Untreated Childhood Sleep Apnea Can Harm the Brain

by Eli Hendel, M.D. Medical Reviewer

As with adults, children who suffer with sleep apnea have periods during sleep when air does not flow easily into their lungs. This results in poor quality sleep and over time, if not treated, it can result in serious health problems. Sleep-disordered breathing is more common among African-American children and children who had preterm births. A study published in Scientific Reports suggests that undiagnosed, untreated pediatric sleep apnea can reduce grey brain matter.

The most common causes of obstructive sleep apnea (OSA) in children include:

  • Large tonsils or adenoids

  • Obesity

  • Problems with throat muscle tone (too relaxed)

  • Genetic syndromes like Down syndrome and Prader-Willi syndrome

  • Abnormal face or throat shape

  • Brain issue that affects breathing control

  • Family history of sleep apnea

Surgery can certainly solve the tonsils or adenoid issue. With childhood obesity rates currently impacting more than 25 percent of kids, associated health risk factors like OSA should be part of routine and ongoing screening. Overall, nearly 5 percent of all children have OSA. Children who suffer with OSA often snore. They might also have periods where they gasp or make choking sounds. They are often restless during sleep and may awaken frequently from sleep. Bedwetting can appear or persist because of their sleep patterns.

These kids often present with attention deficit during daytime hours, and especially at school. Untreated OSA can affect growth problems, cause hypertension and lead to a risk of heart disease and earlier mortality. This new research suggests that there is a link between OSA and loss of neurons or delay in neuronal growth in a child’s developing brain.

In the study, researchers evaluated the sleep patterns of 16 kids with OSA at the University of Chicago’s pediatric sleep laboratory. Each child underwent neuro-cognitive testing and a brain scan using non-invasive magnetic resonance imaging (MRI). The scans and MRIs were compared to those from nine healthy children (without OSA) who matched the subjects’ gender, age, ethnicity and weight. Separately, the results of the 16 scans and MRIs were also compared to an existing National Institute of Health pediatric database compiled from 191 children.

The researchers noted clear reductions in volumes of the grey matter in several regions of the brains of the 16 OSA subjects. Those brain regions involved the frontal cortex (responsible for movement, problem solving, memory, language, judgement and impulse control), the prefrontal cortex (complex behaviors, planning and personality), the temporal lobe (hearing and selective listening), parietal cortices (handles sensory input), and the brainstem (heart and respiratory function). The researchers noted “extensive grey matter reductions.”

Still, it’s not clear what the direct consequences are, though prior studies reference sleep apnea’s impact on cognitive function in adults. The scan findings really don’t offer what exactly happened to the affected neurons — whether they have shrunk or whether they’re gone forever.

The research also doesn’t identify when the damage occurred. At this point, accurately assessing damage or clear health implications is difficult, but other studies done by the same research group do help to connect cognitive defects to the loss of grey matter.

It is clear that untreated OSA has significant and serious health implications that now include cognitive loss. This should prompt public health officials and pediatricians to educate parents, especially those with high-risk children (obesity), to be on the lookout for signs of OSA and to seek confirmation of the diagnosis and treatment.

Currently, adenotonsillectomy is the first line of treatment in children with OSA. If the child is overweight or obese, establishing lifestyle changes that allow for weight loss — or weight maintenance to help normalize the child’s BMI and minimize anatomical (weight) contributions to the OSA — are recommended.

It is important to note, however, that if snoring disappears after the surgery, that does not necessarily mean the OSA is completely resolved. The child should still be screened for OSA after healing from the surgery.

Some kids may benefit from the use of oral appliances that bring the lower jaw and tongue forward during sleep, which can help to improve OSA.

Continuous positive airway pressure (CPAP) or biphasic positive airway pressure (BiPAP) before or after surgery may be needed as a component of the treatment plan. Since children grow quickly, intermittent re-evaluation of the face mask size is crucial in order to ensure that the mask continues to fit well and provide maximal treatment. Comfort is also extremely important, to ensure that the child wears the mask every night. Another consideration is making sure that children (and their parents) understand the need for the treatment, so they are compliant.

Eli Hendel, M.D.
Meet Our Writer
Eli Hendel, M.D.

Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music.