Behavioural and neurocognitive implications of snoring and obstructive sleep apnoea in children: facts and theory

doi:10.1053/prrv.2002.0177

Paediatric Respiratory Reviews

Volume 3, Issue 1, March 2002, Pages 3-9

https://doi.org/10.1053/prrv.2002.0177 Get rights and content

Abstract

The pathophysiology of obstructive sleep apnoea (OSA), a common condition in children, is poorly understood. While adenotonsillar hypertrophy is certainly a major contributor, other factors are needed for OSA to develop. OSA has been associated with substantial morbidities primarily affecting cardiovascular and neurobehavioural systems which may not be completely reversed with appropriate treatment. This paper reviews the available information and attempts to provide the rationale for early diagnosis and treatment of OSA in children.

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Cited by (86)

Obstructive sleep apnea in infancy: evaluation and management
2023, Snoring and Obstructive Sleep Apnea in Children
Obstructive sleep apnea (OSA) in infants is multifactorial and manifests differently than in older children and adults. Maturation of neural control and regulation of breathing in early infancy, along with the anatomy of craniofacial structures and soft tissues, can produce abnormal respiratory patterns that do not have the same adverse consequences as in other age groups. Polysomnographic criteria for the diagnosis of OSA in infants are not universally agreed upon, and controversy exists about making management decisions based on them. Endoscopic examination of the airway can provide clues to the areas of obstruction. Noninvasive medical management is the preferred therapy, with surgery generally reserved for craniofacial and soft tissue anomalies. A multidisciplinary approach with specialists from otolaryngology, pulmonology, neurology, and gastroenterology contributing to the evaluation and management of the infant can optimize outcomes.
Pediatric Obstructive Sleep Apnea: Update for the Primary Care Provider
2022, Pediatric Clinics of North America
Citation Excerpt :
Although it may be common to equate snoring with deep sleep, snoring is a sign of turbulent airflow causing the soft tissues to vibrate. However, even primary snoring, or snoring with the exclusion of OSA, has been associated with adverse neurocognitive consequences.14,15 Other nocturnal signs and symptoms to note are mouth breathing, gasping, choking, and observed pauses in breathing.
Cognitive and behavioral effects of obstructive sleep apnea syndrome in children: a systematic literature review
2018, Sleep Medicine
Citation Excerpt :
Another explanation for the effects of OSA on cognition and behavior is that OSA disrupts sleep, as meta-analytic studies show that shorter sleep time is associated with children's behavioral problems [20] and poor academic performance [21]. Nonsystematic reviews of the OSA pathophysiology literature also showed that children with the syndrome presented more agitation, aggressiveness, and hyperactivity, lower scores on cognitive and academic tests [22], as well as impaired attention, intelligence, memory, learning, and behavior problems [23]. Nenetheless, a systematic review of management of childhood OSA by Marcus et al. [3] noted a low level of evidence for relations between OSA and cognitive/behavioral problems, suggesting that previous studies in this field should be revised given their methodological limitations.
Obstructive sleep apnea syndrome (OSA) is a common respiratory sleep disorder in children that is believed to adversely affect both quality of life and cognition. The purpose of the present systematic review was to obtain evidence of the impact of OSA on children's cognitive/behavioral abilities from primary studies published in MEDLINE/PubMed, LILACS, SciELO, ISI Web of Science, and PsycINFO databases from 2002 to 2016. Of the 649 articles found, only 34 met the eligibility criteria: studies that evaluated cognition, behavior, and/or academic achievement of children meeting clinical criteria for OSA to compare their data to those of healthy controls or normative data, provided that the samples did not present conditions that might affect cognition/behavior irrespective of OSA. The few selected articles with low risk of bias (levels of evidence I and II) showed that OSA children's intellectual abilities may be impaired but remain within the normal range. Which specific cognitive ability drives this impairment is unclear, as there was insufficient evidence of deficits in language, memory, attention, executive functions, and academic performance, due to low levels of evidence, conflicting findings, and/or heterogeneity of tasks and cognitive abilities tapped by the measures used to assess these domains. To determine why this is so, future studies must test OSA patients using measures that allow for fractionated higher- and lower-order cognitive abilities based on accepted cognitive neuropsychology models.
Sleep spindle activity in children with obstructive sleep apnea as a marker of neurocognitive performance: A pilot study
2018, European Journal of Paediatric Neurology
To assess spindle activity as possible markers for neurocognitive consequences in children with mild obstructive sleep apnea.
Children aged 6–11 years diagnosed with mild OSA (i.e., an apnea hypopnea index <5.0) were recruited and compared with age and gender-matched healthy controls. Polysomnographic recordings were analyzed for sleep microstructure and spindle activity. All children completed also an intelligence test battery (i.e., the Wechsler intelligence test for children, 4th version).
Nineteen children with OSA (13 boys, mean age 7.1 ± 1.4 y), and 14 controls (7 boys, mean age 8.1 ± 1.9 y) were included. Mean IQ was 110 ± 12 for the complete sample, in children with OSA 111 ± 13, and in controls 108 ± 12 (p = 0.602). Controls showed a higher spindle index in N2 stage than children with OSA: 143.0 ± 42.5 vs 89.5 ± 56.9, respectively (p = 0.003). Spindle index in NREM was strongly and significantly correlated with Verbal Comprehension Index (VCI), Working Memory Index (WMI), Processing Speed Index (PSI), and total IQ in children with OSA.
Children with mild OSA demonstrate a different pattern of sleep spindle activity that seems to be linked with neurocognitive performance, especially concerning memory. Sleep spindle activity seems to be involved with mechanisms related with neurocognitive consequences in children with OSA.
Urine cysteinyl leukotriene levels in children with sleep disordered breathing before and after adenotonsillectomy
2017, International Journal of Pediatric Otorhinolaryngology
Obstructive sleep apnea (OSA) is a common problem in children and is associated with increased cardiovascular, neurobehavioral and somatic growth consequences. Cysteinyl leukotrienes (CysLTs) play a major role with local and systemic relations to the pathophysiology of OSA. The level of CysLTs in urine, blood, exhaled breath and adenotonsillar tissue of OSA children are increased. However it remains unclear whether inflammatory marker levels are alleviated after adenotonsillectomy. Therefore, we compare the urine leukotriene E4 (uLTE4) levels in children before and after adenotonsillectomy and evaluate clinical outcomes on resolution of OSA.
Children under 15 years who suspected OSA with planned adenotonsillectomy were recruited. Sleep questionnaires, quality of life assessment by OSA-18, physical examination, lateral neck radiographs, overnight SpO₂ monitoring and uLTE4 levels were collected. 4 ± 2 weeks post-surgery, OSA-18 was reevaluated and urine was collected again.
Thirty-three children with sleep disordered breathing (SDB) were included (mean age 8.1 ± 2.8 years). After adenotonsillectomy, the uLTE₄ levels decreased from 961.9 (684.8–1438.2) to 708.6 (538.2–1038.8) pg/mg Cr (P = 0.009). The post-surgery score from sleep questionnaire, OSA-18 questionnaire were significant improved (P < 0.001). Obese children demonstrated an improved quality of life post-surgery, but results were poorer than normal-weight children (P = 0.01). The uLTE4 no obvious improved in obese children.
Adenotonsillectomy remains an effective treatment for SDB children that not only alleviated the severity of SDB and improved quality of life; it also decreased levels of the systemic inflammatory marker, uLTE4. However, benefits were more obvious in non-obese children.
A school-aged boy with snoring and attention-deficit hyperactivity disorder
2017, Pediatric Sleep Pearls

