Neural and neurobehavioral dysfunction in children with obstructive sleep apnea.

Abstract

Research has confirmed what many parents have long suspected: inadequate sleep in children is associated with daytime behavioral problems and poor academic functioning [1–3]. A fact less well-recognized by clinicians and the general public is that sleep-related breathing disorders, which occur in two to ten percent of children depending on how they are defined, can have a significant impact even among children who have normal sleep duration [4]. Snoring is a hallmark symptom of sleep-disordered breathing, and enlarged tonsils are often a contributing factor to the breathing disturbance. We still do not fully understand the mechanism that links snoring or enlarged tonsils with behavioral problems and poor grades. One of the more severe nocturnal breathing disorders, obstructive sleep apnea (OSA), involves partial or complete breathing blockage recurrently during sleep, resulting in intermittent drops in blood oxygen levels and probable sleep disruption. Although brain processes are presumed to mediate the link between these medical factors and daytime behavioral and scholastic problems, our understanding of these processes remains fairly theoretical and speculative. The frontal and hippocampal regions of the brain, which are implicated in the regulation of behavior and memory, respectively, appear to be most vulnerable to OSA [4], but the evidence is indirect. In a new study published in PLoS Medicine, Ann Halbower and colleagues [5] used proton magnetic resonance spectroscopy (MRS), a non-invasive neuroimaging technique that can detect chemical metabolites linked to neural dysfunction, to shed more direct light on the neural functioning of children with OSA.