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Executive Function in Pediatric Sleep-Disordered Breathing: A Meta-analysis

Published online by Cambridge University Press:  02 August 2016

Jonathan J. Mietchen ,
David P. Bennett ,
Trevor Huff ,
Dawson W. Hedges  and
Shawn D. Gale
Jonathan J. Mietchen
Affiliation:
Department of Psychology, Brigham Young University, Provo, Utah
David P. Bennett
Affiliation:
Neuroscience Center, Brigham Young University, Provo, Utah
Trevor Huff
Affiliation:
Neuroscience Center, Brigham Young University, Provo, Utah
Dawson W. Hedges
Affiliation:
Department of Psychology, Brigham Young University, Provo, Utah Neuroscience Center, Brigham Young University, Provo, Utah
Shawn D. Gale*
Affiliation:
Department of Psychology, Brigham Young University, Provo, Utah Neuroscience Center, Brigham Young University, Provo, Utah
*
Correspondence and reprint requests to: Shawn D. Gale, 1060 SWKT, Department of Psychology, Brigham Young University, Provo, Utah 84602. E-mail: shawn_gale@byu.edu
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Abstract

Objectives: Evaluate the association between pediatric sleep-disordered breathing (SDB) and executive functioning. Methods: We searched multiple electronic databases for peer-reviewed journal articles related to pediatric SDB and executive functioning. We included studies that assessed SDB via polysomnography, included objective or questionnaire measures of executive function, and had an age-matched control group. Fourteen articles met inclusion criteria with a total sample of 1697 children ages 5 to 17 years (M=9.81 years; SD=0.34). We calculated an overall effect size for each of the five executive domains (vigilance, inhibition, working memory, shifting, and generativity) as well as effect sizes according to SDB severity: mild, moderate, severe. We also calculated effect sizes separately for objective and subjective questionnaires of executive functioning. Results: We found a medium effect size (−0.427) for just one of five executive function domains on objective neuropsychological measures (generativity). In contrast, effect sizes on all three executive domains measured via questionnaire data were significant, with effect sizes ranging from medium (−0.64) to large (−1.06). We found no difference between executive domains by severity of SDB. Conclusions: This meta-analysis of executive function separated into five domains in pediatric SDB suggested lower performance in generativity on objective neuropsychological measures. There were no differences associated with SDB severity. Questionnaire data suggested dysfunction across the three executive domains measured (inhibition, working memory, shifting). Overall, limited evidence suggested poorer performance in executive function in children with SDB according to objective testing, and subjective ratings of executive function suggested additional worsened performance. (JINS, 2016, 22, 839–850)

Keywords

Sleep apneaSnoringChildAdolescentCognitionNeurobehavioral
Type
Short Review
Information
Journal of the International Neuropsychological Society , Volume 22 , Issue 8 , September 2016 , pp. 839 - 850
Copyright
Copyright © The International Neuropsychological Society 2016 

