Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea

Author:

Yu Phoebe K12,Radcliffe Jerilynn3,Gerry Taylor H4,Amin Raouf S5,Baldassari Cristina M6,Boswick Thomas6,Chervin Ronald D7,Elden Lisa M8,Furth Susan L9,Garetz Susan L10ORCID,George Alisha5,Ishman Stacey L1112,Kirkham Erin M10,Liu Christopher13,Mitchell Ron B1314,Kamal Naqvi S14,Rosen Carol L4ORCID,Ross Kristie R15,Shah Jay R16,Tapia Ignacio E9ORCID,Young Lisa R9,Zopf David A10,Wang Rui1ORCID,Redline Susan117

Affiliation:

1. Brigham and Women’s Hospital, Division of Sleep and Circadian Disorders, Boston, MA, USA

2. Massachusetts Eye and Ear Infirmary, Department of Otolaryngology, Boston, MA, USA

3. Division of Developmental and Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

4. Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, OH, USA

5. Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH, USA

6. Eastern Virginia Medical School, Department of Otolaryngology Head and Neck Surgery, Children’s Hospitals of The King’s Daughters Department of Pediatric Sleep Medicine, Norfolk, VA, USA

7. University of Michigan, Department of Neurology, Ann Arbor, MI, USA

8. Children’s Hospital of Philadelphia, Division of Otolaryngology, Philadelphia, PA, USA

9. Children’s Hospital of Philadelphia, Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Philadelphia, PA, USA

10. University of Michigan, Department of Otolaryngology – Head and Neck Surgery, Ann Arbor, MI, USA

11. University of Cincinnati College of Medicine, Department of Otolaryngology – Head and Neck Surgery, Cincinnati, OH, USA

12. Cincinnati Children’s Hospital Medical Center, Division of Otolaryngology – Head & Neck Surgery, Cincinnati, OH, USA

13. University of Texas Southwestern, Department of Otolaryngology, Dallas, TX, USA

14. University of Texas Southwestern, Department of Pediatrics, Dallas, TX, USA

15. University Hospitals Rainbow Babies & Children’s Hospital, Department of Pediatrics, Cleveland, OH, USA

16. University Hospitals Rainbow Babies & Children’s Hospital, Department of Otolaryngology, Cleveland, OH, USA

17. Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, USA

Abstract

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

Funder

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Neurology (clinical)

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