The impact of sleep-disordered breathing on cognition and behavior in children: a review and meta-synthesis of the literature.
OBJECTIVE
The goal of this review is to provide a synthesis of the current literature addressing the effects of sleep-disordered breathing on cognition and behavior in children aged 2-18.


METHODS
A computerized search was performed to include studies between 1966 and 2001. Studies were assessed based on research question, sampling, intervention, outcomes, confounding, and statistical methods. Sensitivity analyses were performed for quantitative assessments of selection bias, misclassification, and confounding.


RESULTS
Seventeen reports with 5312 patients were reviewed. The majority of these studies demonstrated poor sampling, insufficient consideration of confounders, and imprecise use of statistical tools. However, there was little evidence of bias in two studies when scrutinized using a sensitivity analysis.


CONCLUSIONS
Despite suggested links between daytime behavior problems and neurocognitive deficits, there is little certainty for causality based on the quality of the evidence.


CONCLUSIONS
By discussing the quality of the current evidence, we hope to improve study design and contribute to the development of an understanding of this complex topic.
Ebert
Charles S
CS
Department of Otolaryngology--Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7070, USA. cebert@med.unc.edu
Drake
Amelia F
AF
D000293:Adolescent; D000402:Airway Obstruction / Q000150:complications / Q000453:epidemiology; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000209:etiology*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D015986:Confounding Factors, Epidemiologic; D006801:Humans; D017063:Outcome Assessment, Health Care; D012120:Respiration Disorders / Q000150:complications* / Q000453:epidemiology; D015983:Selection Bias; D012680:Sensitivity and Specificity; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000453:epidemiology; D020919:Sleep Disorders, Intrinsic / Q000150:complications* / Q000453:epidemiology; D012913:Snoring / Q000150:complications / Q000453:epidemiology