Published ahead of print on July 24, 2008, doi:10.1164/rccm.200802-321OC
© 2008 American Thoracic Society doi: 10.1164/rccm.200802-321OC
Determinants of Regional Cerebral Oxygenation in Children with Sleep-disordered Breathing1 Department of Pediatrics, Cairo University, Cairo, Egypt; 2 Division of Pulmonary Medicine, 5 Division of Otolaryngology—Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; 3 Mayo Clinic, Rochester, Minnesota; and 4 University of Cincinnati, Cincinnati, Ohio Correspondence and requests for reprints should be addressed to Raouf Amin, M.D., Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail: Raouf.Amin{at}cchmc.org 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.
Key Words: children • sleep-disordered breathing • cerebral oxygenation
Related articles in AJRCCM:
This article has been cited by other articles:
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
