Language
Discrepant findings have been reported in studies investigating the
impact of pediatric SDB on language. In comparison to normative data,
children with SDB have average expressive language
abilities.11,16-17 These findings are consistent
across multiple language measures, including but not limited to the
WISC-III,16,23 Expressive Vocabulary Test,11,31 and NEPSY: A Developmental Neuropsychological
Assessment32 Language Domain.17Findings regarding receptive language in this population are mixed. The
majority of studies reported average receptive language abilities across
multiple measures, including but not limited to the Peabody Picture
Vocabulary Test11,33 and NEPSY32receptive language tasks.11,18,34-35
Despite broadly average performance on language tasks in children with
SDB compared to normative data, differences emerge when comparing
language abilities in children with SDB to control groups. Multiple
studies reported greater language impairment in children with SDB on
expressive29 and
receptive9,17-18,29-30,34 language tasks compared to
controls. One study that followed infants with SDB over time reported
that at two years of age, children with persistent SDB symptoms scored
5.3 points lower on a measure of language compared to children without
SDB symptoms.29 Other studies reported no differences
on language performance across pediatric SDB and control
groups.18,34
Limited research has investigated differences in expressive and
receptive language performance across multiple SDB severity levels in
children. Hunter et al11 reported that children with
moderate to severe SDB (AHI >5) performed worse on a NEPSY
receptive language task than children with less severe SDB. The same
study reported no differences across SDB severity levels on other
language tasks.11 Biggs et al18similarly reported no significant differences across SDB severity level
and language performance.
To determine the impact of SDB on language, research has explored the
associations between respiratory status and language performance.
Results indicate that a number of respiratory indicators, including the
respiratory disturbance index,18 oxygen
desaturation,36 sleep duration,29and frequency of snoring9 were associated with poorer
expressive29,36 and receptive9,18,29language performance in children with SDB.
The studies reviewed above are limited by their examination of language
as a broad construct. Future studies should expand on language profiles
in children with SDB by incorporating measures of articulation, auditory
processing, and social pragmatics. In addition, the literature reviewed
above is characterized by discrepancies regarding language development
in children with SDB. Definitions of SDB and SDB severity varied across
studies. For example, one study measured SDB with a composite score that
combined respiratory variables,17 while another
measured SDB according to AHI.18 Without consistent
SDB indicators and severity categories, it is challenging to
meaningfully compare results across studies. Additionally, not all
studies measured important covariates such as SES11,36and BMI,16,36 which are known to influence SDB and
cognitive performance.