Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea
Phoebe K Yu, Jerilynn Radcliffe, H Gerry Taylor, Raouf S Amin, Cristina M Baldassari, Thomas Boswick, Ronald D Chervin, Lisa M Elden, Susan L Furth, Susan L Garetz, Alisha George, Stacey L Ishman, Erin M Kirkham, Christopher Liu, Ron B Mitchell, S Kamal Naqvi, Carol L Rosen, Kristie R Ross, Jay R Shah, Ignacio E Tapia, Lisa R Young, David A Zopf, Rui Wang, Susan Redline, Phoebe K Yu, Jerilynn Radcliffe, H Gerry Taylor, Raouf S Amin, Cristina M Baldassari, Thomas Boswick, Ronald D Chervin, Lisa M Elden, Susan L Furth, Susan L Garetz, Alisha George, Stacey L Ishman, Erin M Kirkham, Christopher Liu, Ron B Mitchell, S Kamal Naqvi, Carol L Rosen, Kristie R Ross, Jay R Shah, Ignacio E Tapia, Lisa R Young, David A Zopf, Rui Wang, Susan Redline
Abstract
Study objectives: Obstructive sleep apnea is associated with neurobehavioral dysfunction, but the relationship between disease severity as measured by the apnea-hypopnea index and neurobehavioral morbidity is unclear. The objective of our study is to compare the neurobehavioral morbidity of mild sleep-disordered breathing versus obstructive sleep apnea.
Methods: Children 3-12 years old recruited for mild sleep-disordered breathing (snoring with obstructive apnea-hypopnea index < 3) into the Pediatric Adenotonsillectomy Trial for Snoring were compared to children 5-9 years old recruited for obstructive sleep apnea (obstructive apnea-hypopnea 2-30) into the Childhood Adenotonsillectomy Trial. Baseline demographic, polysomnographic, and neurobehavioral outcomes were compared using univariable and multivariable analysis.
Results: The sample included 453 participants with obstructive sleep apnea (median obstructive apnea-hypopnea index 5.7) and 459 participants with mild sleep-disordered breathing (median obstructive apnea-hypopnea index 0.5). By polysomnography, participants with obstructive sleep apnea had poorer sleep efficiency and more arousals. Children with mild sleep-disordered breathing had more abnormal executive function scores (adjusted odds ratio 1.96, 95% CI 1.30-2.94) compared to children with obstructive sleep apnea. There were also elevated Conners scores for inattention (adjusted odds ratio 3.16, CI 1.98-5.02) and hyperactivity (adjusted odds ratio 2.82, CI 1.83-4.34) in children recruited for mild sleep-disordered breathing.
Conclusions: Abnormal executive function, inattention, and hyperactivity were more common in symptomatic children recruited into a trial for mild sleep-disordered breathing compared to children recruited into a trial for obstructive sleep apnea. Young, snoring children with only minimally elevated apnea-hypopnea levels may still be at risk for deficits in executive function and attention.
Trial registration: Pediatric Adenotonsillectomy for Snoring (PATS), NCT02562040; Childhood Adenotonsillectomy Trial (CHAT), NCT00560859.
Keywords: behavior; neurocognition; obstructive sleep apnea; pediatric; sleep-disordered breathing.
Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2022.
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Source: PubMed