Neurobehavioral function is impaired in children with all severities of sleep disordered breathing.
ABSTRACT Sleep disordered breathing (SDB) is common in children and ranges in severity from primary snoring (PS), to obstructive sleep apnea syndrome (OSAS). This study investigated everyday function (behavior, attention, executive skills) in children with varying degrees of SDB and control children with no history of SDB recruited from the community.
One hundred thirty-six children aged 7-12 were studied. Routine overnight polysomnography (PSG) classified children into 4 groups: PS (n=59), mild OSAS (n=24), moderate/severe OSAS (n=18), and controls (n=35). Behavioral function and behavioral aspects of attention and executive function were assessed using the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF).
Children with all severities of SDB had significantly higher rates of total, internalizing and externalizing behavioral problems compared to control children. Increased rates of behavioral executive dysfunction were also found across the SDB spectrum.
Our findings suggest that behavioral, attention, and executive function difficulties are present in children with PS as well as OSAS. These results have implications for the treatment of milder forms of SDB, particularly PS, which is commonly viewed as benign.
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ABSTRACT: This study examined the impact of traumatic brain injury (TBI) in young children on sleep problems and the relationship of sleep problems to neuropsychological and psychosocial functioning. Participants were drawn from an ongoing longitudinal study of injury in young children recruited from 3 to 6 years of age. They constituted three groups: orthopedic injury (n = 92), complicated mild/moderate TBI (n = 55), and severe TBI (n = 20). Caregivers completed the Children's Sleep Habits Questionnaire (CSHQ), as well as ratings of behavioral adjustment, adaptive functioning, and everyday executive function at 1, 6, 12, and 18 months post-injury. Retrospective ratings of pre-injury sleep and psychosocial functioning were obtained at the initial assessment. Children completed neuropsychological testing at all occasions. Children with complicated mild/moderate TBI demonstrated more total sleep problems than children with OI at 6 months post-injury, but not at 12 or 18 months. Children with severe TBI displayed more bedtime resistance and shorter sleep duration than those with complicated mild/moderate TBI or OI at several occasions. Across groups, total sleep problems predicted more emotional and behavioral problems and worse everyday executive function as rated by parents across follow-up occasions. In contrast, sleep problems were generally not related to neuropsychological test performance. The results suggest that young children with TBI demonstrate more sleep problems than children with injuries not involving the head. Sleep problems, in turn, significantly increase the risk of poor psychosocial outcomes across time, but are not associated with worse neuropsychological test performance. Keywords: Traumatic brain injury; sleep; preschool; cognitive ability; behavior.Journal of neurotrauma 03/2014; · 4.25 Impact Factor
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ABSTRACT: To compare symptoms of obstructive sleep apnea (OSA) and polysomnography (PSG) results in children with Down syndrome and typically developing children. A total of 49 children with Down syndrome referred for PSG between 2008 and 2012 were matched with typically developing children of the same sex, age, and OSA severity who had undergone PSG in the same year. A parent completed a sleep symptom questionnaire for each child. Sleep quality and measures of gas exchange were compared between the matched groups. The 98 children (46 females, 52 males) had mean age of 6.2 years (range, 0.3-16.9 years). Fourteen children had primary snoring, and 34 had OSA (9 mild, 7 moderate, and 19 severe). Children with Down syndrome had more severe OSA compared with 278 typically developing children referred in 2012. Symptom scores were not different between the matched groups. Those with Down syndrome had a higher average pCO2 during sleep (P = .03) and worse McGill oximetry scores. Compared with closely matched typically developing children with OSA of comparable severity, children with Down syndrome had a similar symptom profile and slightly worse gas exchange. Referred children with Down syndrome had more severe OSA than referred typically developing children, suggesting a relative reluctance by parents or doctors to investigate symptoms of OSA in children with Down syndrome. These findings highlight the need for formal screening tools for OSA in children with Down syndrome to improve detection of the condition in this high-risk group.The Journal of pediatrics 03/2014; · 4.02 Impact Factor
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ABSTRACT: Sleep disordered breathing (SDB) is common in children and describes a continuum of nocturnal respiratory disturbance from primary snoring (PS) to obstructive sleep apnoea (OSA). Historically, PS has been considered benign, however there is growing evidence that children with PS exhibit cognitive and behavioural deficits equivalent to children with OSA. There are two popular mechanistic theories linking SDB with daytime morbidity: hypoxic insult to the developing brain; and sleep disruption due to repeated arousals. These theories apply well to OSA, but children with PS experience neither hypoxia nor increased arousals when compared to non snoring controls. So what are we missing? This review summarises the literature examining daytime morbidity in children with PS and discusses the current debates surrounding this relationship. Specifically, questions exist as to the sensitivity of our standard assessment techniques to measure subtle hypoxia and arousal. There is also a suggestion that the association between PS and daytime morbidity may not be mediated by nocturnal respiratory disturbance at all, but by a number of other comorbid, but perhaps unrelated factors. As approximately 70% of children with SDB are diagnosed with PS, but are rarely treated, a paradigm shift in the investigation of PS may be required.Sleep Medicine Reviews 07/2014; · 8.68 Impact Factor