CHILDREN with sleep breathing disorders may experience significant cognitive and neuropsychological impairments, according to a new systematic review and meta-analysis. The study quantifies deficits in areas such as attention, memory, and executive function compared to healthy peers.
The research analysed 15 case-control studies involving a total of 1,137 children, of which 659 had verified sleep breathing disorders. Neurocognitive performance was assessed using the Wechsler Intelligence Scale for Children (WISC), a standardised test for cognitive function.
Cognitive Impact of Sleep Breathing Disorders in Children
The meta-analysis revealed that children with sleep breathing disorders performed significantly worse than healthy controls across almost all cognitive domains measured. Only the Vocabulary domain showed no statistically significant difference. The findings suggest that sleep breathing disorders may directly affect brain development, particularly the prefrontal cortex, which governs executive functions and learning.
Possible Mechanisms Behind Cognitive Deficits
Researchers suggest that the poorer cognitive performance in children with sleep breathing disorders may be caused by intermittent hypoxia during sleep due to disrupted breathing, as well as sleep fragmentation from frequent awakenings. Both factors could interfere with attention, memory, and overall school performance. Nocturnal hypoxaemia and sleep deprivation were highlighted as potential drivers of daytime cognitive impairment.
Neurocognitive Risks for Development
Untreated sleep-related cognitive impairments during childhood could have long-term consequences on intellectual development. Early identification and treatment of sleep breathing disorders, including interventions for mouth breathing and obstructive sleep apnoea, may help mitigate these risks and support healthier cognitive outcomes.
Need for Further Research
While this study provides strong evidence for the link between sleep breathing disorders and cognitive deficits, further research is needed to clarify the exact pathophysiological pathways. Understanding whether hypoxia or sleep fragmentation plays a larger role will be critical for designing effective interventions.
The findings highlight the importance of screening for sleep breathing disorders in children, particularly in cases of academic difficulties, learning challenges, or behavioural issues.
Reference
Fantozzi D et al. Neurocognitive abilities in children affected by sleep breathing disorders. A systematic review and meta-analysis of case control-studies. Eur J Paediatr Dent. 2026;27(1):86-95.
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