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PEDIATRICS Vol. 102 No. 3 September 1998, pp. 616-620

Sleep-Disordered Breathing and School Performance in Children

Received Jan 12, 1998; accepted Apr 17, 1998.

David Gozal

From the Constance S. Kaufman Pediatric Pulmonary Research Laboratory, Tulane University Comprehensive Sleep Disorders Center, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana.

Objective.  To assess the impact of sleep-associated gas exchange abnormalities (SAGEA) on school academic performance in children.

Design.  Prospective study.

Setting.  Urban public elementary schools.

Participants.  Two hundred ninety-seven first-grade children whose school performance was in the lowest 10th percentile of their class ranking.

Methods.  Children were screened for obstructive sleep apnea syndrome at home using a detailed parental questionnaire and a single night recording of pulse oximetry and transcutaneous partial pressure of carbon dioxide. If SAGEA was diagnosed, parents were encouraged to seek medical intervention for SAGEA. School grades of all participating children for the school year preceding and after the overnight study were obtained.

Results.  SAGEA was identified in 54 children (18.1%). Of these, 24 underwent surgical tonsillectomy and adenoidectomy (TR), whereas in the remaining 30 children, parents elected not to seek any therapeutic intervention (NT). Overall mean grades during the second grade increased from 2.43 ± 0.17 (SEM) to 2.87 ± 0.19 in TR, although no significant changes occurred in NT (2.44 ± 0.13 to 2.46 ± 0.15). Similarly, no academic improvements occurred in children without SAGEA.

Conclusions.  SAGEA is frequently present in poorly performing first-grade students in whom it adversely affects learning performance. The data suggest that a subset of children with behavioral and learning disabilities could have SAGEA and may benefit from prospective medical evaluation and treatment.  Key words:  obstructive sleep apnea, hypoxia, sleep fragmentation, neurocognitive performance, hypercapnia.


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K. H. Archbold, B. Giordani, D. L. Ruzicka, and R. D. Chervin
Cognitive Executive Dysfunction in Children with Mild Sleep-Disordered Breathing
Biol Res Nurs, January 1, 2004; 5(3): 168 - 176.
[Abstract] [PDF]

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 PediatricsHome page
G. M. Nixon, A. S. Kermack, G. M. Davis, J. J. Manoukian, K. A. Brown, and R. T. Brouillette
Planning Adenotonsillectomy in Children With Obstructive Sleep Apnea: The Role of Overnight Oximetry
Pediatrics, January 1, 2004; 113(1): e19 - 25.
[Abstract] [Full Text] [PDF]

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 Arch Otolaryngol Head Neck SurgHome page
P. J. P. Poels, A. G. M. Schilder, S. van den Berg, A. W. Hoes, and K. F. M. Joosten
Evaluation of a New Device for Home Cardiorespiratory Recording in Children
Arch Otolaryngol Head Neck Surg, December 1, 2003; 129(12): 1281 - 1284.
[Abstract] [Full Text] [PDF]

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 ChestHome page
V. G. Kirk, S. G. Bohn, W. W. Flemons, and J. E. Remmers
Comparison of Home Oximetry Monitoring With Laboratory Polysomnography in Children
Chest, November 1, 2003; 124(5): 1702 - 1708.
[Abstract] [Full Text] [PDF]

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 ChestHome page
C. Shin, S. Joo, J. Kim, and T. Kim
Prevalence and Correlates of Habitual Snoring in High School Students
Chest, November 1, 2003; 124(5): 1709 - 1715.
[Abstract] [Full Text] [PDF]

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 CLIN PEDIATRHome page
H. E. Montgomery-Downs, V. F. Jones, V. J. Molfese, and D. Gozal
Snoring in Preschoolers: Associations with Sleepiness, Ethnicity, and Learning
Clinical Pediatrics, October 1, 2003; 42(8): 719 - 726.
[Abstract] [PDF]

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 PediatricsHome page
D. J. Gottlieb, R. M. Vezina, C. Chase, S. M. Lesko, T. C. Heeren, D. E. Weese-Mayer, S. H. Auerbach, and M. J. Corwin
Symptoms of Sleep-Disordered Breathing in 5-Year-Old Children Are Associated With Sleepiness and Problem Behaviors
Pediatrics, October 1, 2003; 112(4): 870 - 877.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
M. S. Urschitz, A. Guenther, E. Eggebrecht, J. Wolff, P. M. Urschitz-Duprat, M. Schlaud, and C. F. Poets
Snoring, Intermittent Hypoxia and Academic Performance in Primary School Children
Am. J. Respir. Crit. Care Med., August 15, 2003; 168(4): 464 - 468.
[Abstract] [Full Text] [PDF]

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 ChestHome page
J. L. Goodwin, S. I. Babar, K. L. Kaemingk, G. M. Rosen, W. J. Morgan, D. L. Sherrill, and S. F. Quan
Symptoms Related to Sleep-Disordered Breathing in White and Hispanic Children: The Tucson Children's Assessment of Sleep Apnea Study
Chest, July 1, 2003; 124(1): 196 - 203.
[Abstract] [Full Text] [PDF]

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 Arch Otolaryngol Head Neck SurgHome page
R. B. Mitchell, E. Call, and J. Kelly
Diagnosis and Therapy for Airway Obstruction in Children With Down Syndrome
Arch Otolaryngol Head Neck Surg, June 1, 2003; 129(6): 642 - 645.
[Abstract] [Full Text] [PDF]

