Objectives. This study aimed to explore parent-reported symptoms of attention deficit-hyperactivity disorder (ADHD) and sleep electroencephalogram (EEG) theta/beta ratio (TBR) characteristics in children with sleep disordered breathing (SDB). Methods. The parents of children (aged 6-11 years) with SDB (n = 103) and healthy controls (n = 28) completed the SNAP-IV questionnaire, and children underwent overnight polysomnography. Children with SDB were grouped according to obstructive apnea/hypopnea index: primary snoring, mild, and moderate-severe obstructive sleep apnea (OSA) groups. The TBR in non-rapid eye movement (NREM) periods in three sleep cycles was analyzed. Results. Children with SDB showed worse ADHD symptoms compared with the healthy control. There was no intergroup difference in TBR. The time-related decline in TBR observed in the control, primary snoring and mild OSA groups, which was not observed in the moderate-severe OSA group. Overnight transcutaneous oxygen saturation was negatively associated with the hyperactivity/impulsivity score of ADHD symptom. The global TBR during the NREM period in the first sleep cycle was positively correlated with inattention score. Conclusion. Children with SDB showed more ADHD inattention symptoms than the healthy control. Although we found no difference in TBR among groups, we found significant main effect for NREM period. There existed a relationship between hypoxia, TBR, and scores of ADHD symptoms. Hence, it was speculated that TBR can reflect the nocturnal electrophysiological manifestations in children with SDB, which may be related to daytime ADHD symptoms.
ChanKCShiLSoHK, et al.Neurocognitive dysfunction and grey matter density deficit in children with obstructive sleep apnoea. Sleep Med. 2014;15(9):1055-1061. doi:https://doi.org/10.1016/j.sleep.2014.04.011
2.
MussoMFLindseyHMWildeEA, et al.Volumetric brain magnetic resonance imaging analysis in children with obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2020;138:110369. doi:https://doi.org/10.1016/j.ijporl.2020.110369
3.
HunterSJGozalDSmithDL, et al.Effect of sleep-disordered breathing severity on cognitive performance measures in a large community cohort of young school-aged children. Am J Respir Crit Care Med. 2016;194(6):739-747. doi:https://doi.org/10.1164/rccm.201510-2099OC
4.
OpertoFFPrecenzanoFBitettiI, et al.Emotional intelligence in children with severe sleep-related breathing disorders. Behav Neurol. 2019;2019:6530539. doi:https://doi.org/10.1155/2019/6530539
5.
UrbanoGLTablizoBJMoufarrejY, et al.The link between pediatric obstructive sleep apnea (OSA) and attention deficit hyperactivity disorder (ADHD). Children (Basel). 2021;8(9):824. doi:https://doi.org/10.3390/children8090824
6.
WuYWanZKongFXuZ. Characteristics of attention deficit and hyperactivity disorder in children with sleep disordered breathing. Chinese General Practice. 2022;2(25):180-184.
7.
TsoWChanMHoFK, et al.Early sleep deprivation and attention-deficit/hyperactivity disorder. Pediatr Res. 2019;85(4):449-455. doi:https://doi.org/10.1038/s41390-019-0280-4
8.
WuJGuMChenS, et al.Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups. Medicine (Baltimore). 2017;96(42):e8281. doi:https://doi.org/10.1097/MD.0000000000008281
9.
BrockmannPEUrschitzMSSchlaudMPoetsCF. Primary snoring in school children: Prevalence and neurocognitive impairments. Sleep Breath. 2012;16(1):23-29. doi:https://doi.org/10.1007/s11325-011-0480-6
10.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders :DSM-5. 2013.
11.
MianoSParisiPVillaMP. The sleep phenotypes of attention deficit hyperactivity disorder: The role of arousal during sleep and implications for treatment. Med Hypotheses. 2012;79(2):147-153. doi:https://doi.org/10.1016/j.mehy.2012.04.020
ArnsMConnersCKKraemerHC. A decade of EEG theta/beta ratio research in ADHD: A meta-analysis. J Atten Disord. 2013;17(5):374-383. doi:https://doi.org/10.1177/1087054712460087
14.
