Cognitive and behavioural performance in children with sleep-related obstructive breathing disorders

doi:10.1053/smrv.2001.0165

Sleep Medicine Reviews

Volume 5, Issue 6, December 2001, Pages 447-461

https://doi.org/10.1053/smrv.2001.0165 Get rights and content

Abstract

Sleep-related obstructive breathing disorders (SROBD) are common in children. While the sequelae of cor pulmonae, and growth and developmental impairment have been well documented, neurocognitive deficits have been less well studied. There is emerging evidence that children with SROBD show reduced neurocognitive functioning especially in the inter-related areas of attentional capacity, memory and cognitive function. In addition, these children show increased problematic behaviour and reduced school performance. Early reports suggest that some of these deficits may be reversible with treatment. The genesis of the defects is unclear but may include hypoxaemia and subtle changes in sleep architecture. The natural history of SROBD and long-term effects on neurocognitive functioning and behaviour remain to be fully examined.

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2023, Snoring and Obstructive Sleep Apnea in Children
Sleep disordered breathing (SDB) is a common condition in the pediatric population. Obstructive SDB ranges in severity from primary snoring to obstructive sleep apnea. Pediatric SDB is associated with adverse cardiovascular and neurocognitive outcomes believed to be the consequence of repeated cycles of hypoxia followed by reperfusion, hypercarbia, and sleep fragmentation. The peripheral hypoxia in individuals with SDB may not reflect cerebral oxygenation, and near infrared spectroscopy has been used to determine oxygen delivery and uptake in the brain. This chapter will explore the relationship between obstructive SDB and changes in cerebral oxygenation in infants and children. Identifying any adverse effects to be mitigated as early as possible is essential to minimize potential detrimental effects on the developing brain.
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Whilst there is evidence supporting the relationship between OSA, poor quality of life, behaviour, and neurocognition, there is insufficient evidence correlating poor language outcomes in children with OSA [3]. The speech and language outcomes of this population is significantly under researched, emphasising the need for a multidisciplinary approach in identifying the correlation between OSA, learning and language outcomes as well as effective treatment approaches [19–21]. Furthermore, the paucity of literature on speech and language outcomes of children with OSA has the potential for such difficulties to go unrecognised, misdiagnosed, and thus unresolved, particularly for vulnerable children.
The purpose of this systematic review was to review and synthesize the current evidence on speech and language outcomes of children with Obstructive Sleep Apnea (OSA), or more broadly sleep-disordered breathing.
A comprehensive literature search was conducted across 5 databases. Studies were selected based on the following criteria: 1) peer-reviewed research published between 2000 and 2020, 2) available in English or accessible non-English data, 3) children aged 2–13 years diagnosed with Sleep Disordered Breathing (SDB) or OSA, and 4) speech and language outcomes examined within research.
Studies were appraised using PEDro-P and the overall certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Six studies met the current review selection criteria: one paper examined speech outcomes and the remaining five examined receptive and expressive language outcomes. The overall quality of the body of evidence was rated as very low, with methodological weaknesses present in study designs and sample sizes.
Speech and language difficulties are common in children with OSA/SDB, in addition to neurocognitive and/or neurobehavioral issues. Further investigation of specific speech and language skills, which are compromised in this population, is needed to guide clinical practice and decision making, with particular involvement from speech-language pathologists.
Insights into the effects of sleep disordered breathing on the brain in infants and children: Imaging and cerebral oxygenation measurements
2020, Sleep Medicine Reviews
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Pathophysiological changes as a result of this autonomic dysfunction, are apparent not only in the cardiovascular system but also in the brain [7]. Obstructive SDB also has significant adverse neurocognitive and behavioral sequelae in children [16–22], that are also believed to be due to the intermittent nocturnal hypoxia and sleep fragmentation that occur during SDB. To understand the mechanisms that underpin the association between SDB and the brain, non-invasive tools have been utilized, with the most common being near-infrared spectroscopy (NIRS) and magnetic resonance imaging (MRI).
Sleep disordered breathing (SDB) is a common condition in infants and children. SDB encompasses a spectrum of respiratory disorders, which are defined as either obstructive or central in nature. Obstructive SDB ranges in severity from primary snoring (PS), to obstructive sleep apnea (OSA). There are a number of conditions characterized by central sleep apnea (CSA), including but not limited to periodic breathing in infants, Arnold Chiari malformations, and idiopathic CSA. SDB is associated with adverse cardiovascular and neurocognitive outcomes believed to be the consequence of the repeated cycles of hypoxia followed by reperfusion, hypercarbia, and sleep fragmentation. The peripheral hypoxia in individuals with SDB may not reflect cerebral oxygenation, and near infrared spectroscopy (NIRS) has been used to determine oxygen delivery and uptake in the brain. Neuroimaging in the form of structural and functional magnetic resonance imaging (MRI, fMRI), diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) have become widely used to determine the structural, functional and chemical changes in the brain associated with SDB. This review will explore the relationship between central and obstructive SDB and changes in cerebral oxygenation together with changes in brain structure and function, in infants and children. It is important to identify any adverse effects so that they can be mitigated as early as possible to minimize any detrimental effects on the developing brain.