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 Journal of the American Dental AssociationHome page
N. MOHSENIN, M. T. MOSTOFI, and V. MOHSENIN
The role of oral appliances in treating obstructive sleep apnea
J Am Dent Assoc, April 1, 2003; 134(4): 442 - 449.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
L. M. O'Brien, C. R. Holbrook, C. B. Mervis, C. J. Klaus, J. L. Bruner, T. J. Raffield, J. Rutherford, R. C. Mehl, M. Wang, A. Tuell, et al.
Sleep and Neurobehavioral Characteristics of 5- to 7-Year-Old Children With Parentally Reported Symptoms of Attention-Deficit/Hyperactivity Disorder
Pediatrics, March 1, 2003; 111(3): 554 - 563.
[Abstract] [Full Text] [PDF]

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 CLIN PEDIATRHome page
A. Ivanenko, V. M. Crabtree, R. Tauman, and D. Gozal
Melatonin in Children and Adolescents with Insomnia: A Retrospective Study
Clinical Pediatrics, January 1, 2003; 42(1): 51 - 58.
[Abstract] [PDF]

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 Behav Cogn Neurosci RevHome page
L. A. Femia and M. E. Hasselmo
Is autism partly a consolidation disorder?
Behav Cogn Neurosci Rev, December 1, 2002; 1(4): 251 - 263.
[Abstract] [PDF]

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 J Child NeurolHome page
Y. Leitner, A. M. Bloch, A. Sadeh, O. Neuderfer, L. Tikotzky, A. Fattal-Valevski, and S. Harel
Sleep-Wake Patterns in Children With Intrauterine Growth Retardation
J Child Neurol, December 1, 2002; 17(12): 872 - 876.
[Abstract] [PDF]

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 J Child NeurolHome page
Y. Leitner, A. Mimouni Bloch, A. Sadeh, O. Neuderfer, L. Tikotzky, and S. Harel
Sleep-Wake Patterns in Children With Intrauterine Growth Retardation
J Child Neurol, December 1, 2002; 17(12): 872 - 876.
[Abstract] [PDF]

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 Eur Respir JHome page
O. Norregaard
Noninvasive ventilation in children
Eur. Respir. J., November 1, 2002; 20(5): 1332 - 1342.
[Abstract] [Full Text] [PDF]

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 J. Biol. Chem.Home page
V. Thongboonkerd, E. Gozal, L. R. Sachleben Jr., J. M. Arthur, W. M. Pierce, J. Cai, J. Chao, M. Bader, J. B. Pesquero, D. Gozal, et al.
Proteomic Analysis Reveals Alterations in the Renal Kallikrein Pathway during Hypoxia-Induced Hypertension
J. Biol. Chem., September 13, 2002; 277(38): 34708 - 34716.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
H. Reuveni, T. Simon, A. Tal, A. Elhayany, and A. Tarasiuk
Health Care Services Utilization in Children With Obstructive Sleep Apnea Syndrome
Pediatrics, July 1, 2002; 110(1): 68 - 72.
[Abstract] [Full Text] [PDF]

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 J. Neurosci.Home page
Z. Cheng, S. Z. Guo, A. J. Lipton, and D. Gozal
Domoic Acid Lesions in Nucleus of the Solitary Tract: Time-Dependent Recovery of Hypoxic Ventilatory Response and Peripheral Afferent Axonal Plasticity
J. Neurosci., April 15, 2002; 22(8): 3215 - 3226.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
Section on Pediatric Pulmonology and Subcommittee on Obstructive Sleep Apnea Syndrome
Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Pediatrics, April 1, 2002; 109(4): 704 - 712.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
M. S. Schechter and Section on Pediatric Pulmonology, Subcommittee on
Technical Report: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Pediatrics, April 1, 2002; 109(4): e69 - e69.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
D. Gozal, M. Wang, and D. W. Pope Jr
Objective Sleepiness Measures in Pediatric Obstructive Sleep Apnea
Pediatrics, September 1, 2001; 108(3): 693 - 697.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
R. ARENS, J. M. McDONOUGH, A. T. COSTARINO, S. MAHBOUBI, C. E. TAYAG-KIER, G. MAISLIN, R. J. SCHWAB, and A. I. PACK
Magnetic Resonance Imaging of the Upper Airway Structure of Children with Obstructive Sleep Apnea Syndrome
Am. J. Respir. Crit. Care Med., August 15, 2001; 164(4): 698 - 703.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
C. L. MARCUS
Sleep-disordered Breathing in Children
Am. J. Respir. Crit. Care Med., July 1, 2001; 164(1): 16 - 30.
[Full Text] [PDF]

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 PediatricsHome page
R. D. Chervin, K. H. Archbold, P. Panahi, and K. J. Pituch
Sleep Problems Seldom Addressed at Two General Pediatric Clinics
Pediatrics, June 1, 2001; 107(6): 1375 - 1380.
[Abstract] [Full Text] [PDF]

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 PediatricsHome page
D. Gozal and D. W. Pope Jr
Snoring During Early Childhood and Academic Performance at Ages Thirteen to Fourteen Years
Pediatrics, June 1, 2001; 107(6): 1394 - 1399.
[Abstract] [Full Text] [PDF]