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Does Obstructive Sleep Apnea Increase Cognitive Deficits in Pediatric Sickle Cell Disease?

Published online by Cambridge University Press:  30 July 2019

Sarah E. Bills ,
Tal Katz ,
Jaleel McNeil  and
Jeffrey Schatz
Sarah E. Bills*
Affiliation:
Department of Psychology, University of South Carolina, Columbia, South Carolina 29208, USA
Tal Katz
Affiliation:
Department of Psychology, University of South Carolina, Columbia, South Carolina 29208, USA
Jaleel McNeil
Affiliation:
Department of Psychology, University of South Carolina, Columbia, South Carolina 29208, USA
Jeffrey Schatz
Affiliation:
Department of Psychology, University of South Carolina, Columbia, South Carolina 29208, USA
*
Correspondence and reprint requests to: Sarah E. Bills, M.A., Department of Psychology, University of South Carolina, Columbia, SC 29208, USA. E-mail: sbills@email.sc.edu
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Abstract

Objectives: Although pediatric obstructive sleep apnea (OSA) is estimated to affect 2–3% of the general population, its prevalence in sickle cell disease (SCD) is much higher, with research suggesting a prevalence rate of upwards of 40%. Despite the similar underlying pathophysiological mechanisms of neurocognitive effects in pediatric OSA and SCD, there is a scarcity of information on how these two conditions interact. The aim of this study was to better understand the contribution of sleep apnea to neurocognitive deficits in children diagnosed with SCD. Method: This study assessed cognitive function in 26 children with comorbid SCD and OSA, 39 matched comparisons with SCD only, and 59 matched comparisons in children without a chronic health condition. Results: There were significant differences on measures of processing speed and reading decoding, with children without a chronic health condition scoring better than both chronic health condition groups. Additionally, the no chronic health condition group performed better on a test of quantitative knowledge and reasoning and a test of visual–spatial construction than the SCD-only group. Contrary to our hypotheses, there were no between-group differences suggesting an additive impact of OSA on cognition. Exploratory analyses revealed associations within the group that had OSA showing that more severe OSA correlated with lower performance on measures of processing speed and quantitative knowledge/reasoning. Conclusions: Children with comorbid OSA and SCD do not present with greater deficits in cognitive functioning than children with SCD alone. However, severe OSA may confer additional risk for neurocognitive impairments.

Keywords

AnemiaSickle cellNeurocognitiveNeuropsychologicPediatric chronic illnessOxygen desaturationSleep-disordered breathing
Type
Regular Research
Information
Journal of the International Neuropsychological Society , Volume 25 , Issue 9 , October 2019 , pp. 922 - 930
Copyright
Copyright © INS. Published by Cambridge University Press, 2019. 

