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Learning in children and sleep disordered breathing: Findings of the Tucson Children's Assessment of Sleep Apnea (TuCASA) Prospective Cohort Study

Published online by Cambridge University Press:  12 February 2004

KRIS L. KAEMINGK ,
ALICE E. PASVOGEL ,
JAMES L. GOODWIN ,
SHELAGH A. MULVANEY ,
FERNANDA MARTINEZ ,
PAUL L. ENRIGHT ,
GERALD M. ROSEN ,
WAYNE J. MORGAN ,
RALPH F. FREGOSI  and
STUART F. QUAN
KRIS L. KAEMINGK
Affiliation:
Department of Pediatrics, University of Arizona Health Sciences Center, Tucson, Arizona Steele Memorial Children's Research Center, University of Arizona, Tucson, Arizona
ALICE E. PASVOGEL
Affiliation:
Department of Pediatrics, University of Arizona Health Sciences Center, Tucson, Arizona
JAMES L. GOODWIN
Affiliation:
Arizona Respiratory Center, University of Arizona, Tucson, Arizona
SHELAGH A. MULVANEY
Affiliation:
Department of Psychology, University of Arizona, Tucson, Arizona
FERNANDA MARTINEZ
Affiliation:
Arizona Respiratory Center, University of Arizona, Tucson, Arizona
PAUL L. ENRIGHT
Affiliation:
Department of Medicine, University of Arizona Health Sciences Center, Tucson, Arizona
GERALD M. ROSEN
Affiliation:
Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis, Minnesota
WAYNE J. MORGAN
Affiliation:
Department of Pediatrics, University of Arizona Health Sciences Center, Tucson, Arizona Arizona Respiratory Center, University of Arizona, Tucson, Arizona
RALPH F. FREGOSI
Affiliation:
Department of Physiology, University of Arizona, Tucson, Arizona
STUART F. QUAN
Affiliation:
Arizona Respiratory Center, University of Arizona, Tucson, Arizona Department of Medicine, University of Arizona Health Sciences Center, Tucson, Arizona Sleep Disorders Center, University of Arizona, Tucson, Arizona
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Abstract

We examined the relationship between nocturnal respiratory disturbance and learning and compared learning in children with and without nocturnal respiratory disturbance. Subjects were 149 participants in a prospective cohort study examining sleep in children ages 6–12: The Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep was assessed via home polysomnography. Intelligence, learning and memory, and academic achievement were assessed. Parents rated attention. Group comparisons were used to test the hypothesis that the group with an apnea/hypopnea index (AHI) of 5 or more (n = 77) would have weaker performance than the group with AHI less than 5 (n = 72). The group with AHI of 5 or more had weaker learning and memory though differences between groups decreased when arousals were taken into account. There was a greater percentage of Stage 1 sleep in the AHI 5 or more group, and Stage 1 percentage was negatively related to learning and memory in the sample (n = 149). There were negative relationships between AHI and immediate recall, Full Scale IQ, Performance IQ, and math achievement. Hypoxemia was associated with lower Performance IQ. Thus, findings suggest that nocturnal respiratory disturbance is associated with decreased learning in otherwise healthy children, that sleep fragmentation adversely impacts learning and memory, and that hypoxemia adversely influences nonverbal skills. (JINS, 2003, 9, 1016–1026.)

Keywords

LearningMemorySleep disordered breathingApneaChildren
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 9 , Issue 7 , November 2003 , pp. 1016 - 1026
Copyright
© 2003 The International Neuropsychological Society

