Neurobehavioral function is impaired in children with all severities of sleep disordered breathing

Critical Care and Neuroscience Research, Murdoch Children's Research Institute, Melbourne, Australia.
Sleep Medicine (Impact Factor: 3.1). 02/2011; 12(3):222-9. DOI: 10.1016/j.sleep.2010.08.011
Source: PubMed

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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    • "Bourke 2011 [23] "
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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; 18(6). DOI:10.1016/j.smrv.2014.06.009 · 9.14 Impact Factor
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    • "There are over 400 peer-reviewed publications supporting the reliability, validity, and clinical utility of the BRIEF. Furthermore, it has been translated into over 50 languages and dialects and is used on six continents (e.g., Bourke et al., 2011; Egeland & Fallmyr, 2010; Roy et al., 2009). "
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    ABSTRACT: The Behavior Rating Inventory of Executive Function (BRIEF) is a rating scale designed to assess executive functions in everyday life that is widely used in school and clinical settings and in research studies. It has been recently suggested, however, that the limited geographic stratification of the standardization sample renders the measure overly sensitive. We evaluated this hypothesis by examining BRIEF scores across studies of typically developing children and adolescents. Thirty-nine studies were identified that included at least one of three possible index scores. Mean scores across studies were (a) within one to two T-score units from the standardization sample mean of 50, (b) tended to be slightly lower than 50, and (c) were unrelated to geographic location (US Census regions or internationally). These findings refute recent claims that the BRIEF is overly sensitive and further add to the large body of literature supporting the validity of the measure.
    Child Neuropsychology 03/2014; 21(2). DOI:10.1080/09297049.2014.897318 · 2.18 Impact Factor
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    • "In addition, 36 control subjects with no history or parental concerns of snoring were recruited from the community . The effects of SDB on overnight BP [6], heart rate variability [22], sleep quality [23] [24], behavior and neurocognition [25] [26], and cardiovascular variability during periodic leg movements in sleep [27] have been previously published from this cohort. All subjects were otherwise healthy apart from 22 children diagnosed with asthma, who were not on long-acting bronchodilators and did not use short-acting bronchodilators within 24 h of the study. "
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    ABSTRACT: BACKGROUND: Obstructive sleep apnea (OSA) in adults has been associated with hypertension, low baroreflex sensitivity (BRS), a delayed heart rate response to changing blood pressure (heart period delay [HPD]), and increased blood pressure variability (BPV). Poor BRS may contribute to hypertension by impairing the control of blood pressure (BP), with increased BPV and HPD. Although children with OSA have elevated BP, there are scant data on BRS, BPV, or HPD in this group. METHODS: 105 children ages 7-12years referred for assessment of OSA and 36 nonsnoring controls were studied. Overnight polysomnography (PSG) was performed with continuous BP monitoring. Subjects were assigned to groups according to their obstructive apnea-hypopnea index (OAHI): primary snoring (PS) (OAHI ⩽1event/h), mild OSA (OAHI>1-⩽5events/h) and moderate/severe (MS) OSA (OAHI>5events/h). BRS and HPD were calculated using cross spectral analysis and BPV using power spectral analysis. RESULTS: Subjects with OSA had significantly lower BRS (p<.05 for both) and a longer HPD (PS and MS OSA, p<.01; mild OSA, p<.05) response to spontaneous BP changes compared with controls. In all frequencies of BPV, the MS group had higher power compared with the control and PS groups (low frequency [LF], p<.05; high frequency [HF], p<.001). CONCLUSIONS: Our study demonstrates reduced BRS, longer HPD, and increased BPV in subjects with OSA compared to controls. This finding suggests that children with OSA have altered baroreflex function. Longitudinal studies are required to ascertain if this dampening of the normal baroreflex response can be reversed with treatment.
    Sleep Medicine 06/2013; 14(9). DOI:10.1016/j.sleep.2013.01.015 · 3.10 Impact Factor
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