Upper airway volume measured by MRI was significantly associated with cognitive performance and brain structure in children, with larger airways predicting better cognitive scores, according to a study of nearly 12,000 patients aged nine to 10 years.

The research used data from the Adolescent Brain Cognitive Development Study, applying a deep learning model to analyze more than 5.5 million MRI slices. Each 2.7-fold increase in raw airway volume was associated with a 3.68-point improvement in the National Institutes of Health Toolbox Total Cognition Composite score.

Patients whose parents reported habitual snoring had smaller airway volumes compared with non-snorers. The airway volume increase was also associated with a 0.02 cubic centimeter increase in right temporal pole volume, a brain region involved in social cognition and memory.

Airway volume was not related to total gray matter volume but was associated with the orbital gyri and temporal poles, regions involved in emotional processing, social cognition, and higher-order memory and language. These brain volume differences mediated the relationship between airway volume and cognition, suggesting neurobiological mechanisms underlying the association.

Boys had larger airway volumes than girls, and Black children had smaller volumes on average than White children. The deep learning segmentation model showed high agreement with expert measurements,

The mediation analysis revealed that left and right orbital gyri, temporal poles, and anterior cingulate cortices showed the strongest mediation effects. For example, the left orbital gyrus mediated 18% of the relationship between airway volume and the Total Cognition Composite score.

The researchers noted that upper airway volume could serve as a biomarker for cognitive outcomes in pediatric sleep-disordered breathing and inform risk stratification strategies. They suggested future research could explore more accessible imaging modalities, such as ultrasound, for clinical decision-making.

The researchers noted that airway volume could serve as a biomarker for neurocognitive risk in pediatric sleep-disordered breathing and might complement current diagnostic tools. They suggested future research could explore more accessible imaging modalities, such as ultrasound, for clinical decision-making.

Limitations included the absence of polysomnography, reliance on parental snoring reports, lack of analysis of individual airway structures, and limited socioeconomic detail. The observational design did not allow determination of causality.

Full disclosures can be found in the study.

Source: American Journal of Respiratory and Critical Care Medicine