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.
- SourceAvailable from: Sarah N Biggs[show abstract] [hide abstract]
ABSTRACT: The aim of this study was to assess the construct validity and clinical application of the Pediatric Sleep Survey Instrument (PSSI) as a tool to screen for sleep disordered breathing (SDB) in children. Polysomnography (PSG) outcomes and PSSI subscale scores were compared between a clinical cohort (N = 87, 5-10 years, 62 M/25 F) and a nonsnoring community sample (N = 55, 5-10 years, 28 M/27 F). Group comparisons assessed the ability of the PSSI subscales to discriminate between the clinical and community cohorts. Receiver operating characteristic (ROC) curves assessed construct validity, with the Apnea/Hypopnea Index (AHI) >5 events/h, OSA-18 score >60, and Pediatric Daytime Sleepiness Scale (PDSS) above the 70th percentile as the target references. The clinical group had more respiratory events, respiratory-related arousals, fragmented sleep, and lower oxygen saturation nadir than the community group (p < 0.001 for all). PSSI subscale scores of Morning Tiredness, Night Arousals, SDB, and Restless Sleep were higher (p < 0.001 for all) in the clinical cohort, confirming the tool's ability to identify clinically relevant sleep problems. ROC curves confirmed the diagnostic accuracy of the SDB subscale against an AHI > 5 events/h (area under the curve (AUC) = 0.7), an OSA-18 score >60 (AUC = 0.7), and a PDSS score in the 70th percentile (AUC = 0.8). The Morning Tiredness subscale accurately predicted a PDSS score in the 70th percentile (AUC = 0.8). A cutoff score of 5 on the SDB subscale showed a sensitivity of 0.94 and a specificity of 0.76, correctly identifying 77 and 100 % of the clinical and community cohorts, respectively. The PSSI Sleep Disordered Breathing subscale is a valid tool for screening SDB and daytime sleepiness in children aged 5-10 years.Sleep And Breathing 09/2013; · 2.26 Impact Factor
- Children s Health Care 01/2012; 41(3):183-189. · 0.95 Impact Factor
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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; · 3.49 Impact Factor