Effect of Sleep-disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-aged Children

Abstract

Rationale: Sleep-disordered breathing (SDB) in children is associated with cognitive challenges. However, potential associations between SDB severity and neurocognitive function, as well as the presence of an SDB cutoff, have not been fully explored.Objectives: To determine whether SDB-associated adverse changes in neurocognitive functioning are severity dependent.Methods: A total of 1,010 snoring and nonsnoring children ages 5-7 years were prospectively recruited from public schools and underwent polysomnography and neurocognitive assessments of intellectual, attention, memory, language, and executive function development. The children were subdivided into four severity groups on the basis of apnea-hypopnea index (AHI), followed by comparisons of cognitive function, with a particular focus on standardized subtests of intellectual, language, attention, memory, and executive function.Measurement and Main Results: Differential Ability Scales Verbal (P , 0.001) and Nonverbal (P = 0.002) performance, as well as global conceptual ability (IQ) (P , 0.001) scores, differed significantly across the groups, with individuals with higher AHI showing worse performance. Additionally, specific NEPSY (a Developmental Neuropsychological Assessment) subscores focused on attention and executive skills differed across the groups, indicating differences in levels of engagement and problem solving. Children with higher AHI (.5 per hour of total sleep time) were significantly more impaired than all three lower AHI groups, indicating a dose-response impact of SDB.Conclusions: This large community-based sample of children highlights the significant deleterious impact of SDB, particularly in children with moderate to severe obstructive sleep apnea, and also that even snoring alone affects neurocognitive function. By affecting developing capabilities, as illustrated by cognitive measures in a severity-graded manner, SDB could adversely impact children's capacity to attain academic and adaptive goals, ultimately hampering their ability to reach independence. Our findings support the need for increased awareness of SDB, with particular emphasis on children with more severe obstructive sleep apnea.

Success of Tonsillectomy for Obstructive Sleep Apnea in Children With Down Syndrome

“…A recent study examining neuropsychological measures and their association with OAHI in over 1,000 school-aged children found a clear deleterious effect at OAHI > 5 events/h compared to more mildly affected groups. 26 Third, one would theoretically expect that by removing obstructing tonsils/adenoid and improving airway patency that if a child is referred for noninvasive ventilation, the airway pressure would be lower and/or better tolerated.…”

Association between sleep-related breathing disorders and academic performance among children from Concepción, Chile

“…15 In our study, the abridged version of the PSQ was used, which assessed SRBD-related symptoms only; however, it was not possible to establish their severity. 5 Therefore, in our findings it is not possible to establish such association, which should be addressed in future research.…”

Asociación entre trastornos respiratorios del sueño y rendimiento académico en niños de Concepción, Chile

“…15 E n n u e s t r o e s t u d i o , f u e e m p l e a d o e l cuestionario PSQ, en su versión abreviada, que solo permitió evaluar síntomas relacionados con TRS; sin embargo, no permitió determinar la gravedad de estos. 5 Por lo tanto, no es posible establecer esta asociación en nuestras observaciones, lo cual debería ser abordado en investigaciones futuras.…”