Measuring attention deficit with dass test in children with obstructive sleep apnea

Abstract

Objective : To investigate the relationship between attention deficit and obstructive sleep apnea (OSA). We hypothesized that the severity of obstructive sleep apnea (OSA) correlates positively with negative DASS (Divided Attention Steering Simulation) test scores, which is a measure of attention ability. Methods: DASS tests were administered to 16 children with OSA symptoms and 16 children symptom free. Both groups were similar in age, gender, and body mass index (BMI). Polysomnography testing was given to both groups. OSA measures were: apnea hypopnea index (AHI), mean oxygen desaturation (SpO 2 ), lowest mean SpO 2 . Attention deficit measures were DASS test scores: mean response time, off-road events per hours, failed responses. Results: 18 boys and 14 girls participated in the study. The mean age of the study group and control group was 10.3 years, the mean BMI was 20.1 for the study group and 19.9 for controls. For the OSA symptom group: AHI was 2.2 (95% CI 1.9–2.5), mean lowest SpO2 and lowest SpO 2 were 97.4% and 90.6 % (95% CI 89.5–91.7); for the DASS testing the average response time was 2.2 s, off road events per hour 75.6, failed responses 13.2. For the control group: AHI was 0.8 (95% CI 0.6–1.0); mean lowest SpO 2 and lowest SpO 2 were 98.0% and 96.4% (95% CI 96.0–96.9); for the DASS testing the average response time was 1.4 s, off-road events per hour 10.1; failed responses 1.9. AHI value increase per 1 unit produced the increase of average response time of 0.44 units ( p < .0001). The increase in AHI value was significantly related also to the number of off-road events ( p < .0014) and to failed responses ( p < .0001). Decrease in lowest mean SpO 2 leads to increase in average reaction time ( p < .0002; p < .0001). There was also an increase in off road events when AHI was higher ( p = .0014), also decrease in lowest mean SpO 2 resulted in higher number of off-road events ( p < .0074). Higher AHI with lower mean SpO 2 and mean lower SpO 2 led to more failed responses during the DASS test ( p < .0001; p < .0005; p < .0001). Conclusion: The severity of sleep disordered breathing is related to worse outcomes of DASS testing in case of OSA. DASS test can be used as a diagnostic instrument to measure OSA-related attention deficit problems in children. The authors would like to thank all the participants in this study as well as Pille Kool for her work regarding analyzing the data and our dedicated Sleep Laboratory personnel of Tartu University Ear Clinic.