Neuropsychologic correlates in pediatric sleep apnea

Elise K Hodges PhD (Dr. Hodges of the University of Michigan received fees from Psychological Assessment Resources, Inc as a consultant.)
Lisa A Harker PsyD (Dr. Harker of the University of Michigan has no relevant financial relationships to disclose.)
Kimberly P Heinrich PhD (Dr. Heinrich of the University of Michigan has no relevant financial relationships to disclose.)
Bruno Giordani PhD (Dr. Giordani of the University of Michigan has no relevant financial relationships to disclose.)
Antonio Culebras MD, editor. (

Dr. Culebras of SUNY Upstate Medical University at Syracuse received an honorarium from Jazz Pharmaceuticals for a speaking engagement.

Originally released January 16, 2012; expires January 16, 2015
Notice: This article has expired and is therefore not available for CME credit.


The association between obstructive sleep apnea (OSA) and neuropsychological functioning has been documented in adults, and although studies show a similar association in children, the findings across studies have been mixed. Previous investigations have shown that children with OSA demonstrate poorer performance on neuropsychological measures of intellectual functioning, attention, executive functioning, visual spatial abilities, and memory in comparison to children without OSA. However, the evidence of a causal role of OSA in the development of these neuropsychological inefficiencies has yet to be identified, and research into possible mechanisms is ongoing.

Key points


• Pediatric obstructive sleep apnea (OSA) is typically associated with adenotonsillar hypertrophy.


• Neuropsychological investigations of the impact of OSA in children have been mixed.


• The relationship between OSA and cognitive or behavioral disturbance is complex and without clear predictive findings.


• The most common treatment for children with OSA is adenotonsillectomy.


• In those cases in which OSA is not successfully treated by adenotonsillectomy, other treatment options, such as continuous positive airway pressure (CPAP), should be considered.

Historical note and terminology

Early writings on the relationship between sleep and cognitive functioning go back to the beginning of the 20th century, when William Osler reported on “Pickwickian syndrome” to describe patients who exhibited both obesity and hypersomnolence (Osler 1918). It wasn't until 1970 that Carolo Tassinari, Elio Lugaresi, and others, who specialized in neurophysiology and electroencephalography, conducted clinical sleep studies and provided a complete description of sleep apnea syndrome, including the first characterization of non-obese adults to exhibit obstructive sleep apnea (OSA). These physicians also observed that clear diagnostic markers for OSA included cardiovascular correlates, snoring, and daytime sleepiness (Dement 2005). At the same time, Guilleminault and colleagues reported on the association between adenotonsillar hypertrophy and OSA in children and suggested that adenotonsillectomy might ameliorate associated symptoms (Guilleminault et al 1976; 1981; 1982). Guilleminault was also the first to describe the impact on daytime functioning in children, reporting that poor performance of math problems improved after adenotonsillectomy (Guilleminault et al 1976). Following this landmark paper, numerous studies have been undertaken to explore and characterize features of pediatric OSA, as well as the impact on neuropsychological performances.

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