Neurocognition and Academic Achievement in School-Aged Children with Obstructive Sleep Apnea and Depressive Symptoms

Abstract

The current study investigated the relationship between obstructive sleep apnea (OSA) and depressive symptoms on neuropsychological functioning and academic achievement in a sample of ethnically diverse school-aged children in the Southwest United States. A total of 38 participants aged 6 - 12 were studied as part of an ongoing randomized clinical trial (SleepCATS) investigating the neurocognitive impact of continuous positive airway pressure therapy (CPAP) on neurobehavioral outcomes. Children were identified as having primary snoring, mild OSA, or Moderate-Severe OSA based on in-lab nocturnal polysomnography and were assessed for depressive symptoms using the parent report of the Child Behavior Checklist (CBCL). Neuropsychological testing was conducted using the Cambridge Automated Neuropsychological Test Battery (CANTAB) to assess executive functioning, working memory, and motor control. The Grooved Pegboard Test (GPT) was used to assess fine motor speed and dexterity and academic achievement was assessed on the Woodcock-Johnson Test of Academic Achievement Third Edition (WJ-ACH III). The study identified 39% of the sample as having clinical depressive symptoms and mean depressive symptoms for the sample was nearly one standard deviation above the norms. Multivariate analysis of covariance models (MANCOVA) were used to determine differences in neuropsychological test performance by neurocognitive constructs. Results from the study found significant main effects for OSA severity on the CANTAB Spatial Span Test and a significant interaction of off clinical depressive symptoms and OSA severity on the Applied Problems test of the WJ ACH III. When groups were compared between children with primary snoring and OSA (Mild and Moderate-Severe combined) there were no longer significant effects for academic achievement or working memory, however, there was a significant main effect for motor control on the CANTAB with children with OSA exhibiting lower performance compared to those with primary snoring. The results from this study suggest children with moderate-severe OSA may exhibit increased difficulties in working memory and fine-motor control, and also have increased difficulties with academic math achievement when children with moderate-severe OSA also have depressive symptoms. These findings suggest children with higher severities of OSA may experience increased learning and academic challenges, which may be further exacerbated when accompanied by depression.