Neuropsychologic correlates in pediatric sleep apnea

Thuan D Dang MD MPH (

Dr. Dang of Northwestern University has no relevant financial relationships to disclose.

)
Hrayr P Attarian MD (

Dr. Attarian, Director of the Northwestern University Sleep Disorders Program, received honorariums from Clearview, Eisai, and Insights for consulting work.

)
Michael J Howell MD, editor. (Dr. Howell of the University of Minnesota received grant support from Apnex and GE and honorariums from Inspire as a panel member.)
Originally released January 16, 2012; last updated January 12, 2020; expires January 20, 2023

Overview

The association between obstructive sleep apnea 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 obstructive sleep apnea demonstrate poorer performance on neuropsychological measures of intellectual functioning, attention, executive functioning, visual spatial abilities, and memory in comparison to children without obstructive sleep apnea. However, it is not clear which factors of obstructive sleep apnea (sleep fragmentation, hypoventilation, oxygenation, or degree of respiratory disturbance) are the most pertinent causal factors in neurocognitive morbidity. Research into the exact mechanisms by which obstructive sleep apnea causes neural deficits remains a question to resolve.

Key points

 

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

 

• Neuropsychological investigations of the impact of obstructive sleep apnea in children have been mixed.

 

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

 

• The most common treatment for children with obstructive sleep apnea is adenotonsillectomy.

 

• In those cases in which obstructive sleep apnea 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. These physicians also observed that clear diagnostic markers for obstructive sleep apnea included cardiovascular correlates, snoring, and daytime sleepiness (Dement 2005). At the same time, Guilleminault and colleagues reported on the association between adenotonsillar hypertrophy and obstructive sleep apnea in children and suggested that adenotonsillectomy might ameliorate associated symptoms (Guilleminault et al 1976; Guilleminault et al 1981; Guilleminault et al 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 obstructive sleep apnea, as well as the impact on neuropsychological performances.

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