This study aimed to determine the long term effects of resolution of SDB in preschool children, either following treatment or spontaneous recovery, on cognition and behavior. Children diagnosed with SDB at 3-5y (N = 35) and non-snoring controls (N = 25), underwent repeat polysomnography (PSG) and cognitive and behavioral assessment 3 