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Sleep Med. 2017 Jun;34:170-178. doi: 10.1016/j.sleep.2017.02.028. Epub 2017 Mar 25.

Frequency of snoring, rather than apnea-hypopnea index, predicts both cognitive and behavioral problems in young children.

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Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA; Department of Psychology, Olivet Nazarene University, Bourbonnais, IL, USA. Electronic address:
Department of Pediatrics, The University of Chicago, Chicago, IL, USA.
Department of Pediatrics, The University of Chicago, Chicago, IL, USA; Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, Biological Sciences Division, The University of Chicago, Chicago, IL, USA.



Primary snoring (PS) and obstructive sleep apnea (OSA) not only affect the quality of sleep in a large number of young children, but have also been repeatedly associated with a variety of behavioral and cognitive problems. However, little is known about the potentially differing relationships of behavioral and cognitive pathology within the sleep disordered breathing (SDB) spectrum.


This study examined data from an enriched for snoring community sample of 631 children aged between 4 and 10 years. Multivariate mixed models were used to assess the relationship between both snoring and the apnea-hypopnea index (AHI). Numerous cognitive and behavioral variables were used, while adjusting for several important demographic variables. These were followed by univariate analyses of individual measures and sensitivity analyses.


Results indicated that snoring status is a significant predictor of general behavioral (p = 0.008) and cognitive (p = 0.013) domains, even after adjusting for baseline covariates and AHI severity. More frequent snoring was associated with poorer outcomes independent of AHI. However, AHI did not emerge as a significant predictor of the overall cognitive functioning domain (p = 0.377). Additionally, although AHI was a significant predictor of the general behavioral functioning domain (p = 0.008), the significance pattern and nature of its relationship with individual behavioral measures were inconsistent in post-hoc analyses.


The findings of this study suggest that general behavioral and cognitive function may decline with greater snoring severity. Further, snoring should not simply be assumed to represent a lower severity level of SDB, but should be examined as a potential predictor of relevant outcomes.


Apnea; Behavior; Children; Cognition; Sleep disordered breathing; Snoring

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