Thursday, June 29, 2006

Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury

Ann C. Halbower1*, et al.

1 Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America, 2

Childhood obstructive sleep apnea (OSA) is associated with neuropsychological deficits of memory, learning, and executive function. There is no evidence of neuronal brain injury in children with OSA. We hypothesized that childhood OSA is associated with neuropsychological performance dysfunction, and with neuronal metabolite alterations in the brain, indicative of neuronal injury in areas corresponding to neuropsychological function.

Methods and Findings
We conducted a cross-sectional study of 31 children (19 with OSA and 12 healthy controls, aged 6–16 y) group-matched by age, ethnicity, gender, and socioeconomic status. Participants underwent polysomnography and neuropsychological assessments. Proton magnetic resonance spectroscopic imaging was performed on a subset of children with OSA and on matched controls. Neuropsychological test scores and mean neuronal metabolite ratios of target brain areas were compared.
Relative to controls, children with severe OSA had significant deficits in IQ and executive functions (verbal working memory and verbal fluency). Children with OSA demonstrated decreases of the mean neuronal metabolite ratio N-acetyl aspartate/choline in the left hippocampus (controls: 1.29, standard deviation [SD] 0.21; OSA: 0.91, SD 0.05; p = 0.001) and right frontal cortex (controls: 2.2, SD 0.4; OSA: 1.6, SD 0.4; p = 0.03).

Childhood OSA is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex. We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential.

Citation: Halbower AC, Degaonkar M, Barker PB, Earley CJ, Marcus CL, et al. (2006) Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury. PLoS Med 3(8): e301 doi:10.1371/journal.pmed.0030301

Tuesday, June 06, 2006

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Not all sleep services are created equally…..

Sleep Medicine is a newly recognized medical sub-specialty of Pediatrics, Neurology, Internal Medicine and Otolaryngology .

* Sleep Specialists have undergone fellowship training in sleep medicine at academic centers.

* “Board Certification” indicates that a physician has passed a rigorous nationally standardized examination

Sleep Medicine VS. Sleep Studies

Just like a neurologist uses an MRI, a specialist uses a sleep study as part of your clinical evaluation.

A sleep study (polysomnogram) has a technical component and a professional component. A sleep specialist interprets a sleep study, like a radiologist interprets an MRI.

In the optimal clinical scenario, your physician (who knows your condition) also interprets your sleep study and prescribes treatment.

Where Can You Get a Sleep Study?

Ask your physician....

Sleep studies are performed in a unique setting. While a sleep laboratory is a highly technical neurophysiologic testing center, it should be comfortable and much like a typical bedroom.

Sleep laboratories can be part of a physician’s specialty practice, hospital-based, or owned by corporations and entrepreneurs.

Some parts of a sleep study require very specialized supervison and interpretation, such as EEG.

Pediatric sleep studies are different than adult studies, requiring both technical and professional expertise with children.

An educated consumer should look for indicators of quality, such as:

1) Interpreting physicians should be “Board Certified” in Sleep Medicine.

2) American Academy of Sleep Medicine Standards and Certification.

3) Pediatric and Adolescent services should be supervised and directed by a pediatric sleep specialist. Sleep studies should be interpreted by a pediatric specialist. A board-certified pediatric sleep specilaist is best (American Thoracic Society).

Consider a visit to the sleep lab before undergoing testing. Cleanliness, comfort and personal considerations may impact your diagnostic test.

To increase familiarity, children are especially encouraged to visit a lab before their study.