Aberrant Resting-State Effective Connectivity Between the Insula and Other Regions of the Whole Brain in Children With Obstructive Sleep Apnea.

To investigate the effective connectivity between the bilateral insulae and other regions of the whole brain in children with obstructive sleep apnea (OSA), and to reveal the relationships between these abnormal connections and cognitive dysfunction in this condition. Resting-state functional magnetic resonance imaging (rs-fMRI) data and clinical variables were collected from 55 children with OSA [5.0 (5.0, 8.0) years, 32 males, 28 pre-school children] and 25 healthy controls [6.0 (5.0, 9.0) years, 11 males, 9 pre-school children], matched for age, gender, and education. Rs-fMRI data were analysed to investigative group-difference in the effective connectivity between the bilateral insulae and other regions of the brain of children with OSA with those of controls. Spearman correlation analysis was conducted between these abnormal connections and clinical variables among children with OSA. Compared with controls, children with OSA showed abnormal clinical variables (i.e., increased OAHI, AHI, OAI, HI, ODI, time of SpO₂ < 90%, total AI, and respiratory-related AI, while decreased minimal SpO₂, FIQ, VIQ, and PIQ). Additionally, significant alterations were observed in the effective connectivity between the bilateral insulae and other regions of brain, such as frontal, parietal, occipital, and cerebellum and so forth. Furthermore, the mean values of the effective connectivity in children with OSA were significantly correlated with several sleep-related and neurocognitive parameters. There exist abnormal causal interactions between the bilateral insulae and other regions throughout the brain in OSA children, accompanied by impaired cognitive function, suggesting that the former may be a potential neural mechanism underlying the latter.