Sleep disordered breathing and neurobehavioral deficits in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Sleep disordered breathing (SDB) is broadly recognized to be associated with neurobehavioral deficits, which have significant impacts on developing-aged children and adolescents. Therefore, our study aimed to quantify the proportion of neurobehavioral impairments attributed to SDB in general children and adolescents by population attributable fraction (PAF).

METHODS

The study was registered at PROSPERO (ID: CRD42023388143). We collected two types of literature on the prevalence of SDB and the risk of SDB-related neurobehavioral deficits from ten electronic databases and registers, respectively. The pooled effect sizes (Pe, Pc, RR) by random-effects meta-analysis were separately substituted into Levin's formula and Miettinen's formula to calculate PAFs.

RESULTS

Three prevalence literature and 2 risk literature, all with moderate/high quality, were included in the quantitative analysis individually. The prevalence of SDB was 11% (95%CI 2%-20%) in children and adolescents (Pe), while the SDB prevalence was 25% (95%CI 7%-42%) in neurobehavioral patients (Pc). SDB diagnosis at baseline was probably associated with about threefold subsequent incidence of neurobehavioral deficits (pooled RR 3.24, 95%CI 1.25-8.41), after multi-adjustment for key confounders. Up to 19.8% or 17.3% of neurobehavioral consequences may be attributed to SDB from Levin's formula and Miettinen's formula, respectively.

CONCLUSIONS

A certain number of neurobehavioral consequences may be attributable to SDB. It is essential for clinicians to identify and treat SDB timely, as well as screen for SDB in patients with neurobehavioral impairments. More longitudinal studies of SDB and neurobehavioral deficits are needed in the future to further certify the association between them.

Impact of Adenotonsillectomy on Homework Performance in Children With Obstructive Sleep-Disordered Breathing

OBJECTIVE

As a first line treatment for pediatric obstructive sleep-disordered breathing (SDB), adenotonsillectomy (AT) has been shown to confer physiologic and neurocognitive benefits to a child. However, there is a scarcity of data on how homework performance is affected postoperatively. Our objective was to evaluate the impact of AT on homework performance in children with SDB.

METHODS

Children in grades 1 to 8 undergoing AT for SDB based on clinical criteria with or without preoperative polysomnography along with a control group of children undergoing surgery unrelated to the treatment of SDB were recruited. The primary outcome of interest was the differential change in homework performance between the study group and control at follow-up as measured by the validated Homework Performance Questionnaire (HPQ-P). Adjustments were made for demographics and Pediatric Sleep Questionnaire (PSQ) scores.

RESULTS

116 AT and 47 control subjects were recruited, and follow-up data was obtained in 99 AT and 35 control subjects. There were no significant differences between the general (total) HPQ-P scores and subscale scores between the AT and control subjects at entry and there were no significant differences in the change scores (follow-up minus initial scores) between the groups. Regression modeling also demonstrated that there were no group (AT vs control) by time interactions that predicted differential improvements in the HPQ-P (P > .10 for each model) although initial PSQ score was a significant predictor of lower HPQ-P scores for all models.

CONCLUSIONS

Children with SDB experienced improvement in HPQ-P scores postoperatively, but the degree of change was not significant when compared to controls. Further studies incorporating additional educational metrics are encouraged to assess the true scholastic impact of AT in children with SDB.

Long-term health and socioeconomic outcome of obstructive sleep apnea in children and adolescents

BACKGROUND

There is limited information about the long-term outcome of obstructive sleep apnea (OSA) diagnosed in children and adolescents for educational and social factors. Here, we estimate the long-term socioeconomic outcome and health care costs of OSA.

METHODS

The historical case-control cohort study included Danish individuals with OSA diagnosed in childhood or adolescence between 1994 and 2015. Health care costs and socioeconomic data were obtained from nationwide administrative and health registers. A total of 5419 were diagnosed during this period; of these we traced 1004 patients who we compared with 4085 controls (mean index age, 10.2 years; Standard Deviation (SD), 5.6 years) until the age of 20 years. Controls were matched for age, gender, and residency.

RESULTS

Comparing the OSA patient and control groups at age 20 years we found: 1) lower parental educational level; 2) significantly lower educational level also after adjustment for parental educational level; 3) lower school grade-point averages; 4) lower employment rate and lower income, which was not fully compensated when transfer payments were considered; and 5) patients' initial health care costs were higher due to higher morbidity. Patients showed higher mortality rates than controls (Hazard Ratio (HR) = 7.63, 95% CI = 4.87-11.95, P < 0.001).