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References

Adrover-Roig, D., Sese, A., Barcelo, F., & Palmer, A. (2012). A latent variable approach to executive control in healthy ageing. Brain and Cognition, 78(3), 284–299. doi:10.1016/j.bandc.2012.01.005 Google Scholar
Amin, R.S., Kimball, T.R., Bean, J.A., Jeffries, J.L., Willging, J.P., Cotton, R.T., & Daniels, S.R. (2002). Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine, 165(10), 1395–1399. doi:10.1164/rccm.2105118 Google Scholar
Barkley, R.A., & Fischer, M. (2011). Predicting impairment in major life activities and occupational functioning in hyperactive children as adults: Self-reported executive function (EF) deficits versus EF tests. Developmental Neuropsychology, 36(2), 137–161. doi:10.1080/87565641.2010.549877 Google Scholar
Barkley, R.A., & Murphy, K.R. (2010). Impairment in occupational functioning and adult ADHD: The predictive utility of executive function (EF) ratings versus EF tests. Archives of Clinical Neuropsychology, 25(3), 157–173. doi:10.1093/arclin/acq014 Google Scholar
Beebe, D.W. (2006). Neurobehavioral morbidity associated with disordered breathing during sleep in children: A comprehensive review. Sleep, 29(9), 1115–1134.Google Scholar
Beebe, D.W., & Gozal, D. (2002). Obstructive sleep apnea and the prefrontal cortex: Towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits. Journal of Sleep Research, 11(1), 1–16.Google Scholar
*Beebe, D.W., Ris, M.D., Kramer, M.E., Long, E., & Amin, R. (2010). The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. Sleep, 33(11), 1447–1456.Google Scholar
*Beebe, D.W., Wells, C.T., Jeffries, J., Chini, B., Kalra, M., & Amin, R. (2004). Neuropsychological effects of pediatric obstructive sleep apnea. Journal of the International Neuropsychological Society, 10(7), 962–975.Google Scholar
*Biggs, S.N., Bourke, R., Anderson, V., Jackman, A.R., Killedar, A., Nixon, G.M., & Horne, R.S.C. (2011). Working memory in children with sleep-disordered breathing: Objective versus subjective measures. Sleep Medicine, 12(9), 887–891. doi:10.1016/j.sleep.2011.07.003 Google Scholar
*Blunden, S., Lushington, K., Kennedy, D., Martin, J., & Dawson, D. (2000). Behavior and neurocognitive performance in children aged 5-10 years who snore compared to controls. Journal of Clinical and Experimental Neuropsychology, 22(5), 554–568. doi:10.1076/1380-3395(200010)22:5;1-9;Ft554 Google Scholar
Borenstein, M., Hedges, L.V., Higgins, J.P.T., & Rothstein, H.R. (2009). Introduction to meta-analysis. Chichester, UK: John Wiley & Sons.Google Scholar
*Bourke, R., Anderson, V., Yang, J.S., Jackman, A.R., Killedar, A., Nixon, G.M., & Horne, R.S. (2011a). Cognitive and academic functions are impaired in children with all severities of sleep-disordered breathing. Sleep Medicine, 12(5), 489–496. doi:10.1016/j.sleep.2010.11.010 Google Scholar
*Bourke, R., Anderson, V., Yang, J.S.C., Jackman, A.R., Killedar, A., Nixon, G.M., & Horne, R.S.C. (2011b). Neurobehavioral function is impaired in children with all severities of sleep disordered breathing. Sleep Medicine, 12(3), 222–229. doi:http://dx.doi.org/10.1016/j.sleep.2010.08.011 Google Scholar
Bull, R., Espy, K.A., & Wiebe, S.A. (2008). Short-term memory, working memory, and executive functioning in preschoolers: Longitudinal predictors of mathematical achievement at age 7 years. Developmental Neuropsychology, 33(3), 205–228.Google Scholar
Burgess, P.W., Alderman, N., Evans, J., Emslie, H., & Wilson, B.A. (1998). The ecological validity of tests of executive function. Journal of the International Neuropsychological Society, 4(06), 547–558.Google Scholar
*Calhoun, S.L., Mayes, S.D., Vgontzas, A.N., Tsaoussoglou, M., Shifflett, L.J., & Bixler, E.O. (2009). No relationship between neurocognitive functioning and mild sleep disordered breathing in a community sample of children. Journal of Clinical Sleep Medicine, 5(3), 228–234.Google Scholar
Cartwright, K.B. (2012). Insights from cognitive neuroscience: The importance of executive function for early reading development and education. Early Education & Development, 23(1), 24–36.Google Scholar
