Upper Airway Volume May Be Biomarker for Cognitive Outcomes in Pediatric Sleep-Disordered Breathing

Upper airway volumes may predict cognitive performance and regional brain volumes in children with sleep-disordered breathing (SDB), according to study findings published in the American Journal of Respiratory and Critical Care Medicine.

Researchers hypothesized that using magnetic resonance imaging (MRI)-derived upper airway volumes from deep learning analysis of children with SDB could provide insight into the neurocognitive impacts of SDB. The investigators therefore used data from the Adolescent Brain Cognitive Development (ABCD) study to evaluate the relationship between MRI-derived upper airway volume and cognition in children with SDB. Cognition, the primary outcome, was measured based on the National Institutes of Health Toolbox (NIH-TB) total cognition composite age-corrected score. Other NIH-TB measures and cortical gray matter volumes were also evaluated.

The investigators obtained baseline (year 1) and year 3 (ie, 2-year follow-up) T1-weighted brain MRIs from 50 children (100 MRIs, 25,600 slices; 52% male; mean baseline age, 9.8 years; 68% White; 20% who habitually snored at baseline). An upper airway segmentation model was applied to 21,649 MRI scans (5,552,640 slices) to calculate upper airway volumes for the complete ABCD cohort.

Children who did not habitually snore had smaller average airway volumes vs children who did not snore (mean difference, 1.2 cm³; 95% CI, 1.0-1.4 cm³; F_(2,21593) =105.9; P <.001). An increase in average upper airway volumes over time was observed (F_2,21602 = 94.7; P <.001). Airway volumes were greater among boys vs girls (mean difference, 0.5 cm³), and Black children had the smallest average airway volumes.

In 8 of the 10 models used for data analysis (which were both univariate and multivariable), a significant positive relationship was found between airway volume and cognitive test scores. The most robust relationship occurred between airway volume and total cognition composite score, with a mean difference of 3.7 test score points (95% CI, 2.4-5.0; P <.001) per 1-unit increase in the natural log of airway volume, and about a 2.72-fold increase in raw airway volume.

Snoring weakly predicted total cognition composite scores in the full population (mean difference, –1.0 point; 95% CI, –1.9 to –0.2; P =.02), although the association was mitigated in children who snored nonhabitually and habitually (mean difference, 1.3 points; 95% CI, 0.5-3.1; P =.16).

Significant associations were observed between airway volume and regional brain volumes, but not with whole brain volume (mean difference, 0.01 cm³; 95% CI, –1.17 to 1.19 cm³; P =.94). The strongest associations occurred for the right temporal pole, the right orbital gyrus, and the left orbital gyrus.

Limitations include the use of single-site segmentation and missing data for some cognitive test scores. In addition, the study focused on gross upper airway volumes rather than specific radiomic features of the upper airway.

“These results highlight upper airway volume as a surrogate marker of neurocognitive risk in pediatric sleep-disordered breathing and demonstrate the feasibility of large-scale airway analysis using deep learning, offering insights into the biological pathways linking airway anatomy to cognitive outcomes,” the researchers stated.

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Pulmonology Advisor