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Randomized Controlled Trial
. 2025 Feb 1;151(2):151-159.
doi: 10.1001/jamaoto.2024.4373.

Symptoms, Quality of Life, and Executive Function in Children Who Snore

Phoebe K Yu  1   2 , Kaitlyn Cook  3   4 , Ignacio E Tapia  5 , Kristie R Ross  6 , Sally Ibrahim  6 , Raouf Amin  7 , Stacey L Ishman  8   9 , Fauziya Hassan  10 , Ronald D Chervin  11 , Christopher Liu  12 , Ron B Mitchell  12   13 , Laura Stone  14   15 , H Gerry Taylor  16   17 , Jerilynn Radcliffe  18 , Susan Redline  2   19 , Cristina M Baldassari  14   20
Affiliations
Randomized Controlled Trial

Symptoms, Quality of Life, and Executive Function in Children Who Snore

Phoebe K Yu et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Introduction: Mild sleep-disordered breathing (mSDB) in children is associated with both neurobehavioral morbidity and reduced quality of life (QOL). However, the association between symptom burden and QOL with executive function is not well understood, and it is not known whether QOL and symptom burden may help identify children with neurocognitive dysfunction.

Objective: To assess associations among executive function, QOL, and symptom burden in children with mSDB.

Design, setting, and participants: This cross-sectional study was a secondary analysis of the multicenter Pediatric Adenotonsillectomy Trial for Snoring, which included children aged 3 to 12 years randomized to watchful waiting or adenotonsillectomy for mSDB (snoring and an obstructive apnea-hypopnea index <3) between June 29, 2016, and February 1, 2021. The data for this report were analyzed between December 22, 2020, and October 3, 2024.

Exposure: Pediatric mSDB.

Main outcomes and measures: Quality of life was assessed using the Obstructive Sleep Apnea-18 (OSA-18), and symptom burden was assessed using the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD). Executive function, including self-control and working memory, was measured using the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), and inhibitory control and sustained attention were measured by the GoNoGo vigilance test. Partial Pearson correlations and multiple linear regression models were used to assess the associations among QOL, symptoms, and executive function.

Results: The sample included 459 children (mean [SD] age, 6.1 [2.3] years; 230 female [50.1%]). Moderate correlations were found between the BRIEF GEC and the PSQ-SRBD and OSA-18 (r = 0.58 [95% CI, 0.51-0.64] and 0.59 [95% CI, 0.52-0.64], respectively). After adjusting for age, sex, race and ethnicity, body mass index percentile, household income, maternal education, attention-deficit/hyperactivity disorder, test characteristics, and disease severity, both OSA-18 and PSQ-SRBD scores were associated with the BRIEF GEC (β = 0.41 [95% CI, 0.36-0.47] and 3.66 [95% CI, 3.17-4.15], respectively). In the fully adjusted model, PSQ-SRBD was also associated with GoNoGo inhibitory control (β = -0.04 [95% CI, -0.08 to -0.01]) and sustained attention (β = -0.05 [95% CI, -0.10 to -0.01]).

Conclusions and relevance: In this study, disease-specific QOL and symptom burden were associated with executive function in children with mSDB. These findings may be useful in identifying those children who are at risk for neurocognitive dysfunction.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ross reported receiving grants to her organization from AstraZeneca, Sanofi, and GlaxoSmithKline outside the submitted work. Dr Ishman reported receiving consulting fees from Ethicon outside the submitted work. Dr Hassan reported receiving consulting fees from Eli Lilly outside the submitted work. Dr Chervin reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and personal fees from UpToDate and Eli Lilly; nonfinancial support from the International Pediatric Sleep Association for services as a board member, executive committee member, and president-elect and from Mapi Research Trust; and a patent for copyright held by the University of Michigan licensed to and managed by the Mapi Research Trust for the Pediatric Sleep Questionnaire and Pediatric Sleep Questionnaire–Sleep-Related Breathing Disorder Scale. Dr Liu reported owning stock with AbbVie outside the submitted work. Dr Redline reported receiving grants to her institution from NIH during the conduct of the study; receiving personal fees from Eli Lilly outside the submitted work; and being an unpaid advisor to ApniMed Inc and unpaid member of the board of directors for the National Sleep Foundation and the Alliance of Sleep Apnea Partners. Dr Baldassari reported receiving grants to her institution from NIH during the conduct of the study. No other disclosures were reported.

References

    1. Gottlieb DJ, Chase C, Vezina RM, et al. . Sleep-disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children. J Pediatr. 2004;145(4):458-464. doi:10.1016/j.jpeds.2004.05.039 - DOI - PubMed
    1. Yu PK, Radcliffe J, Gerry Taylor H, et al. . Neurobehavioral morbidity of pediatric mild sleep-disordered breathing and obstructive sleep apnea. Sleep. 2022;45(5):zsac035. doi:10.1093/sleep/zsac035 - DOI - PMC - PubMed
    1. Isaiah A, Ernst T, Cloak CC, Clark DB, Chang L. Associations between frontal lobe structure, parent-reported obstructive sleep disordered breathing and childhood behavior in the ABCD dataset. Nat Commun. 2021;12(1):2205. doi:10.1038/s41467-021-22534-0 - DOI - PMC - PubMed
    1. Isaiah A, Ernst T, Cloak CC, Clark DB, Chang L. Association between habitual snoring and cognitive performance among a large sample of preadolescent children. JAMA Otolaryngol Head Neck Surg. 2021;147(5):426-433. doi:10.1001/jamaoto.2020.5712 - DOI - PMC - PubMed
    1. Archbold KH, Giordani B, Ruzicka DL, Chervin RD. Cognitive executive dysfunction in children with mild sleep-disordered breathing. Biol Res Nurs. 2004;5(3):168-176. doi:10.1177/1099800403260261 - DOI - PubMed

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