Impaired Cognition in Children With OSA and Congenital Heart Disease

Children with congenital heart disease and comorbid obstructive sleep apnea (OSA) are at increased risk for impaired neurocognition compared with children with congenital heart disease who do not have comorbid OSA, according to study results published in CHEST.¹

Studies have shown that children with congenital heart disease are at higher risk for developmental and cognitive abnormalities that adversely affect their educational achievements and health-related quality of life.² Recognized factors that may contribute to neurocognitive impairment include chronic hypoxia (in cyanotic congenital heart disease), surgical procedures requiring cardiopulmonary bypass, anesthesia, and prolonged intensive care stays.¹ Studies have also demonstrated that individuals with congenital heart disease have an elevated apnea-hypoxia index and abnormal overnight oximetry compared with individuals without congenital heart disease,^3,4 however no studies have evaluated the potential contribution of OSA to neurocognitive impairment in children with congenital heart disease.

Therefore, researchers investigated whether OSA is associated with neurocognitive impairment in 30 children aged 6 to 17 years with corrected moderate-complex congenital heart disease without syndromes that may affect neurocognition.¹ Of these children, 17 (57%) were found to have OSA. The total IQ was significantly lower in children with congenital heart disease and comorbid OSA compared with children with congenital heart disease and without OSA (P =.01). In addition, children with congenital heart disease and OSA did significantly worse on the Paired Associates Learning test, with a median of 8 total errors in these children compared with children with congenital heart disease who do not have comorbid OSA (P =.02).

“Our results suggest that OSA is common in children with [congenital heart disease] and is associated with neurocognitive impairment,” concluded the researchers.¹ They added that, “Given that OSA is amenable to treatment, it is possible that OSA treatment may lead to improved neurocognitive outcomes in children with [congenital heart disease].” However, further research is needed to investigate the effects of OSA treatment on neurocognitive impairment in children with congenital heart disease.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

References

1. Combs D, Edgin JO, Klewer S, et al. Obstructive sleep apnea and neurocognitive impairment in children with congenital heart disease [published online March 25, 2020]. CHEST. doi:10.1016/j.chest.2020.03.021

2. Marino BS, Lipkin PH, Newburger JW, et al. Neurodevelopmental outcomes in children with congenital heart disease: evaluation and management: a scientific statement from the American Heart Association. Circulation. 2012;126(9):1143-1172.

3. Ykeda DS, Lorenzi-Filho G, Lopes AA, Alves RS. Sleep in infants with congenital heart disease. Clinics. 2009;64(12):1205-1210.

4. Miles S, Ahmad W, Bailey A, Hatton R, Boyle A, Collins N. Sleep-disordered breathing in patients with pulmonary valve incompetence complicating congenital heart disease. Congenit Heart Dis. 2016;11(6):678-682.