SAN ANTONIO (EGMN) – 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, which was a B–/C+ average vs. 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 U.S. National Institutes of Health. Dr. Beebe reported having no financial conflicts.

Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

圣安东尼奥(EGMN)——一项研究显示，患有阻塞性睡眠呼吸暂停综合征的儿童其在校成绩比未患睡眠呼吸障碍的同班同学差。

 

Dean W. Beebe博士在联合专业睡眠协会年会上报告说，父母和教师对这些年龄介于10~16岁之间的儿童所进行独立评估的结果表明，即便这些儿童仅患有轻度的阻塞性睡眠呼吸暂停综合征(OSA)，他们也更容易出现注意力和学习问题。

 

辛辛那提市儿童医院医学中心的Beebe 博士说：“睡眠呼吸障碍对儿童学习成绩造成的影响令人印象深刻。该疾病会导致患儿出现中至重度的睡眠呼吸暂停，而这造成了极大危害。”

 

该研究共纳入163例年龄介于10~16岁间的超重青年患者，招募地点是患者因睡眠疾病或超重而接受治疗的诊所。经研究者评估后，共有42例患者被诊断为中至重度的OSA，诊断依据为呼吸暂停低通气指数>5次事件/h。另外58例患者存在轻度的OSA，其定义为患者的呼吸暂停低通气指数介于1~5次事件/h。研究者将其中26例受试者划分为打鼾者，与此同时，另外37例患者不存在睡眠呼吸障碍(SDB)。

 

Beebe博士指出，未患SDB类疾病的受试者群体在校平均成绩为B等。打鼾者有取得较差成绩的倾向，尽管这一差异并不显著。但是患有OSA的受试者(无论其病情为轻度或是更为严重)的成绩则要比那些未患SDB类疾病的受试者平均低0.5。这一成绩差异(平均成绩B–/C+对单纯B等)在未来某个时候可能会对他们的升学或就业机会造成影响。

 

在患有中至重度OSA的学生中，有30%平均成绩仅为C等或更糟，与之相比，那些不存在SDB类疾病的学生取得此类成绩的几率仅为15%。与此同时，那些未患SBD类疾病的受试者中有15%平均学习成绩为A等，而在患有中度至重度OSA的受试者中仅有1例学生取得同一成绩。

 

教师们应用经验证的儿童行为评价系统(BASC)对患有轻度或更严重OSA的学生进行了评价，结果显示，他们比未患SDB类疾病的学生存在显著更多的注意力和学习相关问题。教师的评估结果还显示，那些无SDB类疾病的年轻患者在BASC适应能力评价(包括领导能力、社交技巧和学习技巧)方面得分明显更高。

 

学生家长使用BASC系统对学生进行评价的结果显示，他们存在更多与注意力、抑郁、攻击性和多动症相关的问题。

 

据Beebe博士，已有证据显示，罹患SDB类疾病会对患儿学习、行为和认知等方面造成不良影响，考虑到肥胖的流行程度越来越严重，且肥胖是童年中期发生SDB类疾病的主要危险因素，故以上证据可能意味着，这是一个重要的公共卫生问题。

 

他说，在下一阶段研究中，他将观察当患儿的呼吸系统疾病得到治疗后，由SDB类疾病导致其在童年和青少年中期出现的学业和学习障碍是否可以矫正。

 

该研究由美国睡眠医学基金会和美国国立卫生研究院资助。Beebe博士说不存在任何经济利益冲突。

 

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