cohort studies found decrements in intelligence quotient, impaired learning, and vocabulary in children with polysomnography-confirmed cases (Rhodes et al., 1995; Blunden et al., 2000). A study of younger children with sleep apnea also did not find a relationship with academic performance, after adjusting for the effects of socioeconomic status (Chervin et al., 2003). O’Brien and colleagues (2004) found that 35 children with sleep-disordered breathing, compared with matched controls, showed significant deficits in neurocognition, including overall cognitive ability, as well as attention and executive function, but the study did not find behavioral differences. A previous study by the same researchers found higher symptoms of ADHD, according to parents’ reports, in children with OSA (O’Brien et al., 2003). Several other studies have found greater symptoms of ADHD in children with OSA than controls (Weissbluth and Liu, 1983; Stradling et al., 1990; Chervin et al., 1997).

The neurobehavioral effects of OSA may be partially reversible with tonsillectomy and adenoidectomy, a surgical procedure that opens the airway. Treatment is related to partial improvement in school performance, cognition, or behavior (Ali et al., 1996; Friedman et al., 2003). A limitation to this work is that it is often difficult to control for the many confounders that influence cognitive function, with a recent study showing that after robustly adjusting for neighborhood socioeconomic status (Emancipator et al., 2006), effects were much attenuated, although they persisted in a subgroup of children who had been born prematurely. No randomized controlled study has been conducted to address the potential reversibility of cognitive deficits with sleep-disordered breathing; such data would more definitively address this situation. Gozal (1998) studied 54 children with sleep-disordered breathing and low school performance. Half of them underwent surgical tonsillectomy and adenoidectomy to treat OSA. Children undergoing the interventions improved their academic performance, compared to untreated children. One problem with the study design; however, was that surgical treatment was not randomly assigned (parents elected whether or not their children could receive surgery). Given the high proportion of children with sleep-disordered breathing, especially in vulnerable groups such as children in minority populations and those born prematurely, there is a large need to address the role of sleep-disordered breathing and its reversibility in these important outcomes.

Sleep-Disordered Breathing and Cognitive Impairment in Adults

Several cross-sectional studies indicate that sleep-disordered breathing in adults is associated with impaired cognitive function (Greenberg et al., 1987; Bedard et al., 1991; Naegele et al., 1995; Redline et al., 1997; Kim et al., 1997). Cognitive deficits, in turn, partially contribute to poorer work



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