Background: Pediatric obstructive sleep apnea (OSA) is associated with neurocognitive deficits. However, the neural substrates underlying such deficits remain unknown.
Methods: To examine executive control and emotional processing in OSA, 10 children age 7 to 11 y with polysomnographically diagnosed OSA and 7 age- and sex-matched controls underwent a color-word Stroop task and an empathy task consisting of dynamic visual scenarios depicting interpersonal harm or neutral actions in a magnetic resonance imaging (MRI) scanner. Functional MRI data were processed using MATLAB 7.12 with SPM8 for region of interest (ROI) analyses, and a general linear model was used with regressors for each trial type in each task.
Results: For the Stroop task, accuracy was similar in the two groups, with no differences in the effect of incongruency on success rates. OSA showed greater neural activity than controls in eight ROI clusters for incongruent versus congruent trials (P < 0.001). Within the a priori ROIs, the anterior cingulate cortex was significantly different between groups (P < 0.05). For perceiving harm versus neutral actions, ROI analysis revealed a significant correlation between apnea-hypopnea index and left amygdala activity in harm versus neutral actions (r = -0.71, P < 0.05).
Conclusions: These results provide the first functional MRI evidence that cognitive and empathetic processing is influenced by obstructive sleep apnea (OSA) in children. Children with OSA show greater neural recruitment of regions implicated in cognitive control, conflict monitoring, and attentional allocation in order to perform at the same level as children without OSA. When viewing empathy-eliciting scenarios, the severity of OSA predicted less sensitivity to harm in the left amygdala.
Keywords: Pediatric sleep apnea; empathy; executive function; fMRI.