Chervin, R.D., Ruzicka, D.L., Giordani, B.J., Weatherly, R.A., Dillon, J.E., Hodges, E.K., & Guire, K.E. (2006). Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics, 117(4), e769–e778.Google Scholar
Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135–168. doi:10.1146/annurev-psych-113011-143750 Google Scholar
Duke, D.C., & Harris, M.A. (2014). Executive function, adherence, and glycemic control in adolescents with type 1 diabetes: A literature review. Current Diabetes Reports, 14(10), 532. doi:10.1007/s11892-014-0532-y Google Scholar
*Esposito, M., Antinolfi, L., Gallai, B., Parisi, L., Roccella, M., Marotta, R., & Carotenuto, M. (2013). Executive dysfunction in children affected by obstructive sleep apnea syndrome: An observational study. Neuropsychiatric Disease and Treatment, 9, 1087–1094. doi:10.2147/NDT.S47287 Google Scholar
Ferini-Strambi, L., Baietto, C., Di Gioia, M., Castaldi, P., Castronovo, C., Zucconi, M., & Cappa, S. (2003). Cognitive dysfunction in patients with obstructive sleep apnea (OSA): Partial reversibility after continuous positive airway pressure (CPAP). Brain Research Bulletin, 61(1), 87–92.Google Scholar
Forbes, N., Carrick, L., McIntosh, A., & Lawrie, S. (2009). Working memory in schizophrenia: A meta-analysis. Psychological Medicine, 39(06), 889–905.Google Scholar
Ganesalingam, K., Yeates, K.O., Taylor, H.G., Walz, N.C., Stancin, T., & Wade, S. (2011). Executive functions and social competence in young children 6 months following traumatic brain injury. Neuropsychology, 25(4), 466–476. doi:10.1037/a0022768 Google Scholar
*Giordani, B., Hodges, E.K., Guire, K.E., Ruzicka, D.L., Dillon, J.E., Weatherly, R.A., & Chervin, R.D. (2008). Neuropsychological and behavioral functioning in children with and without obstructive sleep apnea referred for tonsillectomy. Journal of the International Neuropsychological Society, 14(4), 571–581. doi:10.1017/S1355617708080776 Google Scholar
Gross, A.C., Deling, L.A., Wozniak, J.R., & Boys, C.J. (2015). Objective measures of executive functioning are highly discrepant with parent-report in fetal alcohol spectrum disorders. Child Neuropsychology, 21(4), 531–538.Google Scholar
*Halbower, A.C., Degaonkar, M., Barker, P.B., Earley, C.J., Marcus, C.L., Smith, P.L., & Mahone, E.M. (2006). Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. PLoS Medicine, 3(8), e301. doi:10.1371/journal.pmed.0030301 Google Scholar
*Hannon, T.S., Rofey, D.L., Ryan, C.M., Clapper, D.A., Chakravorty, S., & Arslanian, S.A. (2012). Relationships among obstructive sleep apnea, anthropometric measures, and neurocognitive functioning in adolescents with severe obesity. Journal of Pediatrics, 160(5), 732–735. doi:10.1016/j.jpeds.2011.10.029 Google Scholar
Johnston, M.V. (2009). Plasticity in the developing brain: Implications for rehabilitation. Developmental Disabilities Research Reviews, 15(2), 94–101.Google Scholar
Kylstra, W.A., Aaronson, J.A., Hofman, W.F., & Schmand, B.A. (2013). Neuropsychological functioning after CPAP treatment in obstructive sleep apnea: A meta-analysis. Sleep Medicine Reviews, 17(5), 341–347. doi:10.1016/j.smrv.2012.09.002 Google Scholar
Langner, R., & Eickhoff, S.B. (2013). Sustaining attention to simple tasks: A meta-analytic review of the neural mechanisms of vigilant attention. Psychological Bulletin, 139(4), 870–900. doi:10.1037/a0030694 Google Scholar
Lehto, J.E., Juujärvi, P., Kooistra, L., & Pulkkinen, L. (2003). Dimensions of executive functioning: Evidence from children. British Journal of Developmental Psychology, 21(1), 59–80.Google Scholar
Marcus, C.L., Moore, R.H., Rosen, C.L., Giordani, B., Garetz, S.L., Taylor, H.G., ... Childhood Adenotonsillectomy Tial. (2013). A randomized trial of adenotonsillectomy for childhood sleep apnea. New England Journal of Medicine, 368(25), 2366–2376. doi:10.1056/NEJMoa1215881 Google Scholar
McNamara, J.P., Reid, A.M., Balkhi, A.M., Bussing, R., Storch, E.A., Murphy, T.K., & Geffken, G.R. (2014). Self-regulation and other executive functions relationship to pediatric OCD severity and treatment outcome. Journal of Psychopathology and Behavioral Assessment, 36(3), 432–442.CrossRefGoogle Scholar