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References

REFERENCES

Baldeweg, T., Hogan, A.M., Saunders, D.E., Telfer, P., Gadian, D.G., Vargha-Khadem, F., & Kirkham, F.J. (2006). Detecting white matter injury in sickle cell disease using voxel-based morphometry. Annals of Neurology, 59(4), 662–672. doi: 10.1002/ana.20790 CrossRefGoogle ScholarPubMed
Beebe, D.W., Wells, C.T., Jeffries, J., Chini, B., Kalra, M., & Amin, R. (2004). Neuropsychological effects of pediatric obstructive sleep apnea. Journal of the International Neuropsychological Society, 10(7), 962–975. doi: 10.1017/S135561770410708X CrossRefGoogle ScholarPubMed
Beery, K.E. (2004). The Beery–Buktenica developmental test of visual-motor integration: Beery VMI, with supplemental developmental tests of visual perception and motor coordination, and stepping stones age norms from birth to age six. Minneapolis, MN: NCS Pearson.Google Scholar
Berkelhammer, L.D., Williamson, A.L., Sanford, S.D., Dirksen, C.L., Sharp, W.G., Margulies, A.S., & Prengler, R.A. (2007). Neurocognitive sequelae of pediatric sickle cell disease: A review of the literature. Child Neuropsychology, 13(2), 120–131. doi: 10.1080/09297040600800956 CrossRefGoogle ScholarPubMed
Friedman, B.C., Hendeles-Amitai, A., Kozminsky, E., Leiberman, A., Friger, M., Tarasiuk, A., & Tal, A. (2003). Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome. Sleep, 26(8), 999–1005. doi: 10.1093/sleep/26.8.999 CrossRefGoogle ScholarPubMed
Gottlieb, D.J., Chase, C., Vezina, R.M., Heeren, T.C., Corwin, M.J., Auerbach, S.H., Weese-Mayer, D.E., & Lesko, S.M. (2004). Sleep-disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children. The Journal of Pediatrics, 145(4), 458–464. doi: 10.1016/j.jpeds.2004.05.039 CrossRefGoogle ScholarPubMed
Gottlieb, D.J., Vezina, R.M., Chase, C., Lesko, S.M., Heeren, T.C., Weese-Mayer, D.E., Auerbach, A.H., & Corwin, M.J. (2003). Symptoms of sleep-disordered breathing in 5-year-old children are associated with sleepiness and problem behaviors. Pediatrics, 112(4), 870–877. doi: 10.1542/peds.112.4.870 CrossRefGoogle ScholarPubMed
Gozal, D., Kheirandish-Gozal, L., Bhattacharjee, R., & Spruyt, K. (2010). Neurocognitive and endothelial dysfunction in children with obstructive sleep apnea. Pediatrics, 126(5), e1161–e1167. doi: 10.1542/peds.2010-0688 CrossRefGoogle ScholarPubMed
Gozal, D. & Pope, D.W. (2001). Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics, 107(6), 1394–1399. doi: 10.1542/peds.107.6.1394 CrossRefGoogle ScholarPubMed
Hassell, K.L. (2010). Population estimates of sickle cell disease in the US. American Journal of Preventive Medicine, 38(4), S512–S521.CrossRefGoogle Scholar
Hijmans, C.T., Fijnvandraat, K., Grootenhuis, M.A., van Geloven, N., Heijboer, H., Peters, M. & Oosterlaan, J. (2010). Neurocognitive deficits in children with sickle cell disease: A comprehensive profile. Pediatric Blood & Cancer, 56(5), 783–788. doi: 10.1002/pbc.22879 CrossRefGoogle ScholarPubMed
Hollocks, M.J., Kok, T.B., Kirkham, F.J., Gavlak, J., Inusa, B.P., DeBaun, M.R., & de Haan, M. (2012). Nocturnal oxygen desaturation and disordered sleep as a potential factor in executive dysfunction in sickle cell anemia. Journal of the International Neuropsychological Society, 18(1), 168–173. doi: 10.1017/S1355617711001469 CrossRefGoogle ScholarPubMed
Katz, T. (2015). The prevalence rate and neurocognitive morbidity associated with obstructive sleep apnea in children with sickle cell disease. ProQuest Information & Learning. Retrieved from https://login.pallas2.tcl.sc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2015-99140-158&site=ehost-live Google Scholar
