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STUDY OBJECTIVES: Children with snoring and mild sleep-disordered breathing may be at increased risk for neurocognitive deficits despite few obstructive events. We hypothesized that actigraphy-based sleep duration and continuity associate with neurobehavioral functioning and explored whether these associations vary by demographic and socioeconomic factors.
METHODS: 298 children enrolled in the Pediatric Adenotonsillectomy Trial, aged 3 to 12 years, 47.3% from racial or ethnic minority groups, with habitual snoring and an apnea-hypopnea index <3 were studied with actigraphy (mean 7.5 ± 1.4 days) and completed a computerized vigilance test (Go-No-Go) and a test of fine motor control (9-Hole Pegboard). Caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF). Regression analyses evaluated associations between sleep exposures (24-hour and nocturnal sleep duration, sleep fragmentation index, sleep efficiency) with the BRIEF Global Executive Composite index, pegboard completion time (fine motor control), and vigilance (d prime on the Go-No-Go), adjusting for demographic factors and study design measures.
RESULTS: Longer sleep duration, higher sleep efficiency and lower sleep fragmentation were associated with better executive function; each additional hour of sleep over 24 hours associated with more than a 3-point improvement in executive function (p=0.002). Longer nocturnal sleep (p=0.02) and less sleep fragmentation (p=0.001) were associated with better fine motor control. Stronger associations were observed for boys and children less than six years old.
CONCLUSIONS: Sleep quantity and continuity are associated with neurocognitive functioning in children with mild sleep-disordered breathing, supporting efforts to target these sleep health parameters as part of interventions for reducing neurobehavioral morbidity.
CLINICAL TRIAL: Pediatric Adenotonsillectomy for Snoring (PATS), clinicaltrials.gov.: NCT02562040.