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., Howerter, A., & Wager, T.D. (2000). The unity and diversity of executive functions and their contributions to complex “Frontal Lobe“ tasks: A latent variable analysis. Cognitive Psychology, 41(1), 49–100. doi:10.1006/cogp.1999.0734 Google Scholar
Moffitt, T.E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R.J., Harrington, H., & Caspi, A. (2011). A gradient of childhood self-control predicts health, wealth, and public safety. Proceedings of the National Academy of Sciences of the United States of America, 108(7), 2693–2698. doi:10.1073/pnas.1010076108 Google Scholar
Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Medicine, 6(7), e1000097. doi:10.1371/journal.pmed.1000097 Google Scholar
*O’Brien, L.M., Mervis, C.B., Holbrook, C.R., Bruner, J.L., Smith, N.H., McNally, N., & Gozal, D. (2004). Neurobehavioral correlates of sleep-disordered breathing in children. Journal of Sleep Research, 13(2), 165–172. doi:10.1111/j.1365-2869.2004.00395.x Google Scholar
Olaithe, M., & Bucks, R.S. (2013). Executive dysfunction in OSA before and after treatment: A meta-analysis. Sleep, 36(9), 1297–1305. doi:10.5665/sleep.2950 Google Scholar
Owens, J., Spirito, A., Marcotte, A., McGuinn, M., & Berkelhammer, L. (2000). Neuropsychological and behavioral correlates of obstructive sleep apnea syndrome in children: A preliminary study. Sleep Breath, 4(2), 67–78. doi:10.1055/s-2000-19814 Google Scholar
*Quan, S.F., Archbold, K., Gevins, A.S., & Goodwin, J.L. (2013). Long-term neurophysiologic impact of childhood sleep disordered breathing on neurocognitive performance. Southwest Journal of Pulmonary & Critical Care, 7(3), 165–175.Google Scholar
Reinert, K.R., Po’e, E.K., & Barkin, S.L. (2013). The relationship between executive function and obesity in children and adolescents: A systematic literature review. Journal of Obesity, 2013, 820956.Google Scholar
Riggs, N.R., Huh, J., Chou, C.P., Spruijt-Metz, D., & Pentz, M.A. (2012). Executive function and latent classes of childhood obesity risk. Journal of Behavioral Medicine, doi:10.1007/s10865-011-9395-8 Google Scholar
Rosen, C.L., Larkin, E.K., Kirchner, H.L., Emancipator, J.L., Bivins, S.F., Surovec, S.A., & Redline, S. (2003). Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: Association with race and prematurity. Journal of Pediatrics, 142(4), 383–389. doi:10.1067/mpd.2003.28 Google Scholar
Roth, R.M., Erdodi, L.A., McCulloch, L.J., & Isquith, P.K. (2015). Much ado about norming: The Behavior Rating Inventory of Executive Function. Child Neuropsychology, 21(2), 225–233.Google Scholar
*Tan, E., Healey, D., Schaughency, E., Dawes, P., & Galland, B. (2014). Neurobehavioural correlates in older children and adolescents with obesity and obstructive sleep apnoea. Journal of Paediatrics and Child Health, 50(1), 16–23. doi:10.1111/jpc.12390 Google Scholar
Toplak, M.E., Bucciarelli, S.M., Jain, U., & Tannock, R. (2009). Executive functions: Performance-based measures and the behavior rating inventory of executive function (BRIEF) in adolescents with attention deficit/hyperactivity disorder (ADHD). Child Neuropsychology, 15(1), 53–72. doi:10.1080/09297040802070929 Google Scholar
Toplak, M.E., West, R.F., & Stanovich, K.E. (2013). Practitioner review: Do performance-based measures and ratings of executive function assess the same construct? Journal of Child Psychology and Psychiatry and Allied Disciplines, 54(2), 131–143. doi:10.1111/jcpp.12001 Google Scholar
Vriezen, E.R., & Pigott, S.E. (2002). The relationship between parental report on the BRIEF and performance-based measures of executive function in children with moderate to severe traumatic brain injury. Child Neuropsychology, 8(4), 296–303.Google Scholar
Willcutt, E.G., Doyle, A.E., Nigg, J.T., Faraone, S.V., & Pennington, B.F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57(11), 1336–1346. doi:10.1016/j.biopsych.2005.02.006 Google Scholar
Yeates, K.O., Ris, M.D., Taylor, H.G., & Pennington, B.F. (Eds.). (2010). Pediatric neuropsychology“ research, theory, and practice (2nd ed.). New York: The Guilford Press.Google Scholar
Zelazo, P.D., & Carlson, S.M. (2012). Hot and cool executive function in childhood and adolescence: Development and plasticity. Child Development Perspectives, 6(4), 354–360.Google Scholar
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