Katz, T., Schatz, J., & Roberts, C.W. (2018). Comorbid obstructive sleep apnea and increased risk for sickle cell disease morbidity. Sleep and Breathing, 22(3), 797–804. doi: 10.1007/s11325-018-1630-x CrossRefGoogle ScholarPubMed
Kawadler, J.M., Clayden, J.D., Kirkham, F.J., Cox, T.C., Saunders, D.E., & Clark, C.A. (2013). Subcortical and cerebellar volumetric deficits in paediatric sickle cell anaemia. British Journal of Haematology, 163(3), 373–376. doi: 10.1111/bjh.12496 CrossRefGoogle ScholarPubMed
Kheirandish, L. & Gozal, D. (2006). Neurocognitive dysfunction in children with sleep disorders. Developmental Science, 9(4), 388–399. doi: 10.1111/j.1467-7687.2006.00504.x CrossRefGoogle ScholarPubMed
Kirkham, F., Hewes, D., Prengler, M., Wade, A., Lane, R., & Evans, J. (2001). Nocturnal hypoxaemia and central-nervous-system events in sickle-cell disease. The Lancet, 357(9269), 1656–1659. doi: 10.1016/S0140-6736(00)04821-2 CrossRefGoogle ScholarPubMed
Kuhle, S., Urschitz, M.S., Eitner, S., & Poets, C.F. (2009). Interventions for obstructive sleep apnea in children: A systematic review. Sleep Medicine Reviews, 13(2), 123–131. doi: 10.1016/j.smrv.2008.07.006 CrossRefGoogle ScholarPubMed
Little, J.A., Rotz, S., Kim, C., O’Riordan, M., Langer, N., & Lance, C. (2014). Nocturnal hypoxemia (not sleep apnea) may drive reticulocytosis in sickle cell disease. Sleep Medicine, 22, 47–49. doi: 10.1016/j.sleep.2016.05.006 Google Scholar
McClellan, C.B., Schatz, J., Sanchez, C., & Roberts, C.W. (2008). Validity of the pediatric quality of life inventory for youth with sickle cell disease. Journal of Pediatric Psychology, 33(10), 1153–1162. doi: 10.1093/jpepsy/jsn036 CrossRefGoogle ScholarPubMed
McGrew, K.S. & Woodcock, R. (2001). Technical manual. Woodcock-Johnson III. Itasca, IL: Riverside Publishing.Google Scholar
Montgomery-Downs, H., Crabtree, V., & Gozal, D. (2005). Cognition, sleep and respiration in at-risk children treated for obstructive sleep apnoea. European Respiratory Journal, 25(2), 336–342. doi: 10.1183/09031936.05.00082904 CrossRefGoogle ScholarPubMed
Newcomer, P.L., & Hammill, D.D. (1988). Test of language development-primary. Austin, TX: Pro-ed.Google Scholar
Naismith, S., Winter, V., Gotsopoulos, H., Hickie, I., & Cistulli, P. (2004). Neurobehavioral functioning in obstructive sleep apnea: Differential effects of sleep quality, hypoxemia and subjective sleepiness. Journal of Clinical and Experimental Neuropsychology, 26(1), 43–54. doi: 10.1076/jcen.26.1.43.23929 CrossRefGoogle ScholarPubMed
Panepinto, J. A., O’mahar, K.M., DeBaun, M.R., Loberiza, F.R., & Scott, J. (2005). Health-related quality of life in children with sickle cell disease: Child and parent perception. British Journal of Haematology, 130(3), 437–444. doi: 10.1111/j.1365-2141.2005.05622.x CrossRefGoogle ScholarPubMed
Perkin, R., & Young, T. (2000). Obstructive sleep apnea in children. Reversing the trend of underdiagnosis. Advance for Nurse Practitioners, 8(10), 57.Google ScholarPubMed
Pijpers, M., Poels, P.J., Vaandrager, J.M., de Hoog, M., van den Berg, S., Hoeve, H.J., & Joosten, K.F. (2004). Undiagnosed obstructive sleep apnea syndrome in children with syndromal craniofacial synostosis. Journal of Craniofacial Surgery, 15(4), 670–674.CrossRefGoogle ScholarPubMed
Powars, D.R., Conti, P.S., Wong, W.-Y., Groncy, P., Hyman, C., Smith, E., Harold, Y., Ewing, N., Keenan, R.N., Zee, C.S., Harold, Y., Hiti, A.L., Teng, E.L., & Chan, L.S. (1999). Cerebral vasculopathy in sickle cell anemia: Diagnostic contribution of positron emission tomography. Blood, 93(1), 71–79.Google ScholarPubMed