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References

REFERENCES

Adams, N., Strauss, M., Schluchter, M., & Redline, S. (2001). Relation of measures of sleep-disordered breathing to neuropsychological functioning. American Journal of Respiratory and Critical Care Medicine, 163, 1626–1631.CrossRefGoogle Scholar
Ali, N.J., Pitson, D., & Stradling, J.R. (1996). Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning. European Journal of Pediatrics, 155, 56–62.CrossRefGoogle Scholar
American Sleep Disorders Association. (1992). EEG arousals: Scoring rules and examples. A preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep, 15, 173–184.Google Scholar
American Thoracic Society. (1999). Cardiorespiratory sleep studies in children: Establishment of normative data and polysomnographic predictors of morbidity. American Journal of Respiratory and Critical Care Medicine, 160, 1381–1387.Google Scholar
Bédard, M., Montplaisir, J., Richer, F., Rouleau, I., & Malo, J. (1991). Obstructive sleep apnea syndrome: Pathogenesis of neuropsychological deficits. Journal of Clinical and Experimental Neuropsychology, 13, 950–964.CrossRefGoogle Scholar
Blunden, S., Lushington, K., Kennedy, D., Martin, J., & Dawson, D. (2000). Behavior and neurocognitive performance in children aged 5–10 years who snore compared to controls. Journal of Clinical and Experimental Neuropsychology, 22, 554–568.CrossRefGoogle Scholar
Brunetti, L., Rana, S., Lospalluti, M.L., Pietrafesa, A., Francavilla, R., Fanelli, M., & Armenio, L. (2001). Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children in southern Italy. Chest, 120, 1930–1935.CrossRefGoogle Scholar
Cheshire, K., Engleman, H., Deary, I., Shapiro, C., & Douglas, N.J. (1992). Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome. Archives of Internal Medicine, 152, 538–541.CrossRefGoogle Scholar
Conners, C.K. (1997). Conners' Parent Rating Scale–Revised (L). North Tonawanda, NY: Multi-Health Systems.
Findley, L.J., Barth, J.T., Powers, D.C., Wilhoit, S.C., Boyd, D.G., & Suratt, P.M. (1986). Cognitive impairment in patients with obstructive sleep apnea and associated with hypoxemia. Chest, 90, 686–690.CrossRefGoogle Scholar
Findley, L.J., Unverzagt, M.E., & Suratt, P.M. (1988). Automobile accidents involving patients with obstructive sleep apnea. American Review of Respiratory Diseases, 138, 337–340.CrossRefGoogle Scholar
Goodwin, J.L., Enright, P.L., Kaemingk, K.L., Rosen, G.M., Morgan, W.J., Fregosi, R.F., & Quan, S.F. (2001). Feasibility of using unattended polysomnography in children for research: Report of the Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep, 24, 937–944.CrossRefGoogle Scholar
Gozal, D. (1998). Sleep-disordered breathing and school performance in children. Pediatrics, 102, 616–620.CrossRefGoogle Scholar
Gozal, D. (2000). Obstructive sleep apnea in children. Minerva Pediatrica, 52, 629–639.Google Scholar
Greenberg, G.D., Watson, R.K., & Deptula, D. (1987). Neuropsychological dysfunction in sleep apnea. Sleep, 10, 254–262.CrossRefGoogle Scholar
Kales, A., Caldwell, A.B., Cadieux, R.J., Vela-Bueno, A., Ruch, L.G., & Mayes, S.D. (1985). Severe obstructive sleep apnea—II: Associated psychopathology and psychosocial consequences. Journal of Chronic Diseases, 38, 427–434.CrossRefGoogle Scholar
Kim, H.C., Young, T., Matthews, C.G., Weber, S.M., Woodward, A.R., & Palta, M. (1997). Sleep-disordered breathing and neuropsychological deficits. A population based study. American Journal of Respiratory and Critical Care Medicine, 156, 1813–1819.CrossRefGoogle Scholar
Marcus, C.L. (2001). Sleep-disordered breathing in children. American Journal of Respiratory and Critical Care Medicine, 164, 16–30.CrossRefGoogle Scholar
Messner, A.H. & Pelayo, R. (2000). Pediatric sleep-related breathing disorders. American Journal of Otolaryngology, 21, 98–107.CrossRefGoogle Scholar
