非持续错误率百分比（P＜0.001）显著更高。另一方面，OSAS 儿童的完成分类数（P=0.036）、总正确分类数（P=0.001）和分类效率（P＜0.001）显著降低。Pearson 相关分析显示，所有错误参数与呼吸暂停低通气指数、氧减饱和指数和 O2 平均减饱和百分比之间存在显著正相关，与平均氧饱和度值之间存在显著负相关，与呼吸暂停低通气指数、氧减饱和指数、O2 平均减饱和百分比之间存在显著负相关，与完成分类数之间存在显著负相关。
我们的研究确定了患有 OSAS 的儿童在执行功能方面的差异，这是首次确定呼吸夜间参数改变与 EF 之间的相关性，而这种相关性在发育年龄尚未报道过。这些发现可以被认为是本报告在大样本儿科人群中的优势和新颖之处。
