Obstructive sleep apnea and oral language disorders☆

Corrêa, Camila de Castro; Cavalheiro, Maria Gabriela; Maximino, Luciana Paula; Weber, Silke Anna Theresa

doi:10.1016/j.bjorl.2016.01.017

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Review articles • Braz. j. otorhinolaryngol. 83 (1) • Jan-Feb 2017 • https://doi.org/10.1016/j.bjorl.2016.01.017 linkcopy

Obstructive sleep apnea and oral language disorders^☆

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction Children and adolescents with obstructive sleep apnea (OSA) may have consequences, such as daytime sleepiness and learning, memory, and attention disorders, that may interfere in oral language.

Objective To verify, based on the literature, whether OSA in children was correlated to oral language disorders.

Methods A literature review was carried out in the Lilacs, PubMed, Scopus, and Web of Science databases using the descriptors “Child Language” AND “Obstructive Sleep Apnea”. Articles that did not discuss the topic and included children with other comorbidities rather than OSA were excluded.

Results In total, no articles were found at Lilacs, 37 at PubMed, 47 at Scopus, and 38 at Web of Science databases. Based on the inclusion and exclusion criteria, six studies were selected, all published from 2004 to 2014. Four articles demonstrated an association between primary snoring/OSA and receptive language and four articles showed an association with expressive language. It is noteworthy that the articles used different tools and considered different levels of language.

Conclusion The late diagnosis and treatment of obstructive sleep apnea is associated with a delay in verbal skill acquisition. The professionals who work with children should be alert, as most of the phonetic sounds are acquired during ages 3–7 years, which is also the peak age for hypertrophy of the tonsils and childhood OSA.

Keywords
Child language; Language disorders; Speech, language and hearing sciences; Obstructive sleep apnea

Authors	Year	Journal	Database
O'Brien et al.²⁵	2004	Pediatrics	PubMed – Web of science – Scopus
Kurnatowski et al.²⁶	2006	Int J Pediatr Otorhinolaryngol	PubMed – Web of science – Scopus
Andreou and Agapitou²⁷	2007	Archives of Clinical Neuropsychology	Web of science
Landau et al.²⁸	2012	Pediatric Pulmonology	PubMed
Liukkonen et al.²⁹	2012	Int J Pediatr Otorhinolaryngol	PubMed – Web of science – Scopus
Yorbik et al.³⁰	2014	Sleep and Biological Rhythms	Web of science – Scopus

Author, year Study design	Objective	Sample	Methods – focus on oral language	OSA diagnostic criteria	Results – focus on oral language	Receptive and/or expressive language	Study limitation
O'Brien et al., 2004²⁵ Cross-sectional	To evaluate the association of primary snoring and neurobehavioral deficits in children.	87 children with primary snoring and 31 healthy subjects, aged 5–7 years.	Used the NEPSY.	Diagnosis of Primary Snoring by PSG, considering the AI < 1; AHI < 5 and no abnormal alterations in gas exchange.	Language showed significantly lower results for the primary snoring group when compared to the control group.	Receptive and expressive language	It did not perform tests to assess hearing.
Kurnatowski et al., 2006²⁶ Cross-sectional	To analyze neurocognitive disorders (sensory-motor coordination, perception, memory, learning, concentration, focused attention and language reception) in children with OSA due to adenotonsillar hypertrophy.	221 children in total. 117 children with OSAS: 87 aged 6–9 years and 34 aged 10–13 years. 104 healthy children.	Token Test (TT) – to assess the level of sensorimotor integration, perception and receptive language processes.	Diagnosis of OSAS by PSG with AHI > 1, oxygen desaturation < 92%.	The groups of children with OSAS had results below those found in healthy children regarding Receptive Language.	Receptive Language	It did not perform tests to assess hearing.
Andreou and Agapitou, 2007²⁷ Cross-sectional	To analyze whether OSA in childhood may be related to verbal fluency and academic performance.	40 adolescents: 20 with OSA and 20 from the control group. Mean age: 18.41 years.	Two standardized tests of verbal fluency in Greek, regarding the semantic and phonological aspects.	OSA diagnosis by PSG, with AHI > 10 and/or SaO₂ < 95% per event, and heart rate > 60 beats per minute.	A difference was observed in the phonological and semantic aspects when comparing children with and without OSA. The adolescents with OSA showed worse results.	Expressive Language	It did not perform tests to assess hearing and cognition.
Landau et al., 2012²⁸ Cross-sectional	To analyze the hypothesis that behavioral and cognitive functions of preschool children with OSA are impaired when compared to healthy children. To verify whether there was improvement after adenotonsillectomy.	45 children with OSA and 26 healthy children aged 2.5–5 years.	The test Kaufman Assessment Battery for Children (K-ABC) was applied.	Diagnosis of OSA by PSG com AHI > 1.	Before surgery, the group with OSA showed worse performance in verbal fluency, and after surgery, there was an improvement in this regard.	Expressive language	It did not perform tests to assess hearing.
Liukkonen et al., 2012²⁹ Cross-sectional	To assess the association between sleep-disordered breathing and cognitive function in children.	44 children with primary snoring and 51 healthy ones, aged 1–6 years.	The NEPSY assessment tool (comprehension of instructions, speeded naming and body part naming).	Diagnosis of Primary snoring by PSG, with AHI < 1. Hypopnea was defined as an airflow volume reduction of <50%, followed by awakening, oxyhemoglobin desaturation >2%.	The group of children with primary snoring obtained the lowest scores in language functions (comprehension of instructions, speeded naming).	Receptive and expressive language	It did not perform tests to assess hearing.
Yorbik et al., 2014³⁰ Cross-sectional	To investigate the effects of snoring and fragmented sleep on mental development in preschool children.	212 children, 37 with complaints of snoring and 25 with fragmented sleep complaints, aged 3.1–6 years.	Peabody Picture Vocabulary Test was used.	Through a questionnaire.	Children with complaints of snoring and with fragmented sleep had lower scores on language.	Receptive Language	It did not perform PSG assessment and did not assess hearing.

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Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[TFN1] PSG, polysomnography; AHI, apnea-hypopnea index; AI, apnea index.