Published online February 1, 2007
PEDIATRICS Vol. 119 No. 2 February 2007, pp. 320-329 (doi:10.1542/peds.2006-1969)
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ARTICLE

Reduced Time in Bed and Obstructive Sleep-Disordered Breathing in Children Are Associated With Cognitive Impairment

Paul M. Suratt, MDa, Jeffrey T. Barth, PhDb, Robert Diamond, PhDb, Lynn D'Andrea, MDc, Margarita Nikova, MDa, Vito A. Perriello, Jr, MDd, Mary A. Carskadon, PhDe and Christopher Rembold, MDf

a Pulmonary Critical Care Division, Department of Internal Medicine
b Department of Psychiatric Medicine
f Cardiovascular Division, Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
c Division of Respiratory Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
d Pediatric Associates of Charlottesville, Charlottesville, Viginia
e Departments of Psychiatry and Human Behavior, Brown Medical School, Brown University, Providence, Rhode Island

OBJECTIVE. The purpose of this study was to determine if reduced time in bed as well as the degree of obstructive sleep-disordered breathing predicted the risk of impaired cognitive function in children with adenotonsillar hypertrophy suspected of having obstructive sleep-disordered breathing.

DESIGN. We studied 56 children, aged 6 to 12 years, with adenotonsillar hypertrophy referred for suspected obstructive sleep-disordered breathing. Children were given a sleep diary and underwent wrist actigraphy for 6 consecutive days and nights. On day 7, the children were given general cognitive tests, memory tests, and continuous performance tests followed by attended polysomnography that night. Parents completed snoring and behavior questionnaires.

RESULTS. Shorter mean time in bed for 6 nights and a history of nightly snoring were highly predictive of lower scores for the vocabulary and similarities cognitive function tests. Children who had a mean time in bed of 557 minutes and did not snore nightly were predicted to have vocabulary and similarities scores more than 1 standard deviation higher than children who had a mean time in bed of 521 minutes and snored nightly. Shorter mean time in bed and the log of the apnea hypopnea index also predicted lower vocabulary and similarities scores. Greater night to night variability in time in bed was significantly predictive of lower vocabulary and similarities scores, but variability was not as predictive as mean time in bed. Neither mean time in bed nor the coefficient of variation of time in bed predicted other cognitive or behavioral scores.

CONCLUSIONS. Short or variable time in bed and nightly snoring or higher apnea hypopnea index predicted impaired vocabulary and similarities scores in children with adenotonsillar hypertrophy suspected of having obstructive sleep-disordered breathing. The degree of cognitive impairment attributable to short time in bed and obstructive sleep-disordered breathing is clinically very significant.

Key Words: time in bed • sleep restriction • sleep disordered breathing • sleep apnea • adenotonsillar hypertrophy • cognitive function • cognitive impairment • actigraphy

Abbreviations: OSDB—obstructive sleep-disordered breathing • TIB—time in bed • TIB1–6—time in bed nights 1 to 6 • OAHI—obstructive apnea hypopnea index • SaO2—oxyhemoglobin saturation • log10(OAHI + 1)—log of the apnea hypopnea index • CI—confidence interval

Accepted Oct 1, 2006.




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 Arch Pediatr Adolesc MedHome page
J. A. Owens, R. Mehlenbeck, J. Lee, and M. M. King
Effect of Weight, Sleep Duration, and Comorbid Sleep Disorders on Behavioral Outcomes in Children With Sleep-Disordered Breathing
Arch Pediatr Adolesc Med, April 1, 2008; 162(4): 313 - 321.
[Abstract] [Full Text] [PDF]