儿童睡眠呼吸障碍的前额叶激活与认知异质性

文献信息

中文摘要

重要性： 在注意力和执行功能任务中前额叶皮层的激活可调节睡眠呼吸障碍（SDB）症状与家长报告行为之间的关联。然而，常规严重程度指标无法解释为何SDB儿童的认知结局存在差异。
目的： 评估反映注意力和冲动控制的前额叶皮层（PFC）活动是否与SDB严重程度和认知相关，以及它是否能区分认知与SDB严重程度不一致的儿童。
设计、场所和参与者： 这项横断面研究纳入2024年1月至2026年3月在2个学术性儿童耳鼻咽喉科中心因评估SDB而转诊的5至11岁患者。排除患有神经肌肉疾病、既往气道手术、持续气道正压通气治疗、镰状细胞病、使用兴奋剂或发育迟缓的患者。
暴露： SDB严重程度通过儿童睡眠相关呼吸障碍问卷、呼吸暂停低通气指数（AHI）和血氧饱和度（SpO2）最低值测量。PFC激活通过功能性近红外光谱（fNIRS）在计算机化go/no-go任务中测量，儿童对频繁出现的提示作出反应并对不频繁出现的提示抑制反应。
主要结局和测量： 家长报告的执行功能（执行功能行为评定量表）和认知（美国国立卫生研究院[NIH] Toolbox认知电池），及其与PFC激活的关联。采用带错误发现率（FDR）校正的线性混合效应模型检验关联和调节效应。
结果： 在284名儿童中（平均[SD]年龄7.9[1.8]岁；130名[45.8%]女性），237名（83.5%）处于SDB高风险。平均（SD）AHI为每小时11.7（14.5）次事件，SpO2最低值为86.4%（8.2%）。较高的AHI与更大的左侧背外侧PFC激活相关（氧合血红蛋白：β，0.08；95% CI，0.03至0.12；脱氧血红蛋白：β，-0.07；95% CI，-0.11至-0.03），较低的SpO2最低值与更大的激活相关（β，0.14；95% CI，0.06至0.23）。FDR校正后，右侧背外侧PFC更大的激活与更差的家长报告执行功能相关。校正后，没有任何严重程度指标与NIH Toolbox表现直接相关。然而，PFC激活调节了SDB严重程度-认知关联：激活更大的儿童尽管SDB更严重，仍保持相当的表现。
结论与意义： 在这项横断面研究中，任务相关PFC激活与SDB严重程度相关，并调节了严重程度-认知关联。fNIRS可能有助于识别认知特征偏离常规严重程度指标的儿童，从而支持个体化认知风险评估。

英文摘要

IMPORTANCE: Activation of the prefrontal cortex during attention and executive-function tasks can moderate associations between sleep-disordered breathing (SDB) symptoms and parent-reported behavior. However, conventional severity measures do not explain why cognitive outcomes vary among children with SDB.
OBJECTIVE: To assess whether prefrontal cortex (PFC) activity, reflecting attention and impulse control, is associated with SDB severity and cognition, and whether it distinguishes children whose cognition diverges from their SDB severity.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included patients aged 5 to 11 years who were referred for evaluation of SDB at 2 academic pediatric otolaryngology centers from January 2024 to March 2026. Patients with neuromuscular disorders, prior airway surgery, continuous positive airway pressure treatment, sickle cell disease, stimulant use, or developmental delay were excluded.
EXPOSURES: SDB severity measured by the Pediatric Sleep-Related Breathing Disorders Questionnaire, Apnea-Hypopnea Index (AHI), and oxygen saturation (SpO2) nadir. PFC activation measured by functional near-infrared spectroscopy (fNIRS) during a computer-based go or no-go task in which children respond to frequent cues and withhold responses to infrequent ones.
MAIN OUTCOMES AND MEASURES: Parent-reported executive function (Behavior Rating Inventory of Executive Function) and cognition (US National Institutes of Health [NIH] Toolbox Cognition Battery), and their associations with PFC activation. Linear mixed-effects models with false discovery rate (FDR) correction tested associations and moderation effects.
RESULTS: Among 284 children (mean [SD] age, 7.9 [1.8] years; 130 [45.8%] female), 237 (83.5%) were at high risk for SDB. The mean (SD) AHI was 11.7 (14.5) events per hour and SpO2 nadir was 86.4% (8.2%). Higher AHI was associated with greater left dorsolateral PFC activation (oxyhemoglobin: β, 0.08; 95% CI, 0.03 to 0.12; deoxyhemoglobin: β, -0.07; 95% CI, -0.11 to -0.03), and lower SpO2 nadir was associated with greater activation (β, 0.14; 95% CI, 0.06 to 0.23). Greater activation in the right dorsolateral PFC was associated with worse parent-reported executive function after FDR correction. No severity measure was directly associated with NIH Toolbox performance after correction. However, PFC activation moderated the SDB severity-cognition association: children with greater activation maintained comparable performance despite more severe SDB.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study, task-related PFC activation was associated with SDB severity and moderated the severity-cognition association. fNIRS may help identify children whose cognitive profiles deviate from conventional severity metrics, thereby supporting individualized cognitive risk assessment.