Insights into the effects of sleep disordered breathing on the brain in infants and children: Imaging and cerebral oxygenation measurements

Sleep disordered breathing (SDB) is a common condition in infants and children. SDB encompasses a spectrum of respiratory disorders, which are defined as either obstructive or central in nature. Obstructive SDB ranges in severity from primary snoring (PS), to obstructive sleep apnea (OSA). There are a number of conditions characterized by central sleep apnea (CSA), including but not limited to periodic breathing in infants, Arnold Chiari malformations, and idiopathic CSA. SDB is associated with adverse cardiovascular and neurocognitive outcomes believed to be the consequence of the repeated cycles of hypoxia followed by reperfusion, hypercarbia, and sleep fragmentation. The peripheral hypoxia in individuals with SDB may not reflect cerebral oxygenation, and near infrared spectroscopy (NIRS) has been used to determine oxygen delivery and uptake in the brain. Neuroimaging in the form of structural and functional magnetic resonance imaging (MRI, fMRI), diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) have become widely used to determine the structural, functional and chemical changes in the brain associated with SDB. This review will explore the relationship between central and obstructive SDB and changes in cerebral oxygenation together with changes in brain structure and function, in infants and children. It is important to identify any adverse effects so that they can be mitigated as early as possible to minimize any detrimental effects on the developing brain.