A Regional and Nationwide Perspective on the Relationship between Sleep Disordered Breathing and Academic Performance in New Zealand Children

Abstract

Objectives

The main aims of this thesis were to: (i) investigate the concurrent associations between sleep disordered breathing (SDB), neurobehavioural, and academic performance at 8 years, (ii) determine the impact of SDB trajectories from 3-to-8 years on academic performance outcomes at 8 years and, (ii) establish the prevalence and correlates of SDB and poor school performance in a Nationwide sample of 6-to-10 year children.

Methods

A sample of 170 local Dunedin (New Zealand) children were involved in a longitudinal study. From ages 3-to-8 years, SDB was assessed through parent-reported history of symptoms, and physical examination of features related to SDB. Children’s neurocognitive, and behavioural functioning and academic performance were measured using researcher-administered standardised tests, and parent- and teacher- ratings. A second sample of community-wide New Zealand parents were recruited to complete a survey assessing primary school-aged (n=1607, mean age 8.2 years) children’s SDB symptoms, alongside their academic, health, behaviour and familial-related demographic information.

Results

Analyses found negative relationships between SDB and numeracy, oral reading retell, and listening retell and comprehension ( =3.86 to -0.05, p=0.046 to 0.011), with results also suggesting that pathways from SDB to poorer school performance were indirect, and mediated through children’s cognitive-linguistic skills (e.g. learning problems and functional communication problems). A child’s SDB status at age 3-years predicted academic outcomes at age 8 for oral reading and retell skills, listening retell skills, and applying numeracy skills, in word problems (all p<0.05). Children whose SDB improved from age 3-to-8 were able to catch-up academically at age 8, from the performance of control children who entered the study at age 3 (i.e. without SDB), in oral reading fluency and basic numeracy tasks (i.e. addition and subtraction). Nationwide survey data found the prevalence of “at risk” for SDB in 6-to-10 year-old children to be 16.2% (95%CI = 14.4 - 18.1%), and18.6% (95%CI = 16.7 – 20.6%) for habitual snoring. Children “at risk” of SDB, had higher odds of poor school performance compared to those “not at risk” (2.0-to-2.8) for reading, writing, and mathematics. Independent risk factors for children at risk of SDB were identified as: total poorer health related quality of life, frequent sore throats, and asthma, with domain-specific shared risk factors identified between SDB and poor school performance, across the reading, writing, and mathematics constructs (e.g. male gender, secondary caregiver education below tertiary, and familial asthma).

Conclusions

The current findings emphasise the association between SDB and poor school performance in school-aged children. Additionally, SDB symptoms can predict children’s later academic performance, with the potential to improve neurocognitive sequelae across childhood following SDB resolution/treatment. SDB has an important role in the healthy neurocognitive development of children, highlighting the need to include screening for sleep difficulties when exploring barriers to children’s learning progress.