Abstract
Childhood obstructive sleep apnea (OSA) is a common chronic sleep-related breathing disorder in children, which leads to growth retardation, neurocognitive impairments, and serious complications. Considering the previous studies about brain structural abnormalities in OSA, in the present study, we aimed to explore the altered spontaneous brain activity among OSA patients, using amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) methods based on resting-state functional magnetic resonance imaging (MRI). Thirty-one untreated OSA children and 33 age-and gender-matched healthy children (HC) were included in this study. Compared with controls, the OSA group showed significant lower ALFF in the right lingual gyrus, decreased fALFF in the left middle frontal gyrus (MFG), but increased fALFF in the left precuneus. Decreased ReHo was found in the left inferior frontal gyrus (orbital part) and left middle frontal gyrus. Notably, the mean fALFF value of left MFG was not only significantly related to multiple sleep parameters but also demonstrated the best performance in ROC curve analysis. These findings revealed OSA children were associated with dysfunctions in the default mode network, the frontal lobe, and the lingual gyrus, which may implicate the underlying neurophysiological mechanisms of intrinsic brain activity. The correlation between the altered spontaneous neuronal activity and the clinical index provides early useful diagnostic biomarkers for OSA children as well.
Highlights
Obstructive sleep apnea (OSA) is a common chronic sleep-related breathing disorder characterized by partial or complete closure of the upper airway during sleep, which results in recurrent intermittent hypoxia, carbon dioxide retention, and frequent awakening (Chen et al, 2016; Stevens et al, 2020)
The affected brain sites included the prefrontal cortex; corpus callosum; and insular, frontal, temporal, hippocampus, and cerebellar areas, which localized within regulated autonomic, respiratory, and cognitive functions (Kheirandish-Gozal et al, 2018). These findings indicated that pediatric obstructive sleep apnea (OSA) presented extensive injury to the brain structures, which might account for underlying executive and cognitive deficits in children
In the OSA group, the mean fractional ALFF (fALFF) value in the left middle frontal gyrus showed significantly negative correlations with HI (r = −0.385, p = 0.043), SaO2 < 90%
Summary
Obstructive sleep apnea (OSA) is a common chronic sleep-related breathing disorder characterized by partial or complete closure of the upper airway during sleep, which results in recurrent intermittent hypoxia, carbon dioxide retention, and frequent awakening (Chen et al, 2016; Stevens et al, 2020). The total prevalence of OSA among children ranges from 1 to 4% (Kirk et al, 2017). Pediatric OSA always presents with loud and irregular snoring and sleep disorders, in contrast to adults, with a range of different symptoms including growth retardation, enuresis, and behavioral problems, such as attention deficit/hyperactivity (ADHD) disorders (Krysta et al, 2017). Noteworthy neurocognitive impairments occur in pediatric OSA, involving learning, memory, executive function, visuospatial function, and psychomotor development (Copes and Rosentswieg, 1972; Hamasaki et al, 2007; Krysta et al, 2017), which severely diminished academic performance, social adaptation, and even the quality of life in children. Compared with adults, the scholars have paid little attention to brain abnormalities of pediatric OSA before
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