What are the adverse effects of sleep fragmentation due to childhood obstructive sleep apnea (OSA)?

Updated: Feb 13, 2019
  • Author: Mary E Cataletto, MD; Chief Editor: Denise Serebrisky, MD  more...
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Healthy adults who were awakened at various intervals during the night demonstrated performance decrements and increased sleepiness on the following day. [9] This was also true when EEG arousals, rather than behavioral arousals, were induced.

The physiological and behavioral effects of partial and total sleep loss due to obstructive sleep apnea in adults have been extensively investigated. Daytime tiredness or fatigue is a common symptom, although sleepiness, which is a subjective notion, may not be directly reported. Significant deterioration in functions that require concentration or dexterity, as well as automatic behavior with retrograde amnesia, disorientation, and morning confusion, have all been reported in patients with sleep fragmentation and has led to the term sleep drunkenness. In addition, personality changes and abnormal behavioral outbursts follow sleep fragmentation. Aggressiveness, irritability, anxiety attacks, and depression may occur.

Sleep fragmentation in adults affects neuropsychological and cognitive performance. No evidence suggests such impairments are absent in children, and such deleterious effects may be worse, given that the child's brain is undergoing active developmental changes. Reports of decreased intellectual function in children with tonsillar and adenoidal hypertrophy date from 1889 when Hill reported on "some causes of backwardness and stupidity in children." Schooling problems have been repeatedly reported in case studies of children with obstructive sleep apnea and, in fact, may underlie more extensive behavioral disturbances, such as restlessness, aggressive behavior, excessive daytime sleepiness, and poor test performances.

The neurocognitive and behavioral consequences of disrupted sleep architecture and hypoxemia caused by sleep-disordered breathing in children with obstructive sleep apnea have only recently been defined by appropriate scientific methodology in the pediatric population. However, some studies have documented that children with sleep disorders tend to have behavioral problems similar to those observed in children with attention deficit hyperactivity disorder (ADHD). A survey study of 782 children documented daytime sleepiness, hyperactivity, and aggressive behavior in children who snore. [10] Inverse correlations between memory and learning performance and the severity of obstructive sleep apnea were also found, and other studies have clearly demonstrated significant improvements in school performance after treatment of obstructive sleep apnea.

In a study of 19 preschool-aged children with obstructive sleep apnea, prior to tonsillectomy and adenoidectomy, cognitive scores were significantly lower in children with obstructive sleep apnea versus control subjects. [11] Following tonsillectomy and adenoidectomy, the scores of the children with obstructive sleep apnea improved compared with preoperative scores and did not differ from those of the matched controls. This underscores the importance of diagnosis and treatment, insofar as the cognitive impairments of children, unlike adults, take place in the developing brain.

Sleep deprivation, sleep disruption, and intermittent hypoxia independently may be sufficient to cause daytime effects in vulnerable children. Preliminary evidence suggests that, if left untreated, sleep-disordered breathing may impose long-term decrements in academic performance and that the combination of 2 or more of these factors can result in particularly impaired daytime functioning.


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