Biggs Sarah N, Walter Lisa M, Jackman Angela R, Nisbet Lauren C, Weichard Aidan J, Hollis Samantha L, Davey Margot J, Anderson Vicki, Nixon Gillian M, Horne Rosemary S C
The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
PLoS One. 2015 Sep 29;10(9):e0139142. doi: 10.1371/journal.pone.0139142. eCollection 2015.
This study aimed to determine the long term effects of resolution of SDB in preschool children, either following treatment or spontaneous recovery, on cognition and behavior. Children diagnosed with SDB at 3-5y (N = 35) and non-snoring controls (N = 25), underwent repeat polysomnography (PSG) and cognitive and behavioral assessment 3 years following a baseline study. At follow-up, children with SDB were grouped into Resolved and Unresolved. Resolution was defined as: obstructive apnea hypopnea index (OAHI) ≤1 event/h; no snoring detected on PSG; and no parental report of habitual snoring. 57% (20/35) of children with SDB received treatment, with SDB resolving in 60% (12/20). 43% (15/35) were untreated, of whom 40% (6/15) had spontaneous resolution of SDB. Cognitive reduced between baseline and follow-up, however this was not related to persistent disease, with no difference in cognitive outcomes between Resolved, Unresolved or Control groups. Behavioral functioning remained significantly worse in children originally diagnosed with SDB compared to control children, regardless of resolution. Change in OAHI did not predict cognitive or behavioral outcomes, however a reduction in nocturnal arousals, irrespective of full resolution, was associated with improvement in attention and aggressive behavior. These results suggest that resolution of SDB in preschool children has little effect on cognitive or behavioral outcomes over the long term. The association between sleep fragmentation and behavior appears independent of SDB, however may be moderated by concomitant SDB. This challenges the assumption that treatment of SDB will ameliorate associated cognitive and behavioural deficits and supports the possibility of a SDB phenotype.
本研究旨在确定学龄前儿童阻塞性睡眠呼吸暂停低通气综合征（SDB）经治疗或自然恢复后缓解对认知和行为的长期影响。对3至5岁被诊断为SDB的儿童（N = 35）和无打鼾对照组（N = 25），在基线研究3年后进行重复多导睡眠图（PSG）检查以及认知和行为评估。在随访时，将患有SDB的儿童分为已缓解组和未缓解组。缓解定义为：阻塞性呼吸暂停低通气指数（OAHI）≤1次/小时；PSG未检测到打鼾；且父母未报告习惯性打鼾。57%（20/35）的SDB儿童接受了治疗，其中60%（12/20）的SDB得到缓解。43%（15/35）未接受治疗，其中40%（6/15）的SDB自然缓解。从基线到随访认知能力下降，但这与持续性疾病无关，已缓解组、未缓解组或对照组之间的认知结果无差异。与对照儿童相比，最初诊断为SDB的儿童的行为功能仍然显著较差，无论是否缓解。OAHI的变化不能预测认知或行为结果，然而，夜间觉醒次数的减少，无论是否完全缓解，都与注意力和攻击行为的改善有关。这些结果表明，学龄前儿童SDB的缓解对认知或行为结果的长期影响很小。睡眠片段化与行为之间的关联似乎独立于SDB，然而可能会受到并发SDB的影响。这挑战了SDB治疗将改善相关认知和行为缺陷的假设，并支持了SDB表型的可能性。
