The intricate relationship between mild sleep-disordered breathing (mSDB) in children, their quality of life (QOL), and cognitive abilities has been a subject of deep scientific interest. A pivotal study by Yu et al. (2024) delves into this connection, presenting strong evidence that symptom severity and QOL measures can serve as predictors of executive function challenges in children with mSDB. Published in JAMA Otolaryngology–Head & Neck Surgery, this research exemplifies a blend of rigorous data analysis and clinical applicability, contributing significantly to the field of paediatric sleep medicine.

Key Findings and Research Approach

Yu et al. conducted a cross-sectional study using data from the Paediatric Adenotonsillectomy Trial for Snoring (PATS), a large, multicenter, randomized clinical trial. This research included 459 children aged 3 to 12 years diagnosed with mSDB, confirmed through polysomnography and assessments like the Obstructive Sleep Apnea-18 (OSA-18) and the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD). To evaluate executive function, researchers employed the Behaviour Rating Inventory of Executive Function (BRIEF) and the GoNoGo vigilance test.

The primary conclusion—that higher symptom burden and reduced QOL are strongly linked to executive function deficits—underscores the importance of caregiver-reported outcomes. Notably, OSA-18 and PSQ-SRBD scores displayed moderate correlations (r ≈ 0.58–0.59) with BRIEF Global Executive Composite (GEC) scores. These findings highlight the utility of these tools in identifying children at risk for neurocognitive challenges.

Quality of Life as a Key Indicator of Cognitive Issues

The OSA-18, a validated QOL assessment tool, emerged as a strong predictor of executive dysfunction in children with mSDB. A single-point increase in the OSA-18 score was associated with a 0.41-point rise in BRIEF GEC scores, even after accounting for factors like age, sex, body mass index, and socioeconomic background. This finding emphasizes the need for comprehensive QOL evaluations in clinical settings, especially when polysomnography fails to capture the broader impact of mSDB on children’s well-being.

Symptom Burden and Cognitive Performance

The severity of symptoms, as measured by the PSQ-SRBD, also showed a strong correlation with executive dysfunction. A 0.1-point increase in PSQ-SRBD scores predicted significant declines in inhibitory control and sustained attention, as demonstrated through the GoNoGo test. These insights reveal the wide-reaching effects of mSDB beyond respiratory symptoms, highlighting its impact on cognitive and behavioural functions.

Implications for Clinical Practice

The findings of this study carry significant implications for paediatric otolaryngology and sleep medicine. By validating the effectiveness of tools like the OSA-18 and PSQ-SRBD, Yu et al. advocate for their routine use in clinical practice. These instruments can help identify children at risk for cognitive impairments and guide treatment decisions, such as whether to pursue adenotonsillectomy or adopt a watchful waiting approach.

Moreover, the research challenges the traditional reliance on apnoea-hypopnea index (AHI) as the sole criterion for determining treatment necessity. By shedding light on the nuanced effects of mSDB on QOL and executive function, this study supports a more holistic, patient-centered approach to care.

Strengths and Limitations of the Study

Yu et al.’s study stands out for its methodological rigor and clinical relevance. The large and diverse sample enhances the generalizability of the findings, while the use of validated instruments ensures robust data. However, relying on caregiver-reported measures introduces the possibility of bias, and the lack of post-treatment longitudinal data limits insights into how QOL and cognitive function evolve after interventions.

Conclusion and Future Research

This groundbreaking study deepens our understanding of how mSDB affects children’s neurocognitive and behavioural health, highlighting the critical role of QOL and symptom evaluations in paediatric sleep medicine. Future research should focus on the long-term effects of treatments like adenotonsillectomy on QOL and executive function. Additionally, developing child-focused tools could enhance the accuracy and reliability of these assessments.

Yu et al. and the team at JAMA Otolaryngology–Head & Neck Surgery deserve recognition for their valuable contributions. Their work not only advances clinical knowledge but also underscores the importance of addressing the broader impacts of mSDB to improve the overall well-being of affected children.

Dr. Prahlada N.B
MBBS (JJMMC), MS (PGIMER, Chandigarh). 
MBA in Healthcare & Hospital Management (BITS, Pilani), 
Postgraduate Certificate in Technology Leadership and Innovation (MIT, USA)
Executive Programme in Strategic Management (IIM, Lucknow)
Senior Management Programme in Healthcare Management (IIM, Kozhikode)
Advanced Certificate in AI for Digital Health and Imaging Program (IISc, Bengaluru). 

Senior Professor and former Head, 
Department of ENT-Head & Neck Surgery, Skull Base Surgery, Cochlear Implant Surgery. 
Basaveshwara Medical College & Hospital, Chitradurga, Karnataka, India. 

My Vision: I don’t want to be a genius.  I want to be a person with a bundle of experience. 

My Mission: Help others achieve their life’s objectives in my presence or absence!

My Values:  Creating value for others. 

Leave a reply