Executive Function in Pediatric Sleep-Disordered Breathing: A Meta-analysis

Mietchen, Jonathan; Bennett, D. P.; Huff, Trevor; Hedges, Dawson W.; Gale, Shawn D.

doi:10.1017/s1355617716000643

Cited by 26 publications

(18 citation statements)

References 52 publications

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“…Further, the relationship between snoring and AHI, although significant, was not particularly strong (r s = 0.24), such that ignoring snoring status or assuming it is adequately captured through AHI measurements could neglect potentially interesting and informative findings. Indeed, a recent meta-analysis that classified severity exclusively via AHI found no severity-related differences in executive function in children [56]. …”

Section: Discussionmentioning

confidence: 99%

Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children

et al. 2017

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Objective Primary snoring (PS) and obstructive sleep apnea (OSA) not only affect the quality of sleep in a large number of young children, but have also been repeatedly associated with a variety of behavioral and cognitive problems. However, little is known about the potentially differing relationships of behavioral and cognitive pathology within the sleep disordered breathing (SDB) spectrum. Method This study examined data from an enriched for snoring community sample of 631 children aged between 4 and 10 years. Multivariate mixed models were used to assess the relationship between both snoring and the apnea–hypopnea index (AHI). Numerous cognitive and behavioral variables were used, while adjusting for several important demographic variables. These were followed by univariate analyses of individual measures and sensitivity analyses. Results Results indicated that snoring status is a significant predictor of general behavioral (p = 0.008) and cognitive (p = 0.013) domains, even after adjusting for baseline covariates and AHI severity. More frequent snoring was associated with poorer outcomes independent of AHI. However, AHI did not emerge as a significant predictor of the overall cognitive functioning domain (p = 0.377). Additionally, although AHI was a significant predictor of the general behavioral functioning domain (p = 0.008), the significance pattern and nature of its relationship with individual behavioral measures were inconsistent in post-hoc analyses. Conclusion The findings of this study suggest that general behavioral and cognitive function may decline with greater snoring severity. Further, snoring should not simply be assumed to represent a lower severity level of SDB, but should be examined as a potential predictor of relevant outcomes.

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Section: Discussionmentioning

confidence: 99%

Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children

et al. 2017

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“…It has been shown that untreated SDB is associated with late graft dysfunction in adult HTx recipients, and pediatric HTx recipients may be at similar risk 6,11 . Furthermore, it is well known that treatment of SDB in children can improve growth, neurocognitive outcomes, and behavior, which may be particularly important in pediatric HTx recipients who are known to be at higher risk for such long‐term complications 22‐26 . While additional focused study of SDB in pediatric heart failure and heart transplant patients is certainly needed, it is likely that identification and treatment of SDB in pediatric HTx recipients could play an important role in improving functional status and long‐term outcomes for these patients.…”

Section: Discussionmentioning

confidence: 99%

“…The negative impact of SDB in children has been well described and includes slowed growth trajectories, neurocognitive delays, and behavioral difficulties 22‐26 . SDB has specifically been associated with increased mortality and lower neurocognitive outcomes in children with congenital heart disease 27,28 .…”

Section: Introductionmentioning

confidence: 99%

Sleep‐disordered breathing in pediatric heart transplant recipients

Powell

Chen

Kraft

et al. 2020

Pediatric Transplantation

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Background Sleep‐disordered breathing is commonly found in adults with heart failure both before and after HTx. Untreated sleep‐disordered breathing post‐transplant has been linked to late graft dysfunction, reduced quality of life, and increased morbidity. Sleep‐disordered breathing has not been investigated in pediatric HTx recipients. Methods We conducted retrospective review of patients <21yo who underwent primary HTx at our center from 2009 to 2019 to describe clinical characteristics, cardiac history, and PSG results. Results One hundred and fifty patients were included; 60% had congenital heart disease, and 40% had cardiomyopathy. Fifty patients had PSG performed at median age of 6.1 years. Forty‐one were referred for symptoms of sleep‐disordered breathing. Obstructive sleep apnea was diagnosed in 45 patients and central sleep apnea in 3 patients. Of those with first PSG post‐transplant (n = 36), median AHI was 9.1/h, and 19 (53%) were diagnosed with moderate or severe sleep apnea. Patients diagnosed with obstructive sleep apnea on PSG had more post‐transplant ventilator days (median 3 vs 2 days, P < .05) and longer post‐transplant lengths of stay (median 28 vs 22 days, P < .05). Conclusions In this single‐center cohort of pediatric HTx recipients, sleep‐disordered breathing was common and associated with longer peri‐transplant respiratory support and length of stay. Given the high incidence of moderate and severe OSA detected in this population, clinicians should regularly screen for SDB and consider PSG testing more frequently in children who have undergone HTx. Further study into the long‐term impact of sleep‐disordered breathing in pediatric HTx recipients is needed.

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“…Neurocognitive manifestations are thought to be more common in children with sleep‐disordered breathing (SDB) and mild OSA 15‐17 as compared to children with severe OSA, although not all the risk factors are known 18 . The neurocognitive manifestations of OSA can be separated into those involving behavioral changes and those involving learning/memory impairments 19 …”

Section: Introductionmentioning

confidence: 99%

Pediatric obstructive sleep apnea: Preoperative and neurocognitive considerations for perioperative management

Chandrakantan

Musso

Floyd

2020

Pediatric Anesthesia

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Obstructive sleep apnea (OSA) affects up to 7.5% of the pediatric population and is associated with a variety of behavioral and neurocognitive sequelae. Prompt diagnosis and treatment is critical to halting and potentially reversing these changes. Depending on the severity of the OSA and comorbid conditions, different treatment paradigms can be pursued, each of which has its own unique risk:benefit ratio. Adenotonsillectomy is first‐line recommended surgical treatment for pediatric OSA. However, it carries its own perioperative risks and the decision regarding surgical timing is therefore made in the context of procedural risk versus patient benefit. This article presents the seminal perioperative and neurocognitive risks from pediatric OSA to aid with perioperative management.

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Executive Function in Pediatric Sleep-Disordered Breathing: A Meta-analysis

Cited by 26 publications

References 52 publications

Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children

Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children

Sleep‐disordered breathing in pediatric heart transplant recipients

Pediatric obstructive sleep apnea: Preoperative and neurocognitive considerations for perioperative management

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