Determinants of regional cerebral oxygenation in children with sleep-disordered breathing.
BACKGROUND
An association between neurocognitive deficits and pediatric sleep-disordered breathing has been suggested; however, weak correlations between disease severity and functional outcomes underscore the lack of knowledge regarding factors modulating cognitive morbidity of sleep-disordered breathing.


OBJECTIVE
To identify the parameters affected by sleep-disordered breathing that modulate cerebral oxygenation, an important determinant of cognition. A further objective was to use these parameters with demographic data to develop a predictive statistical model of pediatric cerebral oxygenation.


METHODS
Ninety-two children (14 control subjects, 32 with primary snoring, and 46 with obstructive sleep apnea) underwent polysomnography with continuous monitoring of cerebral oxygenation and blood pressure. Analysis of covariance was used to relate the blood pressure, sleep diagnostic parameters, and demographic characteristics to regional cerebral oxygenation.


RESULTS
To account for anatomic variability, an index of cerebral oxygenation during sleep was derived by referencing the measurement obtained during sleep to that obtained during wakefulness. In a repeated measures model predicting the index of cerebral oxygenation, mean arterial pressure, rapid eye movement (REM) sleep, female sex, age, and oxygen saturation had a positive effect on cerebral oxygenation levels, whereas arousal index and non-REM (NREM) sleep had a negative effect.


CONCLUSIONS
Increasing mean arterial pressure, age, oxygen saturation, and REM sleep augment cerebral oxygenation, while sleep-disordered breathing, male sex, arousal index, and NREM sleep diminish it. The proposed model may explain the sources of variability in cognitive function of children with sleep-disordered breathing.
Khadra
Maha Abou
MA
Department of Pediatrics, Cairo University, Cairo, Egypt.
McConnell
Keith
K
VanDyke
Rhonda
R
Somers
Virend
V
Fenchel
Matthew
M
Quadri
Syed
S
Jefferies
Jenny
J
Cohen
Aliza P
AP
Rutter
Michael
M
Amin
Raouf
R
D000293:Adolescent; D001794:Blood Pressure; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010092:Oximetry; D010101:Oxygen Consumption / Q000502:physiology*; D017286:Polysomnography; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000378:metabolism* / Q000503:physiopathology; D012895:Sleep, REM / Q000502:physiology