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. 2025 Jul 17:10.1002/ohn.1351.
doi: 10.1002/ohn.1351. Online ahead of print.

Assessing Executive Function in Pediatric Sleep-Disordered Breathing Using Functional Neuroimaging

Nithya Navarathna  1   2 , Sergio L Novi  1 , Sophia Uddin  1 , Daniel C Fong  1 , Heather Bortfeld  3 , Amal Isaiah  1   2   4   5
Affiliations

Assessing Executive Function in Pediatric Sleep-Disordered Breathing Using Functional Neuroimaging

Nithya Navarathna et al. Otolaryngol Head Neck Surg. .

Abstract

Objective: Sleep-disordered breathing (SDB) affects 10% of children and is associated with poor academic performance related to inattention and executive dysfunction. Yet, the underlying neural mechanisms remain poorly understood, especially in elementary school-aged children who cannot sit still for functional magnetic resonance imaging. This study examines the feasibility of using functional near-infrared spectroscopy (fNIRS), a child-friendly neuroimaging tool, to assess prefrontal cortex (PFC) activation in children with SDB.

Study design: Prospective observational study between January and November 2024.

Setting: Tertiary care academic children's hospital.

Methods: We assessed 78 children aged 5 to 11 referred for management of clinically significant SDB. Participants completed a Go/No-Go task measuring response inhibition while undergoing fNIRS recording of PFC activity. Parent-reported SDB symptom burden was assessed using the Pediatric Sleep Questionnaire Sleep-Related Breathing Disorders scale. Executive function was assessed using the Behavior Rating Inventory of Executive Function (BRIEF) scores.

Results: Greater SDB symptom burden was associated with reduced PFC activation during the Go/No-Go task (r = -0.31, P = .028 in left middle frontal gyrus). Higher executive dysfunction correlated with lower PFC activation across multiple regions. The activation of the left dorsolateral PFC moderated the relationship between SDB symptoms and BRIEF Global Executive Composite (coefficient = -8.51, P = .039), suggesting neural compensation.

Conclusion: This study demonstrates the feasibility of using task-based fNIRS to assess neural correlates of SDB in children. SDB symptoms are negatively associated with PFC activation, which may moderate the impact of SDB on behavior. These findings suggest fNIRS could be a practical tool for studying brain function in pediatric SDB.

Keywords: behavior; executive function; functional near‐infrared spectroscopy; pediatric sleep‐disordered breathing; prefrontal cortex.

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Conflict of interest statement

Declaration of Conflicting Interests: Dr. Isaiah receives royalties and holds patents for diagnosis and management of upper airway obstruction outside the submitted work. No other disclosures are reported.

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