Puffer, E.S., Schatz, J.C., Roberts, C.W. (2009). Relationships between somatic growth and cognitive functioning in young children with sickle cell disease. Journal of Pediatric Psychology, 35(8), 892–904.CrossRefGoogle ScholarPubMed
Reed, W., Jagust, W., Al-Mateen, M., & Vichinsky, E. (1999). Role of positron emission tomography in determining the extent of CNS ischemia in patients with sickle cell disease. American Journal of Hematology, 60(4), 268–272. doi: 10.1002/(SICI)1096-8652(199904)60:4<268:AID-AJH3>3.0.CO;2-C 3.0.CO;2-C>CrossRefGoogle ScholarPubMed
Robertson, P.L., Aldrich, M.S., Hanash, S.M., & Goldstein, G.W. (1988). Stroke associated with obstructive sleep apnea in a child with sickle cell anemia. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society, 23(6), 614–616.CrossRefGoogle Scholar
Rosen, C.L., Debaun, M.R., Strunk, R.C., Redline, S., Seicean, S., Craven, D.I., Gavlak, J.C., Wilkey, O., Inusa, B., Roberts, I., Goodpaster, R.L., Malow, B., Rodeghier, M., & Kirkham, F.J. (2014). Obstructive sleep apnea and sickle cell anemia. Pediatrics, 134(2), 273–281. doi: 10.1542/peds.2013-4223 CrossRefGoogle ScholarPubMed
Sanchez, C., Schatz, J., & Roberts, C. (2010). Cerebral blood flow velocity and language functioning in pediatric sickle cell disease. Journal of International Neuropsychological Society, 16(2), 326–334. doi: 10.1017/S135561770991366 CrossRefGoogle ScholarPubMed
Schatz, J., Brown, R., Pascual, J., Hsu, L., & DeBaun, M. (2001). Poor school and cognitive functioning with silent cerebral infarcts and sickle cell disease. Neurology, 56(8), 1109–1111. doi: 10.1212/WNL.56.8.1109 CrossRefGoogle ScholarPubMed
Schatz, J. & Buzan, R. (2006). Decreased corpus callosum size in sickle cell disease: Relationship with cerebral infarcts and cognitive functioning. Journal of the International Neuropsychological Society, 12(1), 24–33. doi: 10.1017/S1355617706060085 CrossRefGoogle ScholarPubMed
Schatz, J., Finke, R.L., Kellett, J.M., & Kramer, J.H. (2002). Cognitive functioning in children with sickle cell disease: A meta-analysis. Journal of Pediatric Psychology, 27(8), 739–748. doi: 10.1093/jpepsy/27.8.739 CrossRefGoogle ScholarPubMed
Schatz, J., Puffer, E.S., Sanchez, C., Stancil, M., & Roberts, C.W. (2009). Language processing deficits in sickle cell disease in young school-age children. Developmental Neuropsychology, 34(1), 122–136. doi: 10.1080/87565640802499191 CrossRefGoogle ScholarPubMed
Schatz, J. & McClellan, C.B. (2006). Sickle cell disease as a neurodevelopmental disorder. Mental Retardation and Developmental Disabilities Research Reviews, 12(3), 200–207. doi: 10.1002/mrdd.20115 CrossRefGoogle ScholarPubMed
Sforza, E. & Roche, F. (2012). Sleep apnea syndrome and cognition. Frontiers in Neurology, 3, 87. doi: 10.3389/fneur.2012.00087 CrossRefGoogle ScholarPubMed
Steen, R.G., Fineberg-Buchner, C., Hankins, G., Weiss, L., Prifitera, A., & Mulhern, R.K. (2005). Cognitive deficits in children with sickle cell disease. Journal of Child Neurology, 20(2), 102–107. doi: 10.1177/08830738050200020301 CrossRefGoogle ScholarPubMed
Tauman, R. & Gozal, D. (2011). Obstructive sleep apnea syndrome in children. Expert Review of Respiratory Medicine, 5(3), 425–440. doi: 10.1586/ers.11.7 CrossRefGoogle ScholarPubMed
Whitesell, P., Owoyemi, O., Oneal, P., Nouraie, M., Klings, E., Rock, A., Mellman, T.A., Berihun, T., Lavella, J., Taylor, R.E., & Perrine, S.P. (2016). Sleep-disordered breathing and nocturnal hypoxemia in young adults with sickle cell disease. Sleep Medicine, 22, 47–49. doi: 10.1016/j.sleep.2016.05.006 CrossRefGoogle ScholarPubMed
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