Abstract
This study aimed to determine the long term effects of resolution of SDB in preschool children, either following treatment or spontaneous recovery, on cognition and behavior. Children diagnosed with SDB at 3-5y (N = 35) and non-snoring controls (N = 25), underwent repeat polysomnography (PSG) and cognitive and behavioral assessment 3 years following a baseline study. At follow-up, children with SDB were grouped into Resolved and Unresolved. Resolution was defined as: obstructive apnea hypopnea index (OAHI) ≤1 event/h; no snoring detected on PSG; and no parental report of habitual snoring. 57% (20/35) of children with SDB received treatment, with SDB resolving in 60% (12/20). 43% (15/35) were untreated, of whom 40% (6/15) had spontaneous resolution of SDB. Cognitive reduced between baseline and follow-up, however this was not related to persistent disease, with no difference in cognitive outcomes between Resolved, Unresolved or Control groups. Behavioral functioning remained significantly worse in children originally diagnosed with SDB compared to control children, regardless of resolution. Change in OAHI did not predict cognitive or behavioral outcomes, however a reduction in nocturnal arousals, irrespective of full resolution, was associated with improvement in attention and aggressive behavior. These results suggest that resolution of SDB in preschool children has little effect on cognitive or behavioral outcomes over the long term. The association between sleep fragmentation and behavior appears independent of SDB, however may be moderated by concomitant SDB. This challenges the assumption that treatment of SDB will ameliorate associated cognitive and behavioural deficits and supports the possibility of a SDB phenotype.
Highlights
Sleep disordered breathing (SDB) affects 12–15% of children [1], with the peak prevalence occurring during the preschool years [2,3]
Of the 191 children who participated in the baseline study, 36 could not be contacted, 76 declined further participation, two controls were ineligible as they were diagnosed with a behavioral disorder following the baseline study, and a further two controls were unable to undertake sleep studies in the available time period
Accident (7%); parent was unhappy with the clinical process at baseline (7%); or the family had moved outside the metropolitan area (7%)
Summary
Sleep disordered breathing (SDB) affects 12–15% of children [1], with the peak prevalence occurring during the preschool years (ages 3–5 y) [2,3]. The association between SDB and cognitive and behavioral dysfunction in school-aged children is well established [4]. Less is known about the impact of SDB in younger children. The few studies that have used the gold standard of overnight polysomnography (PSG) to confirm OSA in preschool children, have reported that affected children had significant behavioral deficits [5,6]. The indication that preschool children with SDB present with normal cognitive development yet older children do not leads to a hypothesis that early treatment may ameliorate cognitive deficits developing in later childhood as a result of persistent disease
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