Cognitive and behavioral effects of obstructive sleep apnea syndrome in children: a systematic literature review
2018, Sleep Medicine
Obstructive sleep apnea syndrome (OSA) is a common respiratory sleep disorder in children that is believed to adversely affect both quality of life and cognition. The purpose of the present systematic review was to obtain evidence of the impact of OSA on children's cognitive/behavioral abilities from primary studies published in MEDLINE/PubMed, LILACS, SciELO, ISI Web of Science, and PsycINFO databases from 2002 to 2016. Of the 649 articles found, only 34 met the eligibility criteria: studies that evaluated cognition, behavior, and/or academic achievement of children meeting clinical criteria for OSA to compare their data to those of healthy controls or normative data, provided that the samples did not present conditions that might affect cognition/behavior irrespective of OSA. The few selected articles with low risk of bias (levels of evidence I and II) showed that OSA children's intellectual abilities may be impaired but remain within the normal range. Which specific cognitive ability drives this impairment is unclear, as there was insufficient evidence of deficits in language, memory, attention, executive functions, and academic performance, due to low levels of evidence, conflicting findings, and/or heterogeneity of tasks and cognitive abilities tapped by the measures used to assess these domains. To determine why this is so, future studies must test OSA patients using measures that allow for fractionated higher- and lower-order cognitive abilities based on accepted cognitive neuropsychology models.
Auditory behavior and auditory temporal resolution in children with sleep-disordered breathing
2017, Sleep Medicine
Intermittent hypoxia caused by obstructive sleep apnea syndrome (OSAS) may lead to damage in brain areas associated to auditory processing. The aim of this study was to compare children with OSAS or primary snoring (PS) to children without sleep-disordered breathing with regard to their performance on the Gaps-in-Noise (GIN) test and the Scale of Auditory Behaviors (SAB) questionnaire.
Thirty-seven children (6–12 years old) were submitted to sleep anamnesis and in-lab night-long polysomnography. Three groups were organized according to clinical criteria: OSAS group (13 children), PS group (13 children), and control group (11 children). They were submitted to the GIN test and parents answered SAB questionnaire. The Kruskal–Wallis statistical test was used to compare the groups; p < 0.05 was considered statistically significant.
The OSAS group performed significantly worse than PS (p = 0.011) and Control (p = 0.029) groups on gap detection percentage, while PS and Control groups showed no significant differences. The three groups showed similar gap detection thresholds. Regarding SAB questionnaire, PS group had significantly worse scores when compared to Control (p = 0.011), but not to OSAS (p = 0.101) groups. No statistical difference between OSAS and Control groups were found.
Children with OSAS showed worse performance on GIN test in comparison to children with PS and children without sleep-disordered breathing. PS negatively affected auditory behavior in children. These findings suggest that sleep-disordered breathing may lead to auditory behavior impairment.
Cognition, temperament, and cerebral blood flow velocity in toddlers and preschool children with sleep-disordered breathing or behavioral insomnia of childhood
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Cognitive decrements, problematic behaviors, and increased cerebral blood flow velocities (CBFVs) have been reported in children aged 3–7 years with sleep-disordered breathing (SDB). Whether similar impairments exist in younger children or those with behavioral insomnia of childhood (BIC) remains unclear. This study aimed to compare cognition and temperament in children aged 1–5 years with SDB or BIC to healthy control children, and to investigate whether cognitive or behavioral deficits associated with sleep problems are related to changes in CBFV.
Toddlers and preschool-aged children (12–67 months) who had been referred for the clinical evaluation of SDB (n = 20) or BIC (n = 13) and a comparative sample of non-snoring healthy sleepers (controls; n = 77) were recruited from the community. Children underwent cognitive assessment (Mullen's Scale of Early Learning) and measurement of resting bilateral CBFV in the middle cerebral artery (MCA) using Transcranial Doppler. Parents completed temperament scales (Early Childhood or Childhood Behavior Questionnaire), a sleep problem questionnaire (Pediatric Sleep Problem Survey Instrument) and performed home-based pediatric sleep monitoring (Actigraphy and Sleep Diary).
SDB children demonstrated impaired receptive skills, more hyperactive and energetic temperaments, and higher bilateral CBFV than controls and children with BIC. Logistic regression analyses indicated that impaired cognition, temperamental difficulties, and increased CBFV are independently associated with SDB.
During early childhood, problematic temperaments, cognitive deficits, and altered cerebrovascular functioning are associated with SDB but not BIC. CBFV does not appear to mediate these daytime deficits and instead may be an independent outcome of SDB. The findings support the need for an early intervention in pediatric SDB.

