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Childhood Apnea May Exact Cognitive Loss


 

MONTREAL – Pediatric obstructive sleep apnea may have lifelong physiologic and cognitive consequences even after it is successfully treated, according to Dr. David Gozal, professor of pediatrics at the University of Louisville (Ky.).

“Children have a plastic system, and as such, they can be conditioned to develop differently than they would otherwise if they were not perturbed by sleep-disordered breathing during their childhood,” he said at the Eighth World Congress on Sleep Apnea. “It is our duty to start identifying this condition very early and to identify those children at risk for consequences later in life.”

Dr. Gozal suggests that sleep apnea may be a childhood antecedent of adult cardiovascular disease in genetically susceptible individuals.

His study in 26 nonobese children with obstructive sleep apnea demonstrated the presence of endothelial dysfunction, compared with controls in response to cuff occlusion applied for 30 seconds to the brachial artery and then released.

“Reperfusion was slow and sluggish in those with sleep apnea, compared to control children,” he said. With effective treatment of their sleep apnea, 18 of the 26 children normalized to the reperfusion rate of controls.

However, in eight children there was no change in reperfusion rate despite complete resolution of obstructive sleep apnea for 6 months.

“These eight children had a special burden–they had very strong family histories of cardiovascular disease. It might be that, if you have sleep apnea and you have a genetic susceptibility to another disease, the sleep apnea could trigger the onset of a disease to which you are predisposed genetically or it could accelerate the process,” he suggested.

Other research by Dr. Gozal and his colleagues has shown that even with treatment, sleep-disordered breathing in early childhood is associated with behavioral and academic problems in middle school. His study of more than 1,500 middle school students found that those in the bottom 25th percentile of academic performance were three times more likely to have received adenotonsillectomy in early childhood for snoring, compared with students in the top 25th percentile. The rate of adenotonsillectomy for recurrent infection was the same in both groups (Pediatrics 2001;107:1394–9).

“This tells us that sleep-disordered breathing is associated with neurocognitive morbidity, which is partially irreversible,” he said.

“If you lose some IQ points and you are male, you may run the risk of never recovering. Given the theory that estrogen provides neural protection, there is some biological plausibility for these findings,” he said in an interview.

Despite his studies showing evidence of residual consequences even after treatment of childhood apnea, other research by Dr. Gozal suggests that early treatment may have the potential to completely reverse such consequences.

“The problem with studies showing residual issues [after treatment] is that we do not know how long the disease was there before it was treated. Therefore, in the current context of late referral, it is likely that residual deficits will remain. However, it is also likely that with early diagnosis and intervention these residual deficits can be prevented,” he said.

Dr. Gozal disclosed that he has various speaking, consultancy, or grant arrangements with Merck & Co., AstraZeneca Pharmaceuticals, and Itamar Medical Ltd.

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