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

Abstract

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.

Prevalence and clinical impact of snoring in older community‐dwelling adults

“…Although the clinical relevance of detecting snoring, especially less‐frequent snoring, remains to be established, the present study has shown that snoring 1–6 nights a week is associated with increased airway symptoms, and the systemic symptoms of hypertension, diabetes and heart disease. This finding suggests that less‐frequent snoring might be related to physical and mental disorders, as was observed in the associations between snoring 1–2 nights per week and a higher prevalence of impaired cognitive function or enuresis in children …”

“…This finding suggests that less-frequent snoring might be related to physical and mental disorders, as was observed in the associations between snoring 1-2 nights per week and a higher prevalence of impaired cognitive function or enuresis in children. 31,32 This study had several limitations. First, Japan Gerontological Evaluation Study 2013 was based on a postal self-reported questionnaire and not on face-to-face interviews or diagnoses by clinical specialists.…”

Nocturnal enuresis and sleep disordered breathing in primary school children: Potential implications

“…In other words, if we consider NE as a morbid consequence of SDB, then even the mildest forms of SDB are sufficient to increase the risk of such morbidity. These findings are reminiscent of recent studies showing that snoring once a week was associated with cognitive and behavioral impairments, the latter being assessed with standardized test batteries . Furthermore, Smith et al also reported that alterations in behavioral measures reached a plateau in the children who snored ≥2 nights per week, while cognitive function was increasingly likely to be impaired as the snoring frequency increased.…”

“…These findings are reminiscent of recent studies showing that snoring once a week was associated with cognitive and behavioral impairments, the latter being assessed with standardized test batteries . Furthermore, Smith et al also reported that alterations in behavioral measures reached a plateau in the children who snored ≥2 nights per week, while cognitive function was increasingly likely to be impaired as the snoring frequency increased. Thus, although causal inferences cannot be drawn from our results, we would propose that NE is a significant and direct end‐organ morbidity of SDB in children, in which dose‐dependency relationships are detectable.…”

A retrospective analysis on patients at high‐risk for obstructive sleep apnea undergoing ear, nose, and throat surgeries

“…The number of apnea and hypopnea episodes per hour during a polysomnographic test is reported as the apnea‐hypoxemia index (AHI), considered to be the gold standard approach to diagnose OSA and assess the severity of sleep disordered breathing (SDB) 12, 17. The AHI definition classifies the threshold values of the estimated prevalence and severity distribution of OSA as normal (<5), mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30) and severe (AHI > 30) 12, 18…”