Symptoms, Quality of Life, and Executive Function in Children Who Snore

Introduction: Mild sleep-disordered breathing (mSDB) in children is associated with both neurobehavioral morbidity and reduced quality of life (QOL). However, the association between symptom burden and QOL with executive function is not well understood, and it is not known whether QOL and symptom burden may help identify children with neurocognitive dysfunction. Objective: To assess associations among executive function, QOL, and symptom burden in children with mSDB. Design, Setting, and Participants: This cross-sectional study was a secondary analysis of the multicenter Pediatric Adenotonsillectomy Trial for Snoring, which included children aged 3 to 12 years randomized to watchful waiting or adenotonsillectomy for mSDB (snoring and an obstructive apnea-hypopnea index <3) between June 29, 2016, and February 1, 2021. The data for this report were analyzed between December 22, 2020, and October 3, 2024. Exposure: Pediatric mSDB. Main Outcomes and Measures: Quality of life was assessed using the Obstructive Sleep Apnea-18 (OSA-18), and symptom burden was assessed using the Pediatric Sleep Questionnaire-Sleep-Related Breathing Disorder Scale (PSQ-SRBD). Executive function, including self-control and working memory, was measured using the Behavior Rating Inventory of Executive Function Global Executive Composite (BRIEF GEC), and inhibitory control and sustained attention were measured by the GoNoGo vigilance test. Partial Pearson correlations and multiple linear regression models were used to assess the associations among QOL, symptoms, and executive function. Results: The sample included 459 children (mean SD age, 6.1 2.3 years; 230 female 50.1%). Moderate correlations were found between the BRIEF GEC and the PSQ-SRBD and OSA-18 (r = 0.58 95% CI, 0.51-0.64 and 0.59 95% CI, 0.52-0.64, respectively). After adjusting for age, sex, race and ethnicity, body mass index percentile, household income, maternal education, attention-deficit/hyperactivity disorder, test characteristics, and disease severity, both OSA-18 and PSQ-SRBD scores were associated with the BRIEF GEC (β = 0.41 95% CI, 0.36-0.47 and 3.66 95% CI, 3.17-4.15, respectively). In the fully adjusted model, PSQ-SRBD was also associated with GoNoGo inhibitory control (β = -0.04 95% CI, -0.08 to -0.01) and sustained attention (β = -0.05 95% CI, -0.10 to -0.01). Conclusions and Relevance: In this study, disease-specific QOL and symptom burden were associated with executive function in children with mSDB. These findings may be useful in identifying those children who are at risk for neurocognitive dysfunction.