BarryRJClarkeARJohnstoneSJMcCarthyRSelikowitzM. Electroencephalogram theta/beta ratio and arousal in attention-deficit/hyperactivity disorder: Evidence of independent processes. Biol Psychiatry. 2009;66(4):398-401. doi:https://doi.org/10.1016/j.biopsych.2009.04.027
15.
McVoyMLytleSFulchieroE, et al.A systematic review of quantitative EEG as a possible biomarker in child psychiatric disorders. Psychiatry Res. 2019;279:331-344. doi:https://doi.org/10.1016/j.psychres.2019.07.004
MatriccianiLOldsTPetkovJ. In search of lost sleep: Secular trends in the sleep time of school-aged children and adolescents. Sleep Med Rev. 2012;16(3):203-211. doi:https://doi.org/10.1016/j.smrv.2011.03.005
18.
ArnsMConnersCKKraemerHC. A decade of EEG theta/beta ratio research in ADHD: A meta-analysis. J Atten Disord. 2013;17(5):374-383. doi:https://doi.org/10.1177/1087054712460087
19.
ArnsMFeddemaIKenemansJL. Differential effects of theta/beta and SMR neurofeedback in ADHD on sleep onset latency. Front Hum Neurosci. 2014;8:1019. doi:https://doi.org/10.3389/fnhum.2014.01019
LevendowskiDJFerini-StrambiLGamaldoC, et al.The accuracy, night-to-night variability, and stability of frontopolar sleep electroencephalography biomarkers. J Clin Sleep Med. 2017;13(6):791-803. doi:https://doi.org/10.5664/jcsm.6618
22.
SpethTRusakBPerrotTCoteKCorkumP. Sleep architecture and EEG power spectrum following cumulative sleep restriction: a comparison between typically developing children and children with ADHD. Brain Sci. 2023;13(5):772. doi:https://doi.org/10.3390/brainsci13050772
23.
ZanusCMiladinovićADe DeaF, et al.Sleep spindle-related eeg connectivity in children with attention-deficit/hyperactivity disorder: An exploratory study. Entropy (Basel). 2023;9(25):1244. doi:https://doi.org/10.3390/e25091244
24.
CastelnovoALividiniABernardiG, et al.Sleep power topography in children with attention deficit hyperactivity disorder (ADHD). Children (Basel). 2022;9(2):197. doi:https://doi.org/10.3390/children9020197
25.
BiancardiCSessoGMasiGFaragunaUSiccaF. Sleep EEG microstructure in children and adolescents with attention deficit hyperactivity disorder: a systematic review and meta-analysis. Sleep. 2021;44(7):zsab006. doi:https://doi.org/10.1093/sleep/zsab006
26.
GauSSShangCYLiuSK, et al.Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale - parent form. Int J Methods Psychiatr Res. 2008;17(1):35-44. doi:https://doi.org/10.1002/mpr.237
27.
HallCLGuoBValentineAZ, et al.The validity of the SNAP-IV in children displaying ADHD symptoms. Assessment. 2020;27(6):1258-1271. doi:https://doi.org/10.1177/1073191119842255
28.
BerryRBBudhirajaRGottliebDJ, et al.Rules for scoring respiratory events in sleep: Update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. J Clin Sleep Med. 2012;8(5):597-619. doi:https://doi.org/10.5664/jcsm.2172
29.
OSA WGOC. Chinese Guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020). Pediatr Investig. 2021;5(3):167-187. doi:https://doi.org/10.1002/ped4.12284
30.
ChristianszJALappinCRWeichardAJ, et al.Slow wave activity and executive dysfunction in children with sleep disordered breathing. Sleep Breath. 2018;22(2):517-525. doi:https://doi.org/10.1007/s11325-017-1570-x
SahinUOzturkOOzturkM, et al.Habitual snoring in primary school children: Prevalence and association with sleep-related disorders and school performance. Med Princ Pract. 2009;18(6):458-465. doi:https://doi.org/10.1159/000235895
AliNJPitsonDStradlingJR. Sleep disordered breathing: Effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr. 1996;155(1):56-62. doi:https://doi.org/10.1007/BF02115629
35.