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^f1: Correspondence should be addressed to: Kurt Lushington, Centre for Sleep Research, Clinical Development Research Centre, The Queen Elizabeth Hospital, Woodville, South Australia, Australia 5011. E-mail: [email protected]

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CLINICAL REVIEWCognitive and behavioural performance in children with sleep-related obstructive breathing disorders

Abstract

Int J Pediatr Otorhi

Chest

Sleep Med Rev

Lancet

J Pediatr

J Pediatr

Child Adol Psych Cl

Chest

Chest

Resp Physiol

Sleep Med Rev

J Theor Biol

The Principles and Practice of Medicine

Sleep apnea in eight children

Pediatrics

Obstructive sleep apnea syndrome in infants and children: clinical features and pathophysiology

Sleep related upper airway obstruction in children and adolescents

Child Adol Psych Cl

Snoring in children: association with respiratory symptoms and passive smoking

Brit Med J

Snoring in French preschool children

Pediatr Pulm

Snoring, sleep disturbance, and behaviour in 4–5 year olds

Arch Dis Child

Natural history of Snoring and Related Behaviour Problems between the ages of 4 and 7 years

Arch Dis Child

Snoring, apnoea and ENT symptoms in the paediatric community

Clin Otolaryngol

prevalence of sleep problems among 7 to 10 year old normal children

Sleep

Estimated frequency of sleep related breathing disorders in general pediatric practices

Sleep

The prevalence of snoring in preschool children and its association with night cough and asthma

Subjective and objective snoring: a population study in Italian children aged 3–6 years

Prevalence of symptoms of obstructive sleep apnea in children – Preliminary report of the Tucson Children Assessment of Sleep Apnea Study (TuCASA)

Sleep

Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children

Clin Pediatr

Snoring: pathogenic, clinical and therapeutic aspects

Clinical features of obstructive sleep apnea hypoventilation syndrome in otherwise healthy children

Pediatr Pulm

Asynchronous breathing in children during sleep

Sleep

Recognition of Sleep Disordered Breathing in Children

Pediatrics

Pulse transit time: an appraisal of potential clinical applications

Thorax

Nocturnal hypoxia and neuropsychological variables

J Clin Exp Neuropsychol

CLINICAL REVIEW
Cognitive and behavioural performance in children with sleep-related obstructive breathing disorders