title: Cognition, temperament, and cerebral blood flow velocity in toddlers and preschool children with sleep-disordered breathing or behavioral insomnia of childhood.
abstract: Cognitive decrements, problematic behaviors, and increased cerebral blood flow velocities (CBFVs) have been reported in children aged 3-7 years with sleep-disordered breathing (SDB). Whether similar impairments exist in younger children or those with behavioral insomnia of childhood (BIC) remains unclear. This study aimed to compare cognition and temperament in children aged 1-5 years with SDB or BIC to healthy control children, and to investigate whether cognitive or behavioral deficits associated with sleep problems are related to changes in CBFV.
  
  
  
  Toddlers and preschool-aged children (12-67 months) who had been referred for the clinical evaluation of SDB (n = 20) or BIC (n = 13) and a comparative sample of non-snoring healthy sleepers (controls; n = 77) were recruited from the community. Children underwent cognitive assessment (Mullen's Scale of Early Learning) and measurement of resting bilateral CBFV in the middle cerebral artery (MCA) using Transcranial Doppler. Parents completed temperament scales (Early Childhood or Childhood Behavior Questionnaire), a sleep problem questionnaire (Pediatric Sleep Problem Survey Instrument) and performed home-based pediatric sleep monitoring (Actigraphy and Sleep Diary).
  
  
  
  SDB children demonstrated impaired receptive skills, more hyperactive and energetic temperaments, and higher bilateral CBFV than controls and children with BIC. Logistic regression analyses indicated that impaired cognition, temperamental difficulties, and increased CBFV are independently associated with SDB.
  
  
  
  During early childhood, problematic temperaments, cognitive deficits, and altered cerebrovascular functioning are associated with SDB but not BIC. CBFV does not appear to mediate these daytime deficits and instead may be an independent outcome of SDB. The findings support the need for an early intervention in pediatric SDB.
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia, St Bernards Road, Adelaide, South Australia 5000, Australia.
authors.forename: Rachael
authors.initials: R
authors.lastname: Spooner
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia, St Bernards Road, Adelaide, South Australia 5000, Australia.
authors.forename: Kurt
authors.initials: K
authors.lastname: Lushington
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia, St Bernards Road, Adelaide, South Australia 5000, Australia.
authors.forename: Hannah A D
authors.initials: HA
authors.lastname: Keage
authors.affiliation: School of Human Health & Social Sciences, Appleton Institute of Behavioural Science, Central Queensland University, Greenhill Road, Adelaide, South Australia 5034, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Blunden
authors.affiliation: Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, King William Road, Adelaide, South Australia 5000, Australia; Department of Respiratory and Sleep Medicine, Women's & Children's Hospital, King William Road, North Adelaide, South Australia 5006, Australia.
authors.forename: J Declan
authors.initials: JD
authors.lastname: Kennedy
authors.affiliation: Department of Paediatric Otolaryngology, Head and Neck Surgery, Women's & Children's Hospital, King William Road, North Adelaide, South Australia 5006, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Schembri
authors.affiliation: Department of Paediatric Otolaryngology, Head and Neck Surgery, Women's & Children's Hospital, King William Road, North Adelaide, South Australia 5006, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Wabnitz
authors.affiliation: Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, King William Road, Adelaide, South Australia 5000, Australia; Department of Respiratory and Sleep Medicine, Women's & Children's Hospital, King William Road, North Adelaide, South Australia 5006, Australia.
authors.forename: A James
authors.initials: AJ
authors.lastname: Martin
authors.affiliation: School of Psychology, Social Work and Social Policy, University of South Australia, St Bernards Road, Adelaide, South Australia 5000, Australia. Electronic address: mark.kohler@unisa.edu.au.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Kohler
mesh_terms: D056044:Actigraphy; D002560:Cerebrovascular Circulation / Q000502:physiology*; D002675:Child, Preschool; D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012891:Sleep Apnea Syndromes / Q000150:complications*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications*; D011795:Surveys and Questionnaires / Q000706:statistics & numerical data; D013694:Temperament
keywords: Behavioral insomnia in childhood; Cerebral blood flow velocity; Cognition; Sleep-disordered breathing; Temperament; Transcranial Doppler