Impairments in Attention in Occasionally Snoring Children: An Event-Related Potential Study

Abstract

Objective To determine whether minimal snoring is benign in children. Procedure 22 rarely snoring children (mean age=6.9 years, 11 females) and age- and sex- matched controls participated in an auditory oddball task wearing 128-electrode nets. Parents completed Conner’s Parent Rating Scales-Revised Long (CPRS-R:L). Results Snorers scored significantly higher on 4 CPRS-R:L subscales. Stepwise regression indicated that two ERP variables from a region of the ERP that peaked at 844 ms post-stimulus onset predicted CPRS-R:L ADHD Index scores. Conclusions Occasional snorers according to parental report do exhibit ADHD-like behaviors. Basic sensory processing is longer than in controls, suggesting that delayed frontal activation requires more effort in snorers.

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

“…Indeed, in published studies in which researchers have used highly sensitive methodologies such as evoked potential arrays for detection of subtle differences in attention between PS children and control subjects, PS children clearly exhibited enhanced recruitment of frontotemporal regions during a Stroop test, even though their neurocognitive function as tested with some of the batteries used herein revealed no significant deficits in this small group (38). Such subtle alterations in end-organ function among PS children have also been reported for cardiovascular and metabolic systems, suggesting that type II errors related to cohort size may account for the previously reported negative findings and that only expansion of the cohort size would enable the detection of such important yet difficult to detect morbidities (39)(40)(41).…”

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.…”

“…Finally, the present study was based on sleep‐related symptoms of snoring and unrefreshing sleep, and not on polysomnographic recordings, such that objective severity estimates of SDB are not possible. There is, however, increasing evidence that even snoring alone in the absence of abnormalities in respiratory disturbance indices in the PSG, is a strong predictor of end‐organ morbidity, particularly behavioral morbidity . Accordingly, we would surmise that using snoring and unrefreshing sleep per se, even in the absence of polysomnographic testing, should raise suspicion of their potential contributory role in the context of NE.…”

“…Of these three factors, the first two are also intimately associated with SDB . Interestingly, habitual snoring, even with concurrent normal findings during polysomnography (PSG), can lead to not only abnormalities in behavior and cognition, as well as in cardiometabolic parameters, but can also increase the risk of NE, while reciprocally, the presence of NE is associated with increased SDB risk …”

Obstructive sleep apnea in children: a critical update

“…From the behavioral standpoint, OSA and habitual snoring have been associated with hyperactivity, attention deficits, concentration difficulties, and impulsivity. Therefore, it should come as no surprise that such children are frequently misdiagnosed as having attention deficit hyperactivity disorder 110–112. Recent 5-year follow up results from the TuCASA study revealed that youth with untreated OSA exhibited hyperactivity, had attention problems and aggressive behaviors, lower social competencies, poorer communication, and/or diminished adaptive skills 113…”