The Impact of Sleep-Disordered Breathing on Cognition and Behavior in Children: A Review and Meta-Synthesis of the Literature

Abstract

OBJECTIVES: The goal of this review is to provide a synthesis of the current literature addressing the effects of sleep-disordered breathing on cognition and behavior in children aged 2–18. STUDY DESIGN AND SETTING: A computerized search was performed to include studies between 1966 and 2001. Studies were assessed based on research question, sampling, intervention, outcomes, confounding, and statistical methods. Sensitivity analyses were performed for quantitative assessments of selection bias, misclassification, and confounding. RESULTS: Seventeen reports with 5312 patients were reviewed. The majority of these studies demonstrated poor sampling, insufficient consideration of confounders, and imprecise use of statistical tools. However, there was little evidence of bias in two studies when scrutinized using a sensitivity analysis. CONCLUSIONS: Despite suggested links between daytime behavior problems and neurocognitive deficits, there is little certainty for causality based on the quality of the evidence. SIGNIFICANCE: By discussing the quality of the current evidence, we hope to improve study design and contribute to the development of an understanding of this complex topic.