| Objective:To explore the significance and role of auditory brainstem response(ABR)with high stimulation rate(51.1/s)and low stimulus rate(11.1/s)in preschool(3-6 years old)children with moderate and severe obstructive sleep apnea(OSA),and to explore whether it can be used as an objective and convenient method to detect cognitive impairment in children with OSA.The outcome of cognitive function was observed 3 months after tonsillectomy and adenoidectomy.Methods:53 preschool children who were scheduled to undergo tonsillectomy and adenoidectomy and met the diagnostic criteria of moderate and severe OSA in the affiliated Hospital of North Sichuan Medical College from January to December in 2021 were selected as the experimental group(OSA group),and 50 preschool children who underwent physical examination in the same hospital at the same period were selected as the control group.The ABR test of stimulation rate of 11.1/s and 51.1/s and the neuropsychological development scale for children aged 0-6 years old were performed in both groups.The parents of the two groups filled in the OSAHS-specific quality of life questionnaire(OSA-18).All data were analyzed by statistical software SPSS 25.0.The main statistical methods included chi-square test,independent sample t-test,paired sample t-test and Pearson correlation analysis.To correlation between the DQ of the neuropsychological development scale for children aged 0-6 years old and the scores and the ABR latency and interwave interval of the high and low stimulation rate in the OSA group was analyzed,and the ABR latency and interwave interval of different stimulation rates before and 3 months after operation in the OSA group were compared.The DQ of each dimension of the neuropsychological development scale for children aged 0-6 years old and the score of OSA-18 questionnaire were compared.Results:1.A total of 62 patients were enrolled in the OSA group.9 patients lost follow-up 3 months after operation,and 53 patients(106 ears)completed follow-up,including 30 males(60 ears)and 23 females(46 ears).The control group included 50 people(100 ears),including 26 males(52 ears)and 24 females(48 ears).There was no significant difference in sex,age,height,weight and BMI between OSA group and control group.2.In the OSA-18 questionnaire,the scores of sleep disorders(t=11.630,P=0.000),physical symptoms(t=11.740,P=0.000),emotional problems(t=3.280,P=0.000),daytime function(t=5.306,P=0.000)and influence on guardians(t=17.302,P=0.000)in the OSA group were significantly higher than those in the control group.3.At 11.1/s,waves Ⅰ,Ⅲ and Ⅴ latencies in OSA group were significantly longer than those in the control group(t=7.685,P=0.000;t=2.893,P=0.005;t=2.909,P=0.004),and there were no significant difference in other latencies and intervals between two groups(P>0.05).4.At 51.1/s,waves Ⅰ,Ⅲ and Ⅴ latencies and wave Ⅰ-Ⅴ internal in OSA group were significantly longer than those in the control group(t=5.324,P=0.000;t=3.739,P=0.000;t=4.409,P=0.000),and there were no significant difference in other latencies and intervals between two groups(P>0.05).5.The scores of adapt ability(t=-2.040,P=0.044),language ability(t=-2.147,P=0.034),social behavior(t-2.255,P=0.026)and total DQ(t=-2.109,P=0.038)in OSA group were significantly lower than those in the control group.There was no significant difference in the scores of other items(P>0.05).6.In OSA group,the obstructive apnea hypopnea index(OAHI)was negatively correlated with fine movement(r=-0.380),language ability(r=-0.273),great movement(r=-0.521)and total DQ(r=-0.360).The difference was statistically significant(P<0.05)and it has no correlation with other DQs(P>0.05).The mean oxygen saturation(MSaO2)was positively correlated with fine movement(r=0.301),language ability(r=0.471),social behavior(r=0.315),great movement(r=0.642)and total DQ(r=0.420).The difference was statistically significant(P<0.05)and it has no correlation with other DQs(P>0.05).The lowest oxygen saturation(LSaO2)was positively correlated with great movement(r=0.416).The difference was statistically significant(P<0.05)and it has no correlation with other DQs(P>0.05).7.At 11.1/s,ABR wave Ⅲ latency of OSA group was negatively correlated with fine movement(r=-0.296),language ability(r=-0.448),social behavior(r=-0.496),great movement(r=-0.306)and total DQ(r=-0.399).Wave Ⅴ latency was negatively correlated with language ability(r=-0.208),and wave Ⅰ-Ⅲ internal was negatively correlated with fine movement(r=-0.318),adapt ability(r=-0.294),language ability(r=-0.422),social behavior(r=-0.476),great movement(r=-0.319,)and total DQ(r=-0.416).The difference was statistically significant(P<0.05)and it has no correlation with other DQs(P>0.05).8.At 51.1/s,ABR wave Ⅲ latency of OSA group was negatively correlated with language ability(r=-0.383),social behavior(r=-0.396)and total DQ(r=-0.312),and wave V latency was negatively correlated with language ability(r=-0.319),social behavior(r=-0.282),great movement(r=-0.294).Wave Ⅰ-Ⅲ internal was negatively correlated with language ability(r=-0.332),social behavior(r=-0.282)and total DQ(=-0.257),and wave Ⅰ-Ⅴ internal was negatively correlated with language ability(r=-0.283).The difference was statistically significant(P<0.05)and it has no correlation with other DQs(P>0.05).9.Three months postoperatively,sleep disorders(t=9.383,P=0.000),physical symptoms(t=11.677,P=0.000),emotional problems(t=2.894,P=0.006),daytime function(t=2.542,P=0.014)and influence on guardians(t=11.309,P=0.000)of the OSA-18 questionnaire in OSA group were significantly lower than those before operation.10.There were no significant difference in the DQ of the neuropsychological development scale for children aged 0-6 years old and the wave Ⅰ,Ⅲ and Ⅴ latencies and wave Ⅰ-Ⅲ,Ⅲ-Ⅴ and Ⅰ-Ⅴ internals of OSA group between before operation and 3 months postoperatively(P>0.05).Conclusion:1.The cognitive function of preschool children with moderate and severe OSA is impaired in adaptive ability,language and social behavior to a certain extent.2.Affected by hypoxia,moderate and severe preschool children with OSA may have injury of cochlear to brainstem pathway.3.The symptoms of preschool children with moderate and severe OSA were greatly relieved after tonsillectomy and adenoidectomy for 3 months,but the cognitive function was not significantly improved.4.ABR may be an objective auxiliary examination for the detection of cognitive impairment in children with OSA. |
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