CONCLUSIONS

OSA in children and adolescent is associated with a significant influence on morbidity, mortality, educational level, grading, social outcome, and welfare consequences.

The Effect of Sleep Quality on Students' Academic Achievement

BACKGROUND

Sleep is an inseparable part of human health and life, which is crucial in learning, practice, as well as physical and mental health. It affects the capacity of individual learning, academic performance, and neural-behavioral functions. This study aimed to determine the relationship between sleep quality and students' academic achievement among students at Kermanshah University of Medical Sciences.

METHODS

In this cross-sectional study, 102 medical students from different fields, with maximum variation sampling, completed Pittsburgh Sleep Quality Index (PSQI). For data analysis, SPSS 19 was used through which Pearson correlation test, Spearman test, and t-test were employed.

RESULTS

Based on the quality of sleep questionnaire scores, the results indicated no significant difference between students with high grades and those with low grades. However, there were moderate and sometimes severe sleep disturbances in both groups.

CONCLUSION

The results showed no significant difference between sleep quality and academic achievement. Nevertheless, longitudinal study should be performed to control for confounding factors.

Sleep disordered breathing symptoms and daytime sleepiness are associated with emotional problems and poor school performance in children

This study examined the prevalence of sleep disordered breathing (SDB) symptoms and their associations with daytime sleepiness, emotional problems, and school performance in Chinese children. Participants included 3979 children (10.99±0.99 years old) from four elementary schools in Jintan City, Jiangsu Province, China. Children completed a self-administered questionnaire on sleep behavior and emotional problems, while parents completed the Child Sleep Habit Questionnaire (CSHQ). SDB symptoms included 3 items: loud snoring, stopped breathing, and snorting/gasping during sleep. Teachers rated the children's school performance. The prevalence rates of parent- and self-reported SDB symptoms were 17.2% and 10.1% for "sometimes" and 8.9% and 5.6% for "usually". SDB symptoms, more prevalent in boys than in girls, increased the risks for depression, loneliness, and poor school performance. Daytime sleepiness mediated the relationship between SDB symptoms and depression, loneliness, and poor school performance. This study suggests the importance of early screening and intervention of SDB and daytime sleepiness in child behavioral and cognitive development.

Sleep Disordered Breathing and Academic Performance: A Meta-analysis

BACKGROUND AND OBJECTIVE

Sleep-disordered breathing (SDB) in children is associated with daytime functioning decrements in cognitive performance and behavioral regulation. Studies addressing academic achievement are underrepresented. This study aimed to evaluate the strength of the relationships between SDB and achievement in core domains and general school performance.

METHODS

Data sources included PubMed, Web of Science, CINAHL, and PsycINFO. Studies of school-aged children investigating the relationships between SDB and academic achievement were selected for inclusion in a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extracted were converted into standardized mean differences; effect sizes (ES) and statistics were calculated by using random-effects models. Heterogeneity tests (I(2)) were conducted.

RESULTS

Of 488 studies, 16 met eligibility criteria. SDB was significantly associated with poorer academic performance for core academic domains related to language arts (ES -0.31; P < .001; I(2) = 74%), math (ES -0.33; P < .001; I(2) = 55%), and science (ES -0.29; P = .001; I(2) = 0%), and with unsatisfactory progress/learning problems (ES -0.23; P < .001; I(2) = 0%) but not general school performance.

CONCLUSIONS

Variable definitions of both academic performance and SDB likely contributed to the heterogeneity among published investigations. Clear links between SDB and poorer academic performance in school-age children are demonstrated. ES statistics were in the small to medium range, but nevertheless the findings serve to highlight to parents, teachers, and clinicians that SDB in children may contribute to academic difficulties some children face.

Psychiatric disorders and symptoms severity in patients with adenotonsillar hypertrophy before and after adenotonsillectomy

OBJECTIVE

The objective of this study was to compare the frequency of psychiatric disorders and the severity of psychiatric symptoms in patients with adenotonsillar hypertrophy with a healthy control group and investigate the potential improvement after adenotonsillectomy.

