Smith Dale L, Gozal David, Hunter Scott J, Kheirandish-Gozal Leila
Public Health Sciences, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, United States.
Olivet Nazarene University, Bourbonnais, IL, United States.
Front Neurol. 2017 Aug 11;8:410. doi: 10.3389/fneur.2017.00410. eCollection 2017.
Numerous studies over the past several decades have illustrated that children who suffer from sleep-disordered breathing (SDB) are at greater risk for cognitive, behavioral, and psychiatric problems. Although behavioral problems have been proposed as a potential mediator between SDB and cognitive functioning, these relationships have not been critically examined.
This analysis is based on a community-based cohort of 1,115 children who underwent overnight polysomnography, and cognitive and behavioral phenotyping. Structural model of the relationships between SDB, behavior, and cognition, and two recently developed mediation approaches based on propensity score weighting and resampling were used to assess the mediational role of parent-reported behavior and psychiatric problems in the relationship between SDB and cognitive functioning. Multiple models utilizing two different SDB definitions further explored direct effects of SDB on cognition as well as indirect effects through behavioral pathology. All models were adjusted for age, sex, race, BMI -score, and asthma status.
Indirect effects of SDB through behavior problems were significant in all mediation models, while direct effects of SDB on cognition were not. The findings were consistent across different mediation procedures and remained essentially unaltered when different criteria for SDB, behavior, and cognition were used.
Potential effects of SDB on cognitive functioning appear to occur through behavioral problems that are detectable in this pediatric population. Thus, early attentional or behavioral pathology may be implicated in the cognitive functioning deficits associated with SDB, and may present an early morbidity-related susceptibility biomarker.
过去几十年的大量研究表明，患有睡眠呼吸障碍（SDB）的儿童出现认知、行为和精神问题的风险更高。尽管行为问题被认为是SDB与认知功能之间的潜在中介因素，但这些关系尚未得到严格检验。
本分析基于一个以社区为基础的队列，该队列包含1115名儿童，他们接受了夜间多导睡眠图检查以及认知和行为表型分析。使用SDB、行为和认知之间关系的结构模型，以及两种基于倾向得分加权和重采样的最新中介方法，来评估父母报告的行为和精神问题在SDB与认知功能关系中的中介作用。利用两种不同SDB定义的多个模型进一步探讨了SDB对认知的直接影响以及通过行为病理学产生的间接影响。所有模型均对年龄、性别、种族、BMI评分和哮喘状态进行了调整。
在所有中介模型中，SDB通过行为问题产生的间接影响均显著，而SDB对认知的直接影响则不显著。不同中介程序的研究结果一致，并且当使用不同的SDB、行为和认知标准时，结果基本保持不变。
SDB对认知功能的潜在影响似乎是通过该儿科人群中可检测到的行为问题发生的。因此，早期的注意力或行为病理学可能与SDB相关的认知功能缺陷有关，并且可能是一种与早期发病相关的易感性生物标志物。
