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Neurocognitive deficits in children with polysomnographically confirmed obstructive sleep apnea: A systematic review
Daniel Turgeman1, Salim Mazzawi1
1Otolaryngology Head and Neck Department, Emek Medical Center, Israel.
Insights
Children with obstructive sleep apnea (OSA) experience moderate neurocognitive deficits, impacting areas like executive function. Early screening and intervention are recommended for these children.
Area of Science:
- Pediatric Sleep Medicine
- Neuropsychology
- Public Health
Background:
- Obstructive sleep apnea (OSA) in children is linked to neurocognitive issues.
- The extent and consistency of these deficits require systematic evaluation using polysomnography (PSG).
Purpose of the Study:
- To quantify the pooled neurocognitive deficits in school-aged children with PSG-confirmed OSA compared to healthy controls.
- To assess the magnitude and consistency of cognitive impairments.
Main Methods:
- A systematic review and meta-analysis (PRISMA 2020 guidelines) were conducted.
- Searches included PubMed, Embase, Cochrane CENTRAL, and PsycINFO.
- Inclusion criteria specified PSG-confirmed OSA, non-snoring controls, standardized assessments, and school-aged children (5-12 years) without ADHD.
Main Results:
- Six studies (n=436) were analyzed, revealing a pooled moderate cognitive deficit (Hedges' g = 0.67).
- Deficits were observed in executive function, working memory, intelligence, and phonological processing.
- Low-to-moderate heterogeneity (I²=25%) and robust sensitivity analyses indicated consistent findings.
Conclusions:
- PSG-confirmed OSA in children is associated with moderate and consistent neurocognitive deficits.
- Findings support the need for neurocognitive screening in children with OSA.
- These results provide a rationale for early intervention strategies.
Background:
Children with obstructive sleep apnea (OSA) frequently exhibit neurocognitive difficulties, but the magnitude and consistency of cognitive deficits have not been systematically quantified using polysomnographic criteria.
Objectives:
To estimate the pooled magnitude of neurocognitive deficits in predominantly school-aged children (mean age approximately 5-12 years) with PSG-confirmed OSA versus healthy non-snoring controls.
Methods:
Systematic review and random-effects meta-analysis (DerSimonian-Laird) following PRISMA 2020 guidelines. PubMed, Embase, Cochrane CENTRAL, and PsycINFO were searched from database inception to July 2026. Inclusion criteria required: (1) PSG-confirmed OSA (AHI ≥1 event/hour); (2) a directly enrolled non-snoring control group; (3) standardised neuropsychological assessment; (4) predominantly school-aged participants (mean age approximately 5-12 years); (5) ADHD excluded. The primary effect measure was Hedges' g.
Results:
Six studies (n = 436; 249 OSA, 187 controls) met eligibility criteria. The pooled Hedges' g was 0.67 (95% CI: 0.44-0.90, p < 0.001), a moderate cognitive deficit. Between-study heterogeneity was low-to-moderate (I2 = 25%, Q = 6.69, df = 5, p = 0.24). Sensitivity analyses confirmed robustness: leave-one-out estimates ranged from g = 0.58 to 0.77 regardless of which study was excluded. Secondary outcomes showed impairment across executive function, working memory, intelligence, and phonological processing. With few studies, heterogeneity estimates should be interpreted cautiously.
Conclusions:
PSG-confirmed OSA in school-aged children is associated with a moderate, relatively consistent neurocognitive deficit across diverse populations, test batteries, and severity strata. These findings support neurocognitive screening in children with OSA and a rationale for early intervention.