Naegëlé, B., Thouvard, V., Pépin, J.L., Lévy, P., Bonnet, C., Perret, J.E., Pellat, J., & Feuerstein, C. (1995). Deficits of cognitive executive functions in patients with sleep apnea syndrome. Sleep, 18, 43–52.Google Scholar
Nieto, F.J., Young, T.B., Lind, B.K., Shahar, E., Samet, J.M., Redline, S., D'Agostino, R.B., Newman, A.B., Lebowitz, M.D., & Pickering, T.G. (2000). Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study. The Journal of the American Medical Association, 283, 1829–1836.Google Scholar
Orr, W.C. & Quan, S.F. (1991). Sleep apnea syndromes—A primer of diagnosis and treatment. Chanhassen, MN: CNS, Inc.
Owens, J.A., Spirito, A., McGuinn, M., & Nobile, C. (2000a). Sleep habits and sleep disturbance in elementary school-aged children. Developmental and Behavioral Pediatrics, 21, 27–36.Google Scholar
Owens, J., Spirito, A., Marcotte, A., McGuinn, M., & Berkelhammer, L. (2000b). Neuropsychological and behavioral correlates of obstructive sleep apnea in children: a preliminary study. Sleep and Breathing, 2, 67–77.Google Scholar
Quan, S.F., Enright, P.L., Kaemingk, K.L., Rosen, G.M., Morgan, W.J., & Fregosi, R.F. (2000). Prevalence of symptoms of obstructive sleep apnea in children—Preliminary report of the Tucson Children Assessment of Sleep Apnea Study (TuCASA). Sleep, 23 (Abstract Supplement 2 A), 195.Google Scholar
Randazzo, A.C., Muehlbach, M.J., Schweitzer, P.K., & Walsh, J.K. (1998). Cognitive function following acute sleep restriction in children ages 10–14. Sleep, 21, 861–868.Google Scholar
Rechtschaffen, A. & Kales, A. (1968). A manual of standardized terminology: Techniques and scoring systems for sleep stages of human subjects. Washington, DC: Public Health Service, U.S. Government Printing Office.
Redline, S., Strauss, M.E., Adams, N., Winters, M., Roebuck, T., Spry, K., Rosenberg, C., & Adams, K. (1997). Neuropsychological function in mild sleep-disordered breathing. Sleep, 20, 160–167.CrossRefGoogle Scholar
Rhodes, S.K., Shimoda, K.C., Waid, L.R., O'Niel, P.M., Oexmann, M.J., Collop, N.A., & Willi, S.M. (1995). Neurocognitive deficits in morbidly obese children with obstructive sleep apnea. Journal of Pediatrics, 127, 741–744.CrossRefGoogle Scholar
Scholle, S., Rieger, B., Kemper, G., Seidler, E., Kemper, A., Glaser, S., & Zwacka, G. (2000). Characteristics of sleep-related obstructive respiratory disturbances in childhood. Sleep and Breathing, 4, 17–21.CrossRefGoogle Scholar
Shahar, E., Whitney, C.W., Redline, S., Lee, E.T., Newman, A.B., Nieto, F.J., O'Connor, G.T., Boland, L.L., Schwartz, J.E., & Samet, J.M. (2001). Sleep-disordered breathing and cardiovascular disease. Cross-sectional results of the Sleep Heart Health Study. American Journal of Respiratory and Critical Care Medicine, 163, 19–25.CrossRefGoogle Scholar
Sheslow, D. & Adams, W. (1990). Wide Range Assessment of Memory and Learning. Wilmington, DE: Wide Range, Inc.
SPPS for Windows version 9.0. (1998). Chicago, IL: Author.
Talley, J.L. (1993). Children's Auditory Verbal Learning Test–2. Odessa, FL: Psychological Assessment Resources, Inc.
The Psychological Corporation. (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Author.
Wechsler, D. (1991). Wechsler Intelligence Scale for Children (3rd ed.). New York: Psychological Corporation.
Woodcock, R.W. & Johnson, M.B. (1989, 1990). Woodcock-Johnson Psycho-Educational Battery–Revised. Allen, TX: DLM Teaching Resources.
Yesavage, J., Bliwise, D., Guilleminault, C., Carskadon, M., & Dement, W. (1985). Preliminary communication: Intellectual deficit and sleep-related respiratory disturbance in the elderly. Sleep, 8, 30–33.CrossRefGoogle Scholar
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993). The occurrence of sleep-disordered breathing among middle-aged adults. New England Journal of Medicine, 328, 1230–1235.CrossRefGoogle Scholar