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

Phoebe K. Yu; Jerilynn Radcliffe; H. Gerry Taylor; Raouf S. Amin; Cristina M. Baldassari; Thomas Boswick; Ronald D. Chervin; Lisa M. Elden; Susan L. Furth; Susan L. Garetz; Alisha George; Stacey L. Ishman; Erin M. Kirkham; Christopher Liu; Ron B. Mitchell; S. Kamal Naqvi; Carol L. Rosen; Kristie R. Ross; Jay R. Shah; Ignacio E. Tapia; Lisa R. Young; David A. Zopf; Rui Wang; Susan Redline

doi:10.1093/sleep/zsac035

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

Phoebe K. Yu, Jerilynn Radcliffe, H. Gerry Taylor, Raouf S. Amin, Cristina M. Baldassari, Thomas Boswick, Ronald D. Chervin, Lisa M. Elden, Susan L. Furth, Susan L. Garetz, Alisha George, Stacey L. Ishman, Erin M. Kirkham, Christopher Liu, Ron B. Mitchell, S. Kamal Naqvi, Carol L. Rosen, Kristie R. Ross, Jay R. Shah, Ignacio E. TapiaLisa R. Young, David A. Zopf, Rui Wang, Susan Redline

Research output: Contribution to journal › Article › peer-review

18 Scopus citations

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.

Original language	English (US)
Article number	zsac035
Journal	Sleep
Volume	45
Issue number	5
DOIs	https://doi.org/10.1093/sleep/zsac035
State	Published - May 1 2022

Keywords

behavior
neurocognition
obstructive sleep apnea
pediatric
sleep-disordered breathing

ASJC Scopus subject areas

General Medicine

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10.1093/sleep/zsac035

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Yu, P. K., Radcliffe, J., Gerry Taylor, H., Amin, R. S., Baldassari, C. M., Boswick, T., Chervin, R. D., Elden, L. M., Furth, S. L., Garetz, S. L., George, A., Ishman, S. L., Kirkham, E. M., Liu, C., Mitchell, R. B., Kamal Naqvi, S., Rosen, C. L., Ross, K. R., Shah, J. R., ... Redline, S. (2022). Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea. Sleep, 45(5), Article zsac035. https://doi.org/10.1093/sleep/zsac035

Yu, PK, Radcliffe, J, Gerry Taylor, H, Amin, RS, Baldassari, CM, Boswick, T, Chervin, RD, Elden, LM, Furth, SL, Garetz, SL, George, A, Ishman, SL, Kirkham, EM, Liu, C , Mitchell, RB , Kamal Naqvi, S, Rosen, CL, Ross, KR, Shah, JR, Tapia, IE, Young, LR, Zopf, DA, Wang, R & Redline, S 2022, 'Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea', Sleep, vol. 45, no. 5, zsac035. https://doi.org/10.1093/sleep/zsac035

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title = "Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea",

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.",

keywords = "behavior, neurocognition, obstructive sleep apnea, pediatric, sleep-disordered breathing",

author = "Yu, {Phoebe K.} and Jerilynn Radcliffe and {Gerry Taylor}, H. and Amin, {Raouf S.} and Baldassari, {Cristina M.} and Thomas Boswick and Chervin, {Ronald D.} and Elden, {Lisa M.} and Furth, {Susan L.} and Garetz, {Susan L.} and Alisha George and Ishman, {Stacey L.} and Kirkham, {Erin M.} and Christopher Liu and Mitchell, {Ron B.} and {Kamal Naqvi}, S. and Rosen, {Carol L.} and Ross, {Kristie R.} and Shah, {Jay R.} and Tapia, {Ignacio E.} and Young, {Lisa R.} and Zopf, {David A.} and Rui Wang and Susan Redline",

note = "Publisher Copyright: {\textcopyright} 2022 Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2022.",

year = "2022",

month = may,

day = "1",

doi = "10.1093/sleep/zsac035",

language = "English (US)",

volume = "45",

journal = "Sleep",

issn = "0161-8105",

publisher = "American Academy of Sleep Medicine",

number = "5",

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TY - JOUR

T1 - Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea

AU - Yu, Phoebe K.

AU - Radcliffe, Jerilynn

AU - Gerry Taylor, H.

AU - Amin, Raouf S.

AU - Baldassari, Cristina M.

AU - Boswick, Thomas

AU - Chervin, Ronald D.

AU - Elden, Lisa M.

AU - Furth, Susan L.

AU - Garetz, Susan L.

AU - George, Alisha

AU - Ishman, Stacey L.

AU - Kirkham, Erin M.

AU - Liu, Christopher

AU - Mitchell, Ron B.

AU - Kamal Naqvi, S.

AU - Rosen, Carol L.

AU - Ross, Kristie R.

AU - Shah, Jay R.

AU - Tapia, Ignacio E.

AU - Young, Lisa R.

AU - Zopf, David A.

AU - Wang, Rui

AU - Redline, Susan

PY - 2022/5/1

Y1 - 2022/5/1

N2 - 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.

AB - 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.

KW - behavior

KW - neurocognition

KW - obstructive sleep apnea

KW - pediatric

KW - sleep-disordered breathing

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JO - Sleep

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

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