KimMJBaeSHLeeSMLeeKHKimDK. Effect of adenotonsillectomy on attention in Korean children with sleep-disordered breathing. Clin Exp Otorhinolaryngol. 2018;11(3):199-204. doi:https://doi.org/10.21053/ceo.2018.00115
36.
BiggsSNWalterLMNisbetLC, et al.Time course of EEG slow-wave activity in pre-school children with sleep disordered breathing: A possible mechanism for daytime deficits?Sleep Med. 2012;13(8):999-1005. doi:https://doi.org/10.1016/j.sleep.2012.05.006
37.
MianoSPaolinoMCUrbanoA, et al.Neurocognitive assessment and sleep analysis in children with sleep-disordered breathing. Clin Neurophysiol. 2011;122(2):311-319. doi:https://doi.org/10.1016/j.clinph.2010.06.019
38.
NormanMBPithersSMTengAYWatersKASullivanCE. Validation of the sonomat against PSG and quantitative measurement of partial upper airway obstruction in children with sleep-disordered breathing. Sleep. 2017;40(3):zsx017. doi:https://doi.org/10.1093/sleep/zsx017
39.
Markovska-SimoskaSPop-JordanovaN. Quantitative EEG in children and adults with attention deficit hyperactivity disorder: Comparison of absolute and relative power spectra and theta/beta ratio. Clin EEG Neurosci. 2017;48(1):20-32. doi:https://doi.org/10.1177/1550059416643824
40.
YangJSNicholasCLNixonGM, et al.Determining sleep quality in children with sleep disordered breathing: EEG spectral analysis compared with conventional polysomnography. Sleep. 2010;33(9):1165-1172. doi:https://doi.org/10.1093/sleep/33.9.1165
41.
MonastraVJLubarJFLindenM. The development of a quantitative electroencephalographic scanning process for attention deficit-hyperactivity disorder: Reliability and validity studies. Neuropsychology. 2001;15(1):136-144. doi:https://doi.org/10.1037//0894-4105.15.1.136
42.
LiJYouJYinG, et al.Electroencephalography theta/beta ratio decreases in patients with severe obstructive sleep apnea. Nat Sci Sleep. 2022;14:1021-1030. doi:https://doi.org/10.2147/NSS.S357722
GosselinNMathieuAMazzaS, et al.Attentional deficits in patients with obstructive sleep apnea syndrome: An event-related potential study. Clin Neurophysiol. 2006;117(10):2228-2235. doi:https://doi.org/10.1016/j.clinph.2006.07.130
45.
GozalDKheirandish-GozalLBhattacharjeeRSpruytK. Neurocognitive and endothelial dysfunction in children with obstructive sleep apnea. Pediatrics. 2010;126(5):e1161-7. doi:https://doi.org/10.1542/peds.2010-0688
46.
SmithDLGozalDHunterSJ, et al.Impact of sleep disordered breathing on behaviour among elementary school-aged children: A cross-sectional analysis of a large community-based sample. Eur Respir J. 2016;48(6):1631-1639. doi:https://doi.org/10.1183/13993003.00808-2016
47.
MianoSAmatoNGarbazzaC, et al.Shooting a high-density electroencephalographic picture on sleep in children with attention-deficit/hyperactivity disorder. Sleep. 2019;42(11):zsz167. doi:https://doi.org/10.1093/sleep/zsz167
48.
KurthSRingliMGeigerA, et al.Mapping of cortical activity in the first two decades of life: A high-density sleep electroencephalogram study. J Neurosci. 2010;30(40):13211-9. doi:https://doi.org/10.1523/JNEUROSCI.2532-10.2010
49.
CampbellIGFeinbergI. Longitudinal trajectories of non-rapid eye movement delta and theta EEG as indicators of adolescent brain maturation. Proc Natl Acad Sci U S A. 2009;106(13):5177-5180. doi:https://doi.org/10.1073/pnas.0812947106
50.
GorgoniMD’AtriAScarpelliSRedaFDe GennaroL. Sleep electroencephalography and brain maturation: Developmental trajectories and the relation with cognitive functioning. Sleep Med. 2020;66:33-50. doi:https://doi.org/10.1016/j.sleep.2019.06.025
