Relationship Between Sleep Disordered Breathing And Attention Deficit Hyperactivity Disorder In Children

Background:Sleep disordered breathing(SDB)is one of the most common sleep-related diseases,including obstructive sleep apnea(OSA),central sleep apnea(CSA),sleep related hypoventilation,sleep related hypoxemia,primary snoring,etc.Tonsil and adenoidal hypertrophy is the main cause of children SDB,which results in upper airway obstruction and leads to snoring and mouth breathing during sleep time.The repeated occurrence of hypoxia and hypercapnia leads to body neurohumoral regulation disorder,even multiple organ dysfunction.The disease profoundly affects physical and mental health development of children.A number of studies at home and abroad shew that adult OSAHS could affect cognition,behavior and emotion,which may relate to hypoxia,hypercapnia and the reduce of rapid eye movement sleep(REMS)caused by sleep structure disorder.Serum homocysteine(Hcy),total cholesterol(TC),and triglyceride(TG)increased as well as high density lipoprotein cholesterol(HDL-C)decreased while cognition dysfunction occurred in OSAHS patients and the level of the index above reflects the severity of cognition disorder to some extent.It hinted that the blood lipid metabolism and serum Hcy had relationship with cognition dysfunction in adult OSAHS patients.For children,tonsillectomy and adenoidectomy could relieve the attention deficit disorder,which hinted that SDB could influence the incidence of attention deficit hyperactivity disorder(ADHD)in children.However,we have no research explaining the exact mechanism and whether SDB could influence on children in different age groups which need further research.Objects:To explore the ADHD incidence of children with SDB,and the functional mechanism of lipid metabolism as well as homocysteine(Hcy).Methods:1.78 children(4?13 years old)suffering from snoring and mouth breathing during sleep time and diagnosed as SDB by PSG in department of otorhinolaryngology of Qilu Hospital between October,2015 and June,2016 were enrolled as observation group.50 health children(4?11 years old)in the Health examination center without SDB were enrolled as control group.Both two groups were divided into pre-school age(4-6 year-old)group and school age(6?13 year-old)group respectively.Meanwhile SDB patients were divided into?1 year group,1?3 years group,3?years group according to disease course.2.All of the individuals enrolled underwent attention text after exclusion of dysgnosia.Conners Rating Scale(Parent Symptom Questionnaire,PSQ)were applied to pre-school age group and the continuous performance task(CPT)were applied to school age group.Blood of the individuals was collected from the cubital veins before breakfast in the morning.Serum Hcy,total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and high density lipoprotein cholesterol(HDL-C)were examined.3.Analyzing the difference of incidence of ADHD and attention text results between SDB and non-SDB children as well as the effect of disease course.Analyzing the effect of Hcy and lipid metabolism on SDB wih ADHD in children.Results:1.There was significant difference of the ADHD incidence between SDB group(35.90%)and non-SDB group(14.00%).In pre-school age group,there were significant differences of conduct disorder,study problem,impulsive-hyperactive and hyperactive index between two groups,while in school age group,there were significant differences of response time and the number of error + omission(P<0.05,respectively).2.In pre-school age group,there were significant differences of conduct disorder,impulsive-hyperactive and hyperactive index among three different groups of disease course(P<0.05).In school age group,there were significant differences of response time and the number of error + omission among different disease course groups(P<0.05).3.There was significant difference of serum Hey level between SDB and non-SDB groups as well as between SDB patients with and without ADHD(P<0.05,respectively).The serum Hey level was also positively correlated to AHI.4.There was significant difference of HDL-C level between SDB and non-SDB groups in overweight children.There was no significant difference of blood lipid between SDB patients with and without ADHD(P>0.05).Conclusions:SDB could improve the incidence of ADHD in children and the severity of attention deficit was related to the disease course.Serum Hey may be the important factor of the mechanisms of attention deficit related to children SDB as adult OSAHS.The research couldn't find the evidence of relationship between lipid metabolism and ADHD related to SDB in children?...