Working memory in children with sleep-disordered breathing: objective versus subjective measures.

BACKGROUND: Parents consistently report working memory deficits in children with sleep-disordered breathing (SDB); however, results from objective testing measures are inconsistent. This study aims to examine and compare working memory performance in children with various degrees of severity of SDB using both parent report and objective testing. METHODS: Subjects included 127 children aged 7-12 years (mean age 9.6 ± 1.6 y: 71 M/56 F). Overnight polysomnography classified subjects into four groups: control (N=34); primary snoring (PS: N=55), mild obstructive sleep apnoea (mild OSA: N=22) and moderate to severe OSA (MS OSA: N=16). The Behaviour Rating Inventory of Executive Function (BRIEF) was used as the parent reported measure of working memory. A computerised task involving immediate recognition of playing cards (CogHealth) was used as the objective measure. RESULTS: Results of the BRIEF revealed working memory deficits at all severities of SDB compared to controls. Results of CogHealth revealed no difference between SDB groups and controls; however, mild OSA performed significantly worse than PS. Comparison of the two measures revealed that parents of controls reported less deficits, and parents of PS reported more deficits, than were found on the objective measure of working memory. CONCLUSIONS: This study showed that parents of children with less severe SDB have a tendency to overestimate the level of working memory deficit in their children, possibly as a reflection of behaviour. This suggests that observation of deficits in working memory may be largely dependent on the assessment method and children with SDB may not be as impaired as previously thought.

Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing.

STUDY OBJECTIVE: The impact of the broad spectrum of SDB severity on cognition in childhood has not been well studied. This study investigated cognitive function in children with varying severities of SDB and control children with no history of SDB. METHODS: One hundred thirty-seven children (75 M) aged 7-12 were studied. Overnight polysomnography (PSG) classified children into four groups: primary snoring (PS) (n = 59), mild obstructive sleep apnea syndrome (OSAS) (n = 24), moderate/severe OSAS (n = 19), and controls (n = 35). Cognition was measured with a short battery of psychological tests including the Wechsler Abbreviated Scale of Intelligence (WASI), the Wide Range Achievement Test-3rd Edition (WRAT-3), the Rey Complex Figure Test (RCFT) and the Controlled Oral Word Association Test (COWAT). RESULTS: There was lower general intellectual ability in all children with SDB regardless of severity. Higher rates of impairment were also noted on measures of executive and academic functioning in children with SDB. CONCLUSIONS: Our findings suggest that neurocognitive deficits are common in children with SDB regardless of disease severity, highlighting that such difficulties may be present in children in the community who snore but are otherwise healthy; thus our results have important implications for the treatment of pediatric SDB.

Neurobehavioral function is impaired in children with all severities of sleep disordered breathing.

OBJECTIVE: Sleep disordered breathing (SDB) is common in children and ranges in severity from primary snoring (PS), to obstructive sleep apnea syndrome (OSAS). This study investigated everyday function (behavior, attention, executive skills) in children with varying degrees of SDB and control children with no history of SDB recruited from the community. METHODS: One hundred thirty-six children aged 7-12 were studied. Routine overnight polysomnography (PSG) classified children into 4 groups: PS (n=59), mild OSAS (n=24), moderate/severe OSAS (n=18), and controls (n=35). Behavioral function and behavioral aspects of attention and executive function were assessed using the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF). RESULTS: Children with all severities of SDB had significantly higher rates of total, internalizing and externalizing behavioral problems compared to control children. Increased rates of behavioral executive dysfunction were also found across the SDB spectrum. CONCLUSION: Our findings suggest that behavioral, attention, and executive function difficulties are present in children with PS as well as OSAS. These results have implications for the treatment of milder forms of SDB, particularly PS, which is commonly viewed as benign.

Inference-based retrospective revaluation in human causal judgments requires knowledge of within-compound relationships.

In an allergist causal-judgment task, food compounds were followed by an allergic reaction (e.g., AB+), and then 1 cue (A) was revalued. Experiment 1, in which participants who were instructed that whatever was true about one element of a causal compound was also true of the other, showed a reverse of the standard retrospective revaluation effect. That is, ratings of B were higher when A was causal (A+) than when A was safe (A-). This effect was taken to reflect inferential reasoning, not an associative mechanism. In Experiment 2, within-compound associations were found to be necessary to produce this inference-based revaluation. Therefore, evidence that within-compound associations are necessary for retrospective revaluation is consistent with the inferential account of causal judgments.