The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood

Sleep. 2010 Nov;33(11):1447-56. doi: 10.1093/sleep/33.11.1447.


Study objectives: (1) to determine the associations of sleep disordered breathing (SDB) with behavioral functioning, cognitive test scores, and school grades during middle- to late-childhood, an under-researched developmental period in the SDB literature, and (2) to clarify whether associations between SDB and school grades are mediated by deficits in cognitive or behavioral functioning.

Design: cross-sectional correlative study.

Setting: Office/hospital, plus reported functioning at home and at school.

Participants: 163 overweight subjects aged 10-16.9 years were divided into 4 groups based upon their obstructive apnea+hypopnea index (AHI) during overnight polysomnography and parent report of snoring: Moderate-Severe OSA (AHI > 5, n = 42), Mild OSA (AHI = 1-5, n = 58), Snorers (AHI < 1 + snoring, n = 26), and No SDB (AHI < 1 and nonsnoring, n = 37).

Measurements: inpatient overnight polysomnography, parent- and self-report of school grades and sleep, parent- and teacher-report of daytime behaviors, and office-based neuropsychological testing.

Results: The 4 groups significantly differed in academic grades and parent- and teacher-reported behaviors, particularly inattention and learning problems. These findings remained significant after adjusting for subject sex, race, socioeconomic status, and school night sleep duration. Associations with SDB were confined to reports of behavioral difficulties in real-world situations, and did not extend to office-based neuropsychological tests. Findings from secondary analyses were consistent with, but could not definitively confirm, a causal model in which SDB affects school grades via its impact on behavioral functioning.

Conclusions: SDB during middle- to late-childhood is related to important aspects of behavioral functioning, especially inattention and learning difficulties, that may result in significant functional impairment at school.

Keywords: Pediatrics; behavioral; cognitive; neuropsychology; sleep apnea.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Analysis of Variance
  • Attention
  • Causality
  • Child
  • Child Behavior Disorders / diagnosis
  • Child Behavior Disorders / epidemiology*
  • Cognition Disorders / diagnosis
  • Cognition Disorders / epidemiology*
  • Comorbidity
  • Cross-Sectional Studies
  • Educational Measurement / methods
  • Educational Measurement / statistics & numerical data*
  • Educational Status
  • Faculty
  • Female
  • Humans
  • Learning Disabilities / diagnosis
  • Learning Disabilities / epidemiology
  • Male
  • Neuropsychological Tests / statistics & numerical data
  • Ohio / epidemiology
  • Overweight / epidemiology*
  • Parents
  • Polysomnography / methods
  • Polysomnography / statistics & numerical data
  • Self Report
  • Severity of Illness Index
  • Sleep Apnea Syndromes / epidemiology*