儿童阻塞性睡眠呼吸暂停综合征对认知和脑功能影响的研究进展

Research progress on the effects of childhood obstructive sleep apnea syndrome on cognition and brain functions

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome, OSAS)作为儿童睡眠障碍中最为常见的疾病之一,其特点是睡眠期间反复出现上气道阻塞,导致间歇性缺氧和睡眠碎片化。患儿如果得不到及时诊断和有效干预会影响脑发育,进而导致认知功能障碍。近年来,磁共振成像、脑电图等技术被广泛应用于探讨OSAS患儿脑结构和功能的异常。总结已有研究发现,OSAS患儿大脑灰质和白质皮层均出现广泛性的受损,额叶和海马等主要脑区功能存在异常,同时一般认知功能和执行功能等显著降低。然而目前对于OSAS影响儿童脑结构和功能的研究仍局限于对大脑局部区域特性的考察,缺乏对整体脑网络机制的关注。此外,OSAS患儿大脑结构和功能的损伤与其认知功能障碍的对应关系尚不清楚。基于此,未来的研究一方面可以借助多模态神经成像技术深入揭示儿童OSAS的脑网络整体变化情况;另一方面可探究脑网络特征与认知功能障碍的关联,从而阐明儿童OSAS的脑网络核心表征指标。这些工作将为儿童OSAS的脑发育监测、临床筛查提供神经影像学依据,有望发展基于脑网络的干预和诊疗措施。

Obstructive sleep apnea syndrome(OSAS), a prevalent sleep disorder in children, is characterized by recurring upper airway obstruction during sleep. OSAS in children can cause intermittent hypoxia and sleep fragmentation, ultimately affect brain development and further lead to cognitive impairment if lack of timely effective intervention. In recent years, magnetic resonance imaging(MRI) and electroencephalogram(EEG) have been employed to investigate brain structure and function abnormalities in children with OSAS. Previous studies have indicated that children with OSAS showed extensive gray and white matter damage,abnormal brain function in regions such as the frontal lobe and hippocampus, as well as a significant decline in general cognitive function and executive function. However, the existing studies mainly focused on the regional activity, and the mechanism of pediatric OSAS affecting brain networks remains unknown. Moreover, it's unclear whether the alterations in brain structure and function are associated with their cognitive impairment. In this review article, we proposed two future research directions: 1) future studies should utilize the multimodal neuroimaging techniques to reveal the alterations of brain networks organization underlying pediatric OSAS;2) further investigation is necessary to explore the relationship between brain network alteration and cognitive dysfunction in children with OSAS. With these efforts, it will be promising to identify the neuroimaging biomarkers for monitoring the brain development of children with OSAS as well as aiding its clinical diagnosis, and ultimately develop more effective strategies for intervention,diagnosis, and treatment.