Behavioral and cognitive correlates of sleep-disordered breathing in a community sample of school children

Abstract

Sleep disordered breathing has been related to problems with memory, attention, executive function and mood disturbance in adults. Similar cognitive as well as behavioral deficits have been hypothesized as daytime consequences of SDB in children. The cognitive and behavioral manifestation of SDB in children may appear similar to ADHD with decrements in attention and increased behavioral impulsivity and hyperactivity. SDB is ideally measured using some combination of reduced airflow, hypoxemia, and sleep fragmentation from overnight polysomnography, although some researchers have used parent report to create research samples. Currently, few pediatric studies exist that examine behavior and cognition in the presence of overnight polysomnographic data. The present study was derived from the Tucson Children's Assessment of Sleep Apnea (TuCASA) which was broadly designed to determine the prevalence of SDB and it's correlates in normal school children ages 6-12. The present analyses were designed to relate SDB as a whole as well as its components to sustained attention and behavior in that population. In addition, the relationship between sleepiness and hyperactivity was examined, as these are two seemingly incongruent manifestations of SDB. Measures of attention and behavior included the Test of Everyday Attention for Children (TEACh), the PVT-192, and the Conners' Parent Rating Scales-Revised. Results indicated that for children with elevated respiratory disturbance indexes (RDI), problems of attention and behavior did not reach clinically relevant levels. However, children were much more likely to show significantly higher levels of a variety of behavioral problems given an elevated RDI. In general linear models, the interaction of two components of SDB predicted performance on two measures of sustained attention, and predicted parent rated levels of Psychosomatic Complaints and Perfectionism. Sleepiness and hyperactivity were not related to each other. Behavioral manifestations of SDB tended to vary with age. Older children showed increased behavior problems at the highest levels of SDB while younger children showed decreased behavior problems. Overall, these results indicate that even in healthy children variation in sleep related breathing may be related to daytime cognition function and behavioral regulation.