Associations Between Sleep-Disordered Breathing and Behavioral and Cognitive Functions in Children With and Without Attention-Deficit/Hyperactivity Disorder

Kyoung Min Kim; Myung Ho Lim; Mina Ha; Ho-Jang Kwon

doi:10.1016/j.jaclp.2021.10.002

Associations Between Sleep-Disordered Breathing and Behavioral and Cognitive Functions in Children With and Without Attention-Deficit/Hyperactivity Disorder

J Acad Consult Liaison Psychiatry. 2022 May-Jun;63(3):234-243. doi: 10.1016/j.jaclp.2021.10.002. Epub 2021 Oct 13.

Authors

Kyoung Min Kim¹, Myung Ho Lim², Mina Ha³, Ho-Jang Kwon⁴

Affiliations

¹ Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea; Environmental Health Center, Dankook University Medical Center, Cheonan, Republic of Korea.
² Environmental Health Center, Dankook University Medical Center, Cheonan, Republic of Korea; Department of Psychology, College of Health Science, Dankook University, Cheonan, Republic of Korea.
³ Environmental Health Center, Dankook University Medical Center, Cheonan, Republic of Korea; Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea.
⁴ Environmental Health Center, Dankook University Medical Center, Cheonan, Republic of Korea; Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea. Electronic address: hojangkwon@gmail.com.

PMID: 34653671
DOI: 10.1016/j.jaclp.2021.10.002

Abstract

Background: Sleep-related problems are highly prevalent comorbidities in Attention-Deficit/Hyperactivity Disorder (ADHD).

Objective: This study aimed to investigate the associations between sleep-disordered breathing (SDB) and behavioral and cognitive functions in children with and without ADHD.

Methods: A total of 341 children were included (ADHD group: 155, control group: 186; age: 6-10 years). The participants' sleep-related symptoms were assessed using a parent-rated questionnaire, and they were categorized into low- and high-risk SDB groups based on their scores. Behavioral symptoms were assessed using the Behavioral Assessment System for Children, Second Edition (BASC-2), and cognitive sustained attention and inhibitory control were assessed using a computer-based continuous performance test.

Results: In the ADHD group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in externalizing problems (F = 4.22; P = 0.042), including hyperactivity (F = 4.65; P = 0.033) and attention problems (F = 8.19; P = 0.005), but not internalizing problems. Meanwhile, in the control group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in internalizing problems (F = 9.89; P = 0.002), depression (F = 9.45; P = 0.002), and somatization (F = 7.83; P = 0.006), as well as in externalizing problems (F = 7.72; P = 0.006), including hyperactivity (F = 6.23; P = 0.013), aggression (F = 5.00; P = 0.027), and conduct problems (F = 6.79; P = 0.010). Contrary to the behavioral outcomes, none of the attention performance subscale scores showed significant differences between the high- and low-risk SDB groups in either the ADHD or control group.

Conclusions: The present findings suggest that SDB is associated with behavioral problems in children with ADHD and controls, with stronger associations in control children. On the contrary, SDB has no association with cognitive attention performance. This study extends our understanding of the associations of SDB with behavioral symptoms and cognitive functions in children.

Keywords: attention-deficit/hyperactivity disorder; behavior; child; cognition; sleep-disordered breathing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / epidemiology
Child
Cognition
Humans
Problem Behavior*
Sleep
Sleep Apnea Syndromes* / complications
Sleep Apnea Syndromes* / epidemiology
Sleep Apnea Syndromes* / psychology