Original Article
Sleep-disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children

https://doi.org/10.1016/j.jpeds.2004.05.039Get rights and content

Abstract

Objective

To assess the relation of sleep-disordered breathing (SDB) symptoms in children to neurocognitive function.

Study design

A cross-sectional, population-based study of 205 5-year-old children. A parent-completed questionnaire was used to ascertain SDB symptoms, defined as frequent snoring, loud or noisy breathing during sleep, or witnessed sleep apnea. Polysomnography (PSG) data were available in 85% of children. Standardized neurocognitive tests were administered by a trained psychometrist unaware of the children's SDB status. Children with (n = 61) and without SDB symptoms were compared using analysis of variance to adjust for demographic and respiratory health variables.

Results

Children with SDB symptoms scored significantly lower than those without SDB symptoms on tests of executive function (95.5 vs 99.9 on NEPSY Attention/Executive Core Domain, P = .02; 10.4 vs 11.2 on Wechsler Preschool and Primary Scale of Intelligence, Revised [WPPSI-R] Animal Pegs test, P = .03), memory (96.8 vs 103.0 on NEPSY Memory Domain, P = .02), and general intellectual ability (105.9 vs 111.7 on WPPSI-R Full Scale IQ, P = .02). There were no significant differences on a computerized continuous performance task. These findings persisted when children with PSG evidence of obstructive sleep apnea (OSA) were excluded from analysis.

Conclusion

Even in the absence of OSA, SDB symptoms are associated with poorer executive function and memory skills and lower general intelligence in 5-year-old children.

Section snippets

Subjects

This study was approved by the Institutional Review Boards of Boston University School of Medicine and Rush University. All children had been previously enrolled in the Infant Care Practices Study (ICPS).21 Briefly, the ICPS is a multicenter, prospective longitudinal study conducted in Massachusetts and Ohio, the principal aim of which was to describe newborn sleep practices and to document changes in infant sleep position over time. Between February 1995 and December 1998, mothers of newborn

Results

Between March 1, 2000 and May 3, 2002, 5-year follow-up was initiated approximately 2 months before the child's fifth birthday for 5811 children enrolled in the ICPS. At the time of this analysis, 3533 questionnaires (61%) had been completed and 219 children had been seen for neurocognitive assessment. Two children with low IQ scores, 5 who were unable to complete the assessment because of extreme shyness or anxiety, and 7 with incomplete data on SDB status were excluded. The remaining 205

Discussion

The present study finds that in a community sample of 5-year-old children, parent-reported symptoms of SDB are associated with impaired behavioral control and with significantly poorer performance on a broad range of neurocognitive tests, including standardized, age-appropriate tests of executive function, memory, and general intellectual ability, after adjustment for potentially confounding sociodemographic and respiratory health variables. Although not statistically significant for the CPT,

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    Supported by National Heart, Lung and Blood Institute grant HL62371 and by the General Clinical Research Center at Boston University Medical Center (National Center for Research Resources grant RR00533). The Infant Care Practices Study was supported by funds from the National Institute of Child Health and Human Development and the National Institute on Deafness and Other Communicative Disorders under contract HD43221.

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