Snoring Link To Cognitive Outcomes In Kids Attenuated By Sociodemographics

While habitual snoring is associated with lower cognitive function in children, a new study suggests that the connection is largely explained by baseline demographic, anthropometric, and socioeconomic factors.

Researchers examined data on 11,873 children aged 9 to 10 years whose habitual snoring was assessed by parent report and who completed cognitive assessments. Overall, 810 children (6.8%) were habitual snorers (3+ nights per week) and 4,058 children (34.2%) were non-habitual snorers (1-2 nights per week).

Total cognitive function scores were significantly lower among habitual snorers than among children who never snored in unadjusted analysis (Cohen d 0.35), researchers report in JAMA Otolaryngology-Head and Neck Surgery.

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But the association weakened considerably (Cohen d 0.16) once researchers adjusted for age, sex, BMI, race, caregiver education, and annual household income.

"It is important to recognize that the previously-recognized association between habitual snoring and cognition could be related to other potential variables such as demographic and socioeconomic factors," said lead study author Dr. Amal Isaiah, an associate professor of otorhinolaryngology-head and neck surgery and pediatrics at the University of Maryland School of Medicine in Baltimore.

"Clinicians should keep these findings in mind and ensure thorough additional assessments prior to recommending treatment," Dr. Isaiah said by email.

There was no meaningful difference in cognitive performance scores between children who didn't snore at all and children who were non-habitual snorers, the study found.

Slightly more than half of the parents and caregivers in the study had either a bachelor's degree (28%) or a postgraduate degree (25.2%). Most of the other parents had some college or an associate degree (29.4%), or a high school diploma or GED (10.6%).

The study population was relatively affluent, with many children in households with annual income above $100,000 (38.4%) or between $50,000 and $100,000 (25.9%). There were also 3,222 children (27.1%) in households with annual income below $50,000.

Mean BMI percentile in the study was 61.0, however, 1,956 children (16.5%) had obesity.

Snoring in children is mostly related to enlargement of the tonsils, adenoids, or both, Dr. Isaiah noted. Children may also snore because they have overweight or obesity.

"While it may not be possible to prevent snoring related to enlargement of the tonsils or adenoids, maintenance of a healthy body weight could potentially prevent snoring," Dr. Isaiah said.

One limitation of the study is that it lacked objective measures of sleep. There is the potential for parental over-reporting of snoring among children who have challenges in school, the study authors note.

The results also may not be generalizable to younger or older children or to other outcomes that are associated with sleep-disordered breathing, such as daytime sleepiness, behavioral or cardiovascular outcomes, the study team points out.

However, the relationship between upper respiratory disease, snoring, and socioeconomic status is well known, said Dr. Patrick Dawes, a clinical associate professor at Dunedin Public Hospital and University of Otago in New Zealand, who wasn't involved in the study.

"The take-home message would appear to be that society should place priority upon improving children's socioeconomic status because, in the long term, this may be expected to have significant health benefits including better upper airway health and reduced snoring," Dr. Dawes said by email.

"In the short term, habitual snoring is recognized as having adverse effect on children's quality of life, and adenotonsillectomy is successful in reversing these effects for most children with habitual snoring," Dr. Dawes added.

—Lisa Rapaport

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