Does auto-adjusting positive airway pressure (APAP) aid memory and learning in children with sickle cell disease and sleep disordered-breathing?

Kolbel, M., Stotesbury, H., Kawadler, J., Howard, J., Inusa, B., Rees, D., Chakravorty, S., Pelidis, M., Thein, S., Kirkham, F. and Slee, A. (2018) Does auto-adjusting positive airway pressure (APAP) aid memory and learning in children with sickle cell disease and sleep disordered-breathing? British Journal of Haematology, 181 (S1), 113-113.

Abstract

Background: Children with sickle cell disease (SCD) are at risk of hypoxic exposure due to complications such as chest crisis and sleep apnoea and are more likely to develop cognitive difficulties over time. Although intermittent hypoxia impairs verbal learning and spatial memory in animal models, there are few data on any association of potential reversible memory or learning difficulty with hypoxic exposure in SCD and the effect of treatment remains very controversial. Sleep disordered breathing (SDB), common in these children, disrupts sleep at night and seems to impair executive function and processing speed, which often find support in memory processes (i.e., working memory) and impaired lead to difficulties in academic attainment and intelligence. In our randomised trial of auto-adjusting positive airway pressure (APAP) in SCD, cancellation, a measure of attention and processing speed, improved. In this secondary analysis we explored any effect of APAP on sleep behaviour, sleepiness and verbal and spatial memory. We hypothesised that APAP compared to standard care alone will improve (1) memory and learning, (2) sleep behaviour and (3) sleepiness. Methods: 30 Patients (mean age 12.6) were randomised for a 6 month at home treatment of either APAP and standard care (n = 15); or standard care alone (n = 15). Questionnaires on sleep behaviour, sleepiness (i.e., Epworth Sleepiness Scale (ESS)) and neu-ropsychological assessment (i.e., Children Memory Scale (CMS): Verbal Memory (i.e., Word Pairs) and Visual/Spatial Memory (i.e., Dot Location) were administered before and after treatment period. Results: Patient receiving the APAP treatment felt less sleepy (ESS: mean-2; 95% confidence intervals (CI)-3.13;-0.87) compared to controls (ESS: mean 0.15; 95% CI-1.03; 1.32), p = 0.018 and took less time to fall asleep (mean-5.39; 95% CI-10.8;-0.03) vs. controls (mean 2.96; 95% CI-2.88; 8.80), p = 0.05. However, no difference was found for total amount of sleep. Raw scores for spatial memory performance improved after APAP treatment for (1) (Dot Location Total: mean 3.26; 95% CI 1.65; 4.87) vs. controls (mean-0.14; 95% CI-1.89; 1.61), p = 0.012 and (Dot Learning: mean 2.50; 95% CI 1.29; 3.70) vs. controls (mean 0.20; 95% CI-1.11; 1.50), p = 0.21. There was no statistically significant difference for Dot Delay. Raw scores for verbal memory performance indicated an improve-ment after APAP use but without statistical significance (e.g., Word Pair Learning: mean 3.95; 95% CI 0.64; 7.25 vs. controls mean 1.91; 95% CI-1.69; 5.51), p = 0.433. The same was true for the overall memory learning performance (mean 6.24; 95% CI 2.48; 10.01) vs. controls (mean 2.34; 95% CI-1.76; 6.43), p = 0.195. Discussion: In accordance with other literature APAP treatment was associated with improved cognitive function, sleepiness and sleep behaviour. The following limitations might have contributed to the differences in results and should be taken into account for future studies: (1) small sample size; (2) compliance with APAP; (3) factors influencing cognitive assessment (i.e., environmental distractions and emotional wellbeing). Improving daytime sleepiness aids concentration thought the day, hence, improves academic attainment. Improving spatial memory, important for planed and guided behaviour could support and improve other cognitive domains (i.e., executive function and processing speed) impaired in children with SCD and SDB.

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Contributors

Author: F. Kirkham

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