The Impact of Pediatric Obstructive Sleep Apnea on Cognitive Development

Historically, most tonsillectomies were performed for recurrent throat infections like strep throat. But now, about 80 percent of these surgeries are done for obstructive sleep apnea in children.

Obstructive sleep apnea results from a blockage in the airway, usually caused by enlarged tonsils and adenoids. Sleep-disordered breathing can lead to various health issues, including impaired cognitive functioning.

Decreased Attention

When people are engaged in a task, they find it exciting or motivating; they tend to remain focused for extended periods. However, fatigue, hunger, noise, emotions, and other distractions can decrease the time on task.

Suppose your child has a short attention span, difficulty paying attention in school or class, snores and seems to wake up gasping or choking often, or has behavioral issues. In that case, talking with your doctor about pediatric obstructive sleep apnea Los Angeles CA may be worthwhile. A polysomnogram or overnight sleep study can determine whether your child has OSA.

Decreased Memory

Occasional memory lapses are normal and can occur if your child hasn’t slept well or is feeling stressed. However, repeated and chronic memory lapses can indicate a more serious mental health issue.

Pediatric obstructive sleep apnea is associated with brain-related cognitive impairment, especially in areas involved with attention and memory. They have also found that the longer a child has had obstructive sleep apnea, the more likely they are to experience these cognitive problems.

Children with obstructive sleep apnea had reduced volume of gray matter in multiple brain regions, including the frontal cortex (which handles movement, problem-solving, and memory), parietal lobes (integrating sensory input), temporal lobes (hearing and memory), and brainstem (controlling cardiovascular and respiratory functions). This may be why it takes longer for children with obstructive sleep apnea to perform complex tasks than those without obstructive sleep apnea. Moreover, the relationship between sleep-disordered breathing and these cognitive deficits is stronger for those with more severe obstructive sleep apnea than those with less severe symptoms.

Decreased Learning

Children with sleep apnea often have trouble distinguishing sounds, affecting their learning ability. This is known as auditory processing disorder. Kids with this problem could not hear low pitches, making it harder to understand spoken language and spell. They also had difficulty sounding out words to read and write.

Fortunately, pediatric obstructive sleep apnea is treatable. A tonsillectomy to remove the enlarged tonsils and adenoids often cures this condition. Sometimes, a child will need a mouthpiece to keep the airway open.

In addition, arousal from sleep disturbs cognitive processes. Arousals from sleep disrupt the heart’s rhythm, which can cause irregular blood pressure and oxygen saturation. Several studies have found that these changes in the brain can cause cognitive deficits in children with obstructive sleep apnea. These cognitive deficits may be due to the reduced grey matter volume associated with pediatric obstructive sleep apnea.

Decreased Self-Awareness

Obstructive sleep apnea has been linked to obesity in children, with increased body weight and fat mass more strongly associated with the severity of a child’s obstructive sleep disorder. It is also associated with insulin resistance and altered lipidemia.

Interestingly, obesity is not the sole cause of these metabolic changes. Adenotonsillectomy has been shown to improve these metabolites and decrease obesity in children with severe obstructive sleep apnea.

In addition to negatively impacting sleep and cognition, pediatric obstructive sleep apnea can negatively affect mood, behavior, and academic performance. These effects are long-term and can continue into adulthood. Adequate management of pediatric obstructive sleep apnea may mitigate these consequences and improve quality of life.

As more is learned about the mechanisms of end-organ morbidity in OSA, it is clear that genetic susceptibility (as dictated by single-nucleotide polymorphisms) and environmental/lifestyle conditions are critical components of phenotype.