G98 Attention deficits in paediatric sickle cell disease; links with nocturnal oxygen desaturation in adolescents, but not children

Stotesbury, H., Kirkham, F.J., Balfour, P., Koelbel, M., Inusa, B., Chakraborty, S., Rees, D.C., Downes, M. and Kawadler, J. (2017) G98 Attention deficits in paediatric sickle cell disease; links with nocturnal oxygen desaturation in adolescents, but not children. Archives of Disease in Childhood, 102 (Suppl 1), A40-A41. (doi:10.1136/archdischild-2017-313087.97).

Abstract

Objective: Sickle cell disease (SCD) is associated with neurological compromise and cognitive difficulties. Tentative associations between cognitive difficulties and low daytime oxygen saturation (SpO2) are reported, but any effects of nocturnal desaturation are unknown. Methods: Sixteen children (8-12y, 6F) and twenty-four adolescents (13-18y, 11F) enrolled on the Prevention of Morbidity in Sickle Cell Disease phase-2 trial underwent cognitive assessment, which included the Wechsler Intelligence Scales, the Tower and Sorting tests from the Delis-Kaplan-Executive- Function System (D-KEFS) and the Conners Continuous Performance Test (CPT). Overnight oximetry was conducted within 2 weeks of assessment. Multiple deprivation indices (MDI) were derived from postcodes. Results: There were no significant differences between groups in any of the cognitive or oximetry measures. In adolescents, after correcting for the effects of MDI, relationships were found between mean nocturnal SpO2 and full-scale IQ (FSIQ; r=0.486, p=0.016), processing speed index (PSI; r=0.350, p=0.094) and working memory index (WMI: r=0.442, p=0.031), between minimum SpO2 and PSI (r=0.432, p=0.035) and tower time-time-per-move ratio (r=0.348, p=0.096), between the number of 3% oxygen dips per hour and the number of correct sorts (r=-0.447, p=0.029) and sorting descriptions (r=-0.438, p=0.032), and between the time spent with SpO2 <94% and FSIQ (r=-0.549, p=0.005), PSI (r=-0.434, p=0.034), and WMI (r=-0.464, p=0.022). In children the only significant relationship found was in the opposite direction; performance on the tower test was negatively related to mean SpO2 (r=-0.537, p=0.039). Findings were similar for the CPT. Conclusion: This study demonstrates, for the first time in SCD, links between nocturnal desaturation and difficulties in processing speed and executive function in adolescents but no similar links and a relationship in the opposite direction in children. These preliminary data may indicate that the effects of hypoxia on these domains only emerge over developmental time. Early interventions aimed at reducing hypoxic exposure may hold promise.

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Contributors

Author: F.J. Kirkham

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