title: Long-Term Cognitive and Behavioral Outcomes following Resolution of Sleep Disordered Breathing in Preschool Children.
abstract: This study aimed to determine the long term effects of resolution of SDB in preschool children, either following treatment or spontaneous recovery, on cognition and behavior. Children diagnosed with SDB at 3-5y (N = 35) and non-snoring controls (N = 25), underwent repeat polysomnography (PSG) and cognitive and behavioral assessment 3 years following a baseline study. At follow-up, children with SDB were grouped into Resolved and Unresolved. Resolution was defined as: obstructive apnea hypopnea index (OAHI) ≤1 event/h; no snoring detected on PSG; and no parental report of habitual snoring. 57% (20/35) of children with SDB received treatment, with SDB resolving in 60% (12/20). 43% (15/35) were untreated, of whom 40% (6/15) had spontaneous resolution of SDB. Cognitive reduced between baseline and follow-up, however this was not related to persistent disease, with no difference in cognitive outcomes between Resolved, Unresolved or Control groups. Behavioral functioning remained significantly worse in children originally diagnosed with SDB compared to control children, regardless of resolution. Change in OAHI did not predict cognitive or behavioral outcomes, however a reduction in nocturnal arousals, irrespective of full resolution, was associated with improvement in attention and aggressive behavior. These results suggest that resolution of SDB in preschool children has little effect on cognitive or behavioral outcomes over the long term. The association between sleep fragmentation and behavior appears independent of SDB, however may be moderated by concomitant SDB. This challenges the assumption that treatment of SDB will ameliorate associated cognitive and behavioural deficits and supports the possibility of a SDB phenotype.
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Biggs
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Walter
authors.affiliation: Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Jackman
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Nisbet
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.
authors.forename: Aidan J
authors.initials: AJ
authors.lastname: Weichard
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.
authors.forename: Samantha L
authors.initials: SL
authors.lastname: Hollis
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's, Monash Medical Centre, Melbourne, Australia.
authors.forename: Margot J
authors.initials: MJ
authors.lastname: Davey
authors.affiliation: Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, Australia.
authors.forename: Vicki
authors.initials: V
authors.lastname: Anderson
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's, Monash Medical Centre, Melbourne, Australia.
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Nixon
authors.affiliation: The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
authors.forename: Rosemary S C
authors.initials: RS
authors.lastname: Horne
mesh_terms: D002652:Child Behavior / Q000523:psychology*; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000503:physiopathology*; D012892:Sleep Deprivation / Q000503:physiopathology*; D012913:Snoring / Q000503:physiopathology