Introduction: Mild sleep-disordered breathing (mSDB) in children is associated with neurobehavioral morbidity and poor quality of life (QOL). However, the correlation between execution function and QOL is not well understood.
Methods: The Pediatric Adenotonsillectomy Trial for Snoring (PATS) is an ongoing trial with children ages 3-12 randomized to watchful waiting or adenotonsillectomy for mSDB (obstructive apnea-hypopnea index <3). QOL was assessed by the OSA-18 total score and the Pediatric Sleep Questionnaire-Sleep Related Breathing Disorders (PSQ-SRBD). Executive function, including neurobehavioral factors such as self-control and working memory, was measured by the Behavior Rating Inventory of Executive Function (BRIEF).
Results: 459 children were included with a mean age of 6.1 years and 51.5% identifying as white. Only 5% of children with low PSQ-SRBD scores (defined as scores <0.33) had abnormal BRIEF scores (global composite T-score >65), compared to 94.5% of children with elevated PSQ-SRBD scores (defined as scores >0.33) having abnormal BRIEF scores (p < 0.0001). Children with moderate to severe disturbances in OSA-18 also had higher rates of abnormal BRIEF scores (p < 0.001). The correlation between BRIEF with PSQ-SRBD was 0.57 (p < 0.001) and with OSA-18 was 0.58 (p < 0.001). Adjusting for age, gender, race, body-mass index percentile, household income, maternal education, attention deficit/hyperactivity disorder history, and apnea-hypopnea index, OSA-18 and PSQ-SRBD were both significant predictors of BRIEF scores with estimates of 0.24 (95% CI 0.16, 0.31) and 18.87 (95% CI 12.11, 25.64) respectively.
Conclusion: Poorer executive function is associated with worse QOL in children with mSDB. There were moderate correlations between disease-specific QOL scores and executive function. Disease-specific QOL questionnaires may serve as marker for neurobehavioral morbidity in children presenting with mSDB. Further research is needed to assess the impact of adenotonsillectomy on these parameters.