View all citing articles on Scopus

^f1: Correspondence to: Dr David Gozal. Tel: +1 502 852 2323; Fax: +1 502 852 2215; E-mail: [email protected]

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Regular ArticleBehavioural and neurocognitive implications of snoring and obstructive sleep apnoea in children: facts and theory

Abstract

Chest

Resp Physiol

Lancet

J Pediatr

Neurosci Lett

J Pediatr

Neurosci Lett

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

A Manual of Diseases of the Throat and Nose, Including the Pharynx, Larynx, Trachea Oesophagus, Nasal Cavities, and Neck

Sleep apnea in eight children

Pediatrics

Am J Respir Crit Care Med

Snoring, sleep disturbance and behaviour in 4–5 year olds

Arch Dis Child

The epidemiology of sleep related breathing disorders in children

Int J Pediatr Otorhinolaryngol

Snoring in Portuguese primary school children

Pediatrics

Comparison of static mechanical properties of the passive pharynx between normal children and children with sleep-disordered breathing

Am J Respir Crit Care Med

Obstructive sleep apnea syndrome in children and adolescents

Semin Resp Crit Care Med

Adenotonsillectomy for treatment of obstructive sleep apnea in children

Arch Otolaryngol Head Neck Surg

The effect of adenotonsillectomy in children with obstructive sleep apnea syndrome on serum insulin like growth factor-I and growth

Am J Respir Crit Care Med

Total energy expenditure in children with obstructive sleep apnoea syndrome

Eur Respir J

Failure to thrive due to obstructive sleep apnea

Clin Pediatr

Obstructive apnea presenting as failure to thrive in infancy

J Paediatr Child Health

Effect of treating obstructive sleep apnea by tonsillectomy and/or adeniodectomy on obesity in children

Arch Pediatr Adolesc Med

Obstructed breathing in children during sleep monitored by echocardiography

Acta Paediatr

Echocardiographic changes in children with obstructive sleep apnea

Sleep

Effect of episodic eucapnic and hypocapnic hypoxia on systemic blood pressure in hypertension-prone rats

J Appl Physiol

Heart rate variability in children with obstructive sleep apnea

Sleep

Autonomic cardiovascular control in children with obstructive sleep apnea

Clin Auton Res

The pulse transit time as a measure of respiratory arousal in children with sleep-disordered breathing

Sleep

Blood pressure in children with obstructive sleep apnea

Am J Respir Crit Care Med

Behavioral and anatomical correlates of chronic episodic hypoxia during sleep in the rat

J Neurosci

Regular Article
Behavioural and neurocognitive implications of snoring and obstructive sleep apnoea in children: facts and theory