MATERIALS AND METHODS

The study group consisted of 40 patients with adenotonsillar hypertrophy and a control group consisted of 35 healthy volunteers without adenotonsillar hypertrophy. A routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry were carried out. The same procedures were applied to the control group. The parents of all the participants were required to fill out the Early Childhood Inventory-4 form, the Strengths and Difficulties Questionnaire and a personal information form. At postoperative month six, the patients were re-examined, and their parents were required to fill out the same forms.

RESULTS

Attention deficit hyperactivity disorders and sleep disorders determined with the Early Childhood Inventory-4 were more common in the patients with adenotonsillar hypertrophy than in the control group. There was a significant decrease in the rates of both types of disorders at postoperative month six. The total psychiatric symptom severity was higher in the patients with adenotonsillar hypertrophy and the following were more frequent: cases of attention deficit hyperactivity disorder, oppositional defiant disorder, symptom severity of anxiety disorders and sleep disorders determined with the Early Childhood Inventory-4, as well as emotional problems, attention deficit hyperactivity disorder problems, behavioural problems and peer problems determined with the Strengths and Difficulties Questionnaire parent-report form. There was a statistically significant decrease in all the other symptoms at postoperative month six, except for the severity of oppositional defiant disorder symptoms determined with the Early Childhood Inventory-4 and behavioural problems determined with the Strengths and Difficulties Questionnaire parent-report form. There were no differences in the severity of psychiatric disorders or symptoms between the adenotonsillar hypertrophy group and the control group at postoperative month six.

CONCLUSION

Adenotonsillar hypertrophy is associated with psychiatric disorders and symptoms. Adenotonsillectomy ameliorated the symptoms and the severity of these disorders in most cases.

The prevelance of psichiatric symptoms in preschool children with adenotonsillar hypertrophy

OBJECTIVES

The aim of this study was to determine the prevalence of psychiatric disorders and symptoms in preschool-age children who are indicated for operation due to adenotonsillar hypertrophy.

MATERIALS AND METHODS

Forty-eight patients between the ages of three and five years with indication for adenotonsillectomy were included in the study, as well as 40 control patients. Cases underwent routine ear nose throat (ENT) examination, flexible nasopharyngoscopy and tympanometry. The Early Childhood Inventory-4 (ECI-4) parent form and Strengths and Difficulties Questionnaire (SDQ) parent form were completed by the parent caring for the child. The SPSS for Windows 16.0 program was used for statistical analysis.

RESULTS

Groups were compared according to they received at least one psychiatric diagnosis measured by ECI-4, the group of adenotonsillar hypertrophy was diagnosed more than the control group. Attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and sleep disorders were detected at a higher rate in patients with adenotonsillar hypertrophy. It also was established that in the comparison of the severity of psychiatric symptoms determined by ECI-4, symptom severity of ADHD, ODD, anxiety disorders, and sleep disorders was higher in the adenotonsillar hypertrophy group than in the control group. In the evaluation of the SDQ parent form, it was determined that attention deficit, hyperactivity, behavioral, and peer relations problems occurred more frequently in the adenotonsillar hypertrophy group.

CONCLUSIONS

In addition to oral respiration, snoring, and disordered breathing during sleep, adenotonsillar hypertrophy may also associated with psychiatric disorders and symptoms.

Effects of sleep-disordered breathing on physical traits, school performance, and behavior of Korean elementary school students in the upper grade levels

OBJECTIVES

We investigated the physical traits, school performance, and behavior of Korean children with sleep-disordered breathing (SDB).

METHODS

We recruited 679 students from an elementary school in Seoul, Korea. We used a survey to collect information on the absence or presence of SDB at both the child's preschool age and his or her current age and on the degree of behavioral disturbance. Physical traits and examination scores were also analyzed. We divided the children into 4 groups: non-SDB group, past SDB group, recent SDB group, and continuous SDB group. Comparisons between these four groups were conducted.

RESULTS

Sixty-one students were excluded because of incomplete information. The current body mass index was significantly higher in the past (19.7 +/- 3.6), recent (21.2 +/- 3.6), and continuous SDB groups (20.7 +/- 3.9) than in the non-SDB group (18.8 +/- 3.2), but only for male students (p < 0.001). The examination scores were not different among the four groups, but the behavioral disturbance scores were much higher in the past, recent, and continuous SDB groups than in the non-SDB group for both genders.

CONCLUSIONS

Among these Korean elementary school students in the upper grade levels, the presence of current or past SDB appeared to influence the current body mass index in boys and the presence of behavioral disturbances in both genders. However, SDB was not associated with school performance.