Brain Structure Alterations and Behavioral Problems Among Children Associated With Obstructive Sleep Disordered Breathing

Brain outlined in girls head
While parents frequently report behavioral problems in children who snore, the relationship between symptoms of obstructive sleep disordered breathing (oSDB) and childhood behavioral problems associated with brain structural alterations is limited. The study authors examined the associations between oSDB symptoms, behavioral measures such as inattention, and brain morphometry.

Behavioral problems among children with obstructive sleep disordered breathing (oSDB) were associated with regional structural alterations of cortical gray matter, according to results of the Adolescent Brain Cognitive 52.Development (ABCD) study published in Nature Communications.

Children (N=10,140) were enrolled at 21 sites in the United States in 2018 for this prospective, observational study. The children underwent a magnetic resonance imaging (MRI) scan, were assessed for oSDB by their primary caregiver, and by the Child Behavior Checklist (CBCL).

The children were 52.3% boys, 54.7% White, and 15.5% were obese. CBCL scores for externalizing problems were 45.6±10.2 and internalizing problems were 48.5±10.6. Snoring, breathing problems, and respiratory pauses were associated with BMI (F[1,23.57], 119.60; DR2, 1.11; P <1016), asthma (F[1,23.57], 108.41; DR2, 0.98; P <1016), and ethnicity (F[4,23.57], 21.82; DR2, 0.70; P <1016).

oSDB factor scores predicted total CBCL sores (F[1,35.96], 334.14; DR2, 2.96; P <1016) and associated with externalizing (F[1,34.61], 185.27; DR2, 1.68; P <1016) and internalizing (F[1,34.37], 243.18; DR2, 2.20; P <1016) problems.

oSDB had an effect on total cortical volume (F[1,37.98], 12.88; DR2, 0.08; P =.0003), average cortical thickness (F[1,39.46], 5.77; DR2, 0.03; P =.016), and cortical surface area (F[1,43.47], 7.34; DR2, 0.04; P =.006). The strongest negative correlation between oSDB were observed in the left medial orbital sulcus (P =1.76×105) and left precentral gyrus (P =6.23×105).

The relationship between oSDB and CBCL scores were mediated by lower precentral gyrus volumes of the right (2.03% mediated; 95% CI, 0.74%-3.51%; P <.001) and left (1.71% mediated; 95% CI, 0.91%-2.84%; P <.001) hemispheres.

This study was limited by its cross-sectional design. It remains unclear which factor of the association between brain morphology, sleeping quality, and behavior is causative.

These data indicated that there was sleep-related neurobehavioral burden among children. The study authors recommended children should be evaluated early for symptoms of upper airway obstruction such that potential long-term consequences from poor sleep may be reduced.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Isaiah A, Ernst T, Cloak CC, Clark DB, Chang L. Associations between frontal lobe structure, parent-reported obstructive sleep disordered breathing and childhood behavior in the ABCD dataset. Nat Commun. Published online April 13, 2021. doi:10.1038/s41467-021-22534-0