Snore-Associated Sleep Fragmentation in Infancy: Mental Development Effects and Contribution of Secondhand Cigarette Smoke Exposure

Abstract

OBJECTIVE. The link between sleep-disordered breathing and neurocognitive functioning in preschool and school-aged children now has been established clearly. Within these age groups, isolated studies have examined the potential effect of snoring without gas exchange abnormalities on aspects of cognitive competence. The goal of the study was to test the potential association between snoring and decrements in developmental performance among infants.METHODS. Thirty-five healthy community infants (8.2 Ϯ 0.4 months) were administered the Bayley Scales of Infant Development, including the Mental Development Index (MDI), after standard, overnight research polysomnography.RESULTS. The apnea-hypopnea index for all infants was 0. Respiratory arousal index was significantly correlated with MDI. Snoring-associated arousals accounted exclusively for this relationship; spontaneous arousals and those that were associated with central apnea and oxyhemoglobin desaturation episodes (Ն4%) were not significantly correlated with MDI. Living in a smoking household was not significantly associated with the presence of objectively recorded snoring but was associated with an increase in arousal frequency in snoring infants.CONCLUSIONS. Infants with lower scores on a standardized mental development assessment had higher snoring-arousal indices. Because neither apnea nor hypopnea was present, these findings constitute additional evidence that snoring is not just an innocent noise during sleep in infants but may in fact represent the lower end of the disease spectrum associated with sleep-disordered breathing. Secondhand exposure to cigarette smoke may increase the deleterious effects of infant snoring. e496MONTGOMERY-DOWNS and GOZAL by guest on May 12, 2018 http://pediatrics.aappublications.org/ Downloaded from T HERE IS NOW substantial and compelling evidence indicating that sleep-disordered breathing (SDB) during early childhood is deleterious to cognition. Furthermore, SDB in early childhood leads to greater utilization of health care resources, 1 more frequent dosedependent cardiovascular morbidity 2,3 and comorbid chronic illnesses, 4,5 as well as greater psychiatric and behavioral comorbidities. 6-10 Impairments associated with SDB have been shown on cognition and school performance. 6,9,[11][12][13][14][15][16] The cumulative evidence points to at least partial reversibility of many of these effects in children [17][18][19][20] and in animal models, 21,22 highlighting the importance of early detection of pediatric SDB. Indeed, failure to thrive associated with SDB, which has been reported in up to 52% of patient samples, has been shown to be reversible in infants who are younger than 18 months after treatment. 23 Although report of snoring history is insufficient for diagnosis of SDB, it is known that snoring is reliably present in children with obstructive sleep apnea (OSA). 24 The prevalence of SDB among school-aged children is estimated at 2% to 3%, 25,26 and symptoms that are consistent with risk for SDB have been repo...

Obstructive Sleep Apnea in Children: Implications for the Developing Central Nervous System

“…Furthermore, infants with higher snore-related arousal indices exhibit lower scores on standardized mental developmental assessments, thereby providing further evidence that snoring is not just an innocent noise during sleep in infants or young children. We further propose that habitual snoring may in fact represent the low end of the disease spectrum associated with sleep-disordered breathing (72).…”

“…Inattentive behaviors have been reported in children with OSA and in those children with habitual snoring (1,(69)(70)(71)(72). Furthermore, a dose response has emerged in the scores obtained using attention-impulsivity scales in the presence of OSA in children (87).…”

Primary snoring in school children: prevalence and neurocognitive impairments

“…sleep fragmentation and disruption) could explain why children with PS show significant NCI even in the absence of hypoxia [12,29]. Notwithstanding this, previous studies have failed to demonstrate differences in electroencephalographic arousals between children with PS and children who have never snored [30].…”

“…Furthermore, poor academic performance has also been found in children with SDB without intermittent hypoxia [10,11]. Other possible mechanisms that may be involved are arousal, sleep fragmentation, and sleep disruption [12,13]. Previous studies, however, may not have clearly separated PS from other forms of SDB like the upper airway resistance syndrome (UARS) [5,11,14].…”

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

“…(1) SDB has been linked to hypertension,(2) growth failure,(3) enuresis, (4,5) and impairment of cognition, attention, and executive functions. (6)(7)(8)(9)(10)(11)(12) Identification of children at high risk for SDB and its associated morbidities is particularly important given the growing body of evidence that treatment with adenotonsillectomy may improve quality of life and neurocognitive function. (5,(13)(14)(15)(16)(17) Preterm infants are especially vulnerable both to SDB and its sequelae.…”