Facial Emotion Recognition Deficit in Children with Moderate/Severe Obstructive Sleep Apnea

Abstract

Although previous studies have reported a facial expression classification deficit among adults with SDB, we do not know whether these findings can be generalized to children. In our study, children with sleep-disordered breathing (SDB) were divided into three groups: primary snoring (n = 51), mild obstructive sleep apnea (OSA) (n = 39), and moderate/severe OSA (n = 26). All participants, including 20 healthy controls, underwent an overnight polysomnography recording and the Emotional Expression Recognition Task. Psychosocial problems were evaluated using the parent-reported Strengths and Difficulties Questionnaire (SDQ). There was a borderline significant interaction between expression category and group on reaction times. Further analysis revealed that positive classification advantage (PCA) disappeared in the moderate/severe OSA group, whereas it persisted in the control, primary snoring, and mild OSA groups. Emotional symptoms were positively correlated with OAHI. In both the happy and sad conditions, RT was negatively related to age and body mass index (BMI) but was independent of the obstructive apnea-hypopnea index (OAHI), arterial oxygen (SaO₂) and total sleep time. The accuracy of identifying a sad expression was negatively related to conduct problems. Children with moderate/severe OSA exhibited dysfunction in facial expression categorization, which could potentially affect social communication ability.

Keywords: children; emotional expression recognition task; obstructive sleep apnea; positive classification advantage; schematic face; sleep-disordered breathing.

Figure 1

Flow chart of the experimental paradigm.

Figure 2

Reaction times of responses to different expression stimuli among groups. PS = primary snoring, MSOSA = moderate/severe OSA. * p < 0.05, ** p < 0.01, *** p < 0.001.