Abstract P584: Sleep in Pediatric Stroke Study (SleePSS): Neuroimaging and Neurocognitive Correlates of Sleep Health in Pediatric Stroke

Abstract

Introduction: Pediatric arterial ischemic stroke (AIS) is a serious cause of lifelong neurological and cognitive disabilities. Although they are at increased risk of obstructive sleep apnea (OSA), children with AIS may have abnormal sleep indices even in the absence of OSA diagnosis. This can adversely affect their blood vessels health (impaired cerebrovascular reactivity, CVR) and can lead to neurocognitive impairments. Therefore, we aimed to investigate the association of cerebral blood vessels health with polysomnographic measures and cognitive function in children with AIS. Hypothesis: Quantitative measure of negative CVR, i.e. fractional negativity (fneg) and negative CVR correlate significantly with abnormal overnight oxygen and carbon dioxide levels in children with AIS, even in the absence of OSA. Methods: We conducted a single-centre cross-sectional study in children with AIS aged between 8 and 18 years old and who were not at risk of OSA (i.e., pediatric sleep questionnaire score<0.33). All children were evaluated using: (1) Non-invasive Blood Oxygen Level Dependent magnetic resonance imaging to study CVR. (2) An overnight polysomnography (3) Comprehensive evaluation of intellectual abilities, attention and executive function. Results: Ten children with AIS (40% males; median age: 14.3 years) were included after a median of 8.8 years following stroke onset. None of the children was diagnosed with OSA. We found significant correlations between fneg and minimum oxygen saturation during REM sleep (r=0.81, r=0.68 and r=0.76 in grey matter, white matter and whole brain, respectively; p<0.05). The whole brain mean negative CVR correlated significantly with the visual spatial, fluid reasoning, and emotion regulation indices (r=-0.82, -0.8, and 0.75, respectively, p<0.05). Mean negative CVR in white matter correlated significantly with the indices of executive function (emotion regulation, cognitive regulation and global executive composite scores, r=0.72-0.76, p<0.05). Conclusion: Impaired CVR in children with AIS correlates with abnormal sleep indices even in the absence of OSA diagnosis. This can potentially result in cognitive difficulties, the majority of which remain not fully explained by stroke-related factors.