Cognitive and behavioral effects of obstructive sleep apnea syndrome in children: a systematic literature review

Area of Science:

• Pediatric Sleep Medicine
• Neuropsychology
• Developmental Pediatrics

Background:

• Obstructive sleep apnea syndrome (OSA) is a prevalent respiratory disorder in children.
• OSA is suspected to negatively influence children's quality of life and cognitive functions.
• Existing research on the cognitive impact of pediatric OSA requires systematic evaluation.

Purpose of the Study:

• To systematically review primary studies investigating the effects of OSA on cognitive and behavioral abilities in children.
• To synthesize evidence from studies published between 2002 and 2016 across major scientific databases.
• To identify specific cognitive domains affected by OSA in pediatric populations.

Main Methods:

• Systematic literature search of MEDLINE/PubMed, LILACS, SciELO, Web of Science, and PsycINFO (2002-2016).
• Inclusion criteria: studies evaluating cognition/behavior/academic achievement in children with OSA compared to controls, with low risk of bias (Levels I-II).
• Exclusion criteria: samples with conditions confounding cognitive assessment.

Main Results:

• Out of 649 articles, 34 met eligibility criteria.
• Selected studies suggest potential impairment in intellectual abilities of children with OSA, but generally within the normal range.
• Insufficient evidence exists to confirm deficits in specific cognitive areas like language, memory, attention, executive functions, or academic performance due to low evidence levels and study heterogeneity.

Conclusions:

• Pediatric OSA may be associated with subtle intellectual impairments, though not definitively proven across all cognitive domains.
• Heterogeneity in study methodologies and outcome measures limits definitive conclusions on specific cognitive deficits.
• Future research should employ detailed cognitive neuropsychology models to fractionate higher- and lower-order cognitive abilities in children with OSA.