The relationship between sleep-disordered breathing and neurocognitive problems in children : objective and subjective measures of snoring

The literature on the relationship between sleep disordered breathing (SDB), neurocognitive performance and behavioral problems in children shows mixed findings, possibly due to differences in diagnostic techniques, cut-off criteria and a lack of objective measures of snoring. This study looked at the relationship between SDB and neurocognitive function in children, comparing results from a parent-reported questionnaire and objective measures using polysomnography (PSG), with audio for objective snoring and obstructive sleep apnea (OSA) defined as an apnea-hypopnea index (AHI) ≥ 1. Participants were 110 children (35% girls) aged 10-13 years old, 55 that snored or had apneas according to parents, matched to 55 children with no history of SDB. The results showed that children with reported snoring, had lower scores on the Wechsler Intelligence Scale for Children (WISC-IV), indices of Perceptual Reasoning and Processing Speed than controls. Children with objective snoring had more omission errors and lower d‘ on measures of Conners‘ Continuous Performance Test (CPT) and children with OSA had lower scores on Processing Speed index than the control group. Therefore, objective measures showed that OSA was associated with poor processing speed while snoring was associated with missing more targets and being less sensitive to the difference between targets and non-targets on CPT, which are common symptoms of attention deficit hyperactivity disorder (ADHD) inattentive type. The results show a clear relationship between SDB and cognitive performance where both AHI and snoring (≥ 2%) predict worse cognitive performance. The linear relationship between AHI and snoring to outcome variables is similarly strong