Cognition, temperament and cerebral blood flow velocity in toddlers and preschool children with sleep disordered breathing or behavioral insomnia of childhood

Publication date: Available online 17 February 2016
Source:Sleep Medicine
Author(s): Rachael Spooner, Kurt Lushington, Hannah A.D. Keage, Sarah Blunden, J. Declan Kennedy, Mark Schembri, David Wabnitz, James Martin, Mark J. Kohler
BackgroundCognitive decrements, problematic behaviours and increased cerebral blood flow velocities (CBFV) have been reported in children aged 3-7 years with sleep disordered breathing (SDB). Whether similar impairments in younger children or those with behavioral insomnia of childhood (BIC) is unclear. This study aimed to compare cognition and temperament in children aged 1-5 years with SDB or BIC to healthy control children, and to investigate whether cognitive or behavioral deficits associated with sleep problems are related to changes in CBFV.MethodToddlers and preschool aged children (12-67 months) who had been referred for the clinical evaluation of SDB (n =20) or BIC (n =13) and a comparative sample of non-snoring healthy sleepers (controls; n =77) were recruited from the community. Children underwent cognitive assessment (Mullen's Scale of Early Learning) and measurement of resting bilateral CBFV in the Middle Cerebral Artery using Transcranial Doppler. Parents completed temperament scales (Early Childhood or Childhood Behaviour Questionnaire), a sleep problems questionnaire (Pediatric Sleep Problem Survey Instrument) and performed home-based pediatric sleep monitoring (Actigraphy and Sleep Diary).ResultsSDB children demonstrated impaired receptive skills, more hyperactive and energetic temperaments, and higher bilateral CBFV than controls and children with BIC. Logistic regression analyses indicated that impaired cognition, temperamental difficulties and increased CBFV are independently associated with SDB.ConclusionsDuring early childhood, problematic temperaments, cognitive deficits and altered cerebrovascular functioning are associated with SDB but not BIC. CBFV does not appear to mediate these daytime deficits, and instead may be an independent outcome of SDB. The findings support the need for early intervention in pediatric SDB.



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