Sleep Disordered Breathing and Academic Performance: A Meta-analysis.
OBJECTIVE
Sleep-disordered breathing (SDB) in children is associated with daytime functioning decrements in cognitive performance and behavioral regulation. Studies addressing academic achievement are underrepresented. This study aimed to evaluate the strength of the relationships between SDB and achievement in core domains and general school performance.


METHODS
Data sources included PubMed, Web of Science, CINAHL, and PsycINFO. Studies of school-aged children investigating the relationships between SDB and academic achievement were selected for inclusion in a systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data extracted were converted into standardized mean differences; effect sizes (ES) and statistics were calculated by using random-effects models. Heterogeneity tests (I(2)) were conducted.


RESULTS
Of 488 studies, 16 met eligibility criteria. SDB was significantly associated with poorer academic performance for core academic domains related to language arts (ES -0.31; P < .001; I(2) = 74%), math (ES -0.33; P < .001; I(2) = 55%), and science (ES -0.29; P = .001; I(2) = 0%), and with unsatisfactory progress/learning problems (ES -0.23; P < .001; I(2) = 0%) but not general school performance.


CONCLUSIONS
Variable definitions of both academic performance and SDB likely contributed to the heterogeneity among published investigations. Clear links between SDB and poorer academic performance in school-age children are demonstrated. ES statistics were in the small to medium range, but nevertheless the findings serve to highlight to parents, teachers, and clinicians that SDB in children may contribute to academic difficulties some children face.
Departments of Women's & Children's Health, and barbara.galland@otago.ac.nz.
Barbara
B
Galland
Department of Developmental and Behavioral Pediatrics, Jiao Tong University School of Medicine, Shanghai, China; Faculty of Psychology, Vrije Universiteit Brussel and School for Mental Health and Neurosciences, Maastricht University, Maastricht, Netherlands;
Karen
K
Spruyt
Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand;
Patrick
P
Dawes
Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, New Zealand; and.
Philippa S
PS
McDowall
Department of Paediatrics and Child Health, Wellington School of Medicine, University of Otago, Wellington, New Zealand; and.
Dawn
D
Elder
Department of Psychology, University of Otago, Dunedin, New Zealand.
Elizabeth
E
Schaughency
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004521:Educational Measurement / Q000379:methods*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D012574:Schools; D012891:Sleep Apnea Syndromes / Q000150:complications*