The Role of Sleep-Disordered Breathing Symptoms in Neurocognitive
Function Among Youth with Sickle Cell Disease
Abstract
Objective: Impairment in executive and attentional function is common in
youth with sickle cell disease (SCD) without history of stroke,
indicating that mechanisms other than infarction contribute to cognitive
deficits. Sleep-disordered breathing (SDB) may be a unique contributor
due to increased prevalence rates in SCD and well-established
associations with executive and attentional impairments in healthy
peers. The current study examines associations between SDB and executive
and attentional function in a heterogenous pediatric SCD sample.
Methods: Participants included 60 youth with SCD ages 8-18 years
(M=13.05, SD=3.10) and a caregiver. The Pediatric Sleep
Questionnaire (PSQ) was used as a proxy for SDB. Cognition was measured
by the Delis Kaplan Executive Function System (DKEFS) Trail Making Test,
Psychomotor Vigilance Test (PVT), and the Parent Report Behavior Rating
Inventory of Executive Function, Second Edition (BRIEF-2). Results: Half
of youth (50%) met the clinical cut-off for SDB based on caregiver
ratings on the PSQ. Performance based measures of cognition (e.g.,
DKEFS, PVT) were consistent with impaired performance regardless of
stroke status, whereas caregiver ratings on the BRIEF-2 were not
consistent with impairment in everyday executive dysfunction. The PSQ
significantly predicted the BRIEF-2, F(1, 58)=37.95,
p<0.001, R2=0.39,
f2=0.64, but not the PVT or DKEFS,
p>0.05. Conclusions: Sleep-disordered breathing may
contribute to parent report of everyday executive dysfunction in
pediatric SCD. Future research is needed to delineate the impact of SDB
on cognition across youth with varying stroke status and SDB severity.