Obstructive sleep apnea and neurocognitive impairment in children with congenital heart disease

Abstract Background Children with congenital heart disease (CHD) have an increased risk of neurocognitive impairment. No prior studies have evaluated the role of obstructive sleep apnea (OSA), which is associated with neurocognitive impairment in children without CHD. Research Question Is OSA is associated with neurocognitive impairment in children with CHD? Study Design and Methods Children age 6-17 years with corrected moderate-complex CHD without syndromes that may affect neurocognition were recruited from the pediatric cardiology clinic. Participants underwent home sleep testing and neurocognitive testing including a validated IQ test as well as validated tests of memory (Paired Associates Learning test), executive function (Intra-Extra Dimensional set shift test) and attention (Simple Reaction Test) from the CANTAB neurocognitive testing battery. Results Complete results were available for 30 children. Seventeen children (57%) were found to have OSA. Total IQ was markedly lower in children with CHD and comorbid OSA compared to children with CHD without comorbid OSA (mean 86 ± 12, vs 98 ± 11, p=0.01). Children with CHD and OSA did significantly worse on the Paired Associates Learning test, with a median of 8 total errors (interquartile range [IQR] 2.25-15) compared to children with CHD without OSA (median total errors 2, IQR 1-8), p=0.02. Interpretation Children with CHD and comorbid OSA have impaired neurocognition compared to children with CHD without comorbid OSA. OSA may be a reversible cause of neurocognitive impairment in children with CHD. Further research is needed to evaluate the effects of OSA treatment on neurocognitive impairment in children with CHD.