SAN ANTONIO — Children with obstructive sleep apnea get worse grades in school than do their classmates without sleep-disordered breathing, a study shows.
These 10- to 16-year-olds with even mild obstructive sleep apnea (OSA) were also independently rated both by parents and by teachers as more likely to have attention and learning problems, Dean W. Beebe, Ph.D., reported at the annual meeting of the Associated Professional Sleep Societies.
“There was an impressive impact of sleep-disordered breathing on academic grades. That leaves the subjects with moderate to severe sleep apnea at a serious disadvantage,” said Dr. Beebe of Cincinnati Children's Hospital Medical Center.
The study included 163 overweight youths aged 10–16 years, who were recruited from sleep or weight management clinics. Investigators rated 42 of them as having moderate to severe OSA based on an apnea-hypopnea index in excess of 5 events/hr. Another 58 had mild OSA, defined by an apnea-hypopnea index of 1–5 events/hr. Twenty-six participants were classified as snorers, while 37 were free of sleep-disordered breathing (SDB).
Subjects without SDB maintained a collective B average at school. Snorers trended toward lower grades, although the difference was not significant. But participants with OSA, whether mild or more severe, averaged half a grade point lower than did those without SDB. The difference—a B–/C+ average rather than a solid B—could have implications down the road in terms of college and career opportunities, Dr. Beebe noted.
Thirty percent of students with moderate to severe OSA had a C average or less, compared with just 15% of those without SDB. And while 15% of subjects with no SDB had an A average academically, that was the case for only a single student with moderate to severe OSA.
On the validated Behavior Assessment System for Children (BASC), teachers rated the students with mild or more severe OSA as having significantly more attention and learning problems than those without SDB. Teachers also rated the non-SDB youths significantly higher in terms of the BASC adaptive functioning domains of leadership, social skills, and study skills.
Parents of students with SDB rated them on the BASC as having more attention, anxiety, depression, aggression, and hyperactivity problems.
Given the worsening obesity epidemic and the fact that obesity is a major risk factor for SDB in middle childhood, the evidence that SDB has adverse academic, behavioral, and cognitive consequences suggests a major public health concern, according to Dr. Beebe.
He said the next stage of his research will be to see whether the academic and learning deficits associated with SDB in middle childhood and adolescence are remediable when the respiratory condition is treated.
The study was funded by the American Sleep Medicine Foundation and the National Institutes of Health. Dr. Beebe reported having no financial conflicts.