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Associations Between Sleep-Disordered Breathing and Behavioral and Cognitive Functions in Children With and Without

Kyoung Min Kim¹, Myung Ho Lim², Mina Ha³

¹Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea; Environmental Health Center, Dankook University Medical Center, Cheonan, Republic of Korea.

Journal of the Academy of Consultation-Liaison Psychiatry

|October 15, 2021

Insights

Sleep-disordered breathing (SDB) is linked to behavioral issues in children with and without Attention-Deficit/Hyperactivity Disorder (ADHD). However, SDB did not affect cognitive attention performance in either group.

Area of Science:

Pediatric Neurology
Sleep Medicine
Child Psychology

Background:

Sleep-related problems are common in children with Attention-Deficit/Hyperactivity Disorder (ADHD).
Investigating the link between sleep-disordered breathing (SDB) and neurodevelopmental and behavioral outcomes is crucial.

Purpose of the Study:

To examine the association between sleep-disordered breathing (SDB) and behavioral and cognitive functions in children.
To compare these associations in children with and without ADHD.

Main Methods:

341 children (ages 6-10) were assessed, including 155 with ADHD and 186 controls.
Participants were categorized into low- and high-risk SDB groups based on parent-reported symptoms.
Behavioral symptoms (BASC-2) and cognitive functions (continuous performance test) were evaluated.

Main Results:

In the ADHD group, high-risk SDB was associated with more externalizing problems, including hyperactivity and attention issues.
In the control group, high-risk SDB correlated with internalizing and externalizing problems.
No significant differences in cognitive attention performance were found between high- and low-risk SDB groups in either cohort.

Conclusions:

Sleep-disordered breathing is associated with behavioral problems in children, with a stronger link observed in controls compared to those with ADHD.
Sleep-disordered breathing does not appear to impact cognitive attention performance in children.
This research enhances understanding of SDB's impact on child behavior and cognition.

Read full analysis

Abstract

Background:

Sleep-related problems are highly prevalent comorbidities in Attention-Deficit/Hyperactivity Disorder (ADHD).

Objective:

This study aimed to investigate the associations between sleep-disordered breathing (SDB) and behavioral and cognitive functions in children with and without ADHD.

Methods:

A total of 341 children were included (ADHD group: 155, control group: 186; age: 6-10 years). The participants' sleep-related symptoms were assessed using a parent-rated questionnaire, and they were categorized into low- and high-risk SDB groups based on their scores. Behavioral symptoms were assessed using the Behavioral Assessment System for Children, Second Edition (BASC-2), and cognitive sustained attention and inhibitory control were assessed using a computer-based continuous performance test.

Results:

In the ADHD group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in externalizing problems (F = 4.22; P = 0.042), including hyperactivity (F = 4.65; P = 0.033) and attention problems (F = 8.19; P = 0.005), but not internalizing problems. Meanwhile, in the control group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in internalizing problems (F = 9.89; P = 0.002), depression (F = 9.45; P = 0.002), and somatization (F = 7.83; P = 0.006), as well as in externalizing problems (F = 7.72; P = 0.006), including hyperactivity (F = 6.23; P = 0.013), aggression (F = 5.00; P = 0.027), and conduct problems (F = 6.79; P = 0.010). Contrary to the behavioral outcomes, none of the attention performance subscale scores showed significant differences between the high- and low-risk SDB groups in either the ADHD or control group.

Conclusions:

The present findings suggest that SDB is associated with behavioral problems in children with ADHD and controls, with stronger associations in control children. On the contrary, SDB has no association with cognitive attention performance. This study extends our understanding of the associations of SDB with behavioral symptoms and cognitive functions in children.

Keywords:

attention-deficit/hyperactivity disorder behavior child cognition sleep-disordered breathing

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