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Comparative Study
. 2008 Oct 15;178(8):870-5.
doi: 10.1164/rccm.200802-321OC. Epub 2008 Jul 24.

Determinants of regional cerebral oxygenation in children with sleep-disordered breathing

Maha Abou Khadra  1 , Keith McConnell, Rhonda VanDyke, Virend Somers, Matthew Fenchel, Syed Quadri, Jenny Jefferies, Aliza P Cohen, Michael Rutter, Raouf Amin
Affiliations
Comparative Study

Determinants of regional cerebral oxygenation in children with sleep-disordered breathing

Maha Abou Khadra et al. Am J Respir Crit Care Med. .

Abstract

Rationale: 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.

Objectives: 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.

Measurements and main 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.

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Figures

<b>Figure 1.</b>
Figure 1.
Normalized regional cerebral oxygenation (ΔrSO2) means for sleep stages 1, 2, 3, and 4 and rapid eye movement for control subjects, children with primary snoring, and children with OSA. ΔrSO2 = difference in cerebral oxygenation between sleep and wake periods; OSA = obstructive sleep apnea.
<b>Figure 2.</b>
Figure 2.
Thirty-minute means for (A) ΔrSO2, (B) systolic blood pressure, (C) diastolic blood pressure, and (D) mean arterial blood pressure by group. †P < 0.05 between control subjects and subjects with OSA; *P < 0.05 between control subjects and primary snoring.
<b>Figure 3.</b>
Figure 3.
Schematic of predictive model of regional cerebral oxygenation.
See this image and copyright information in PMC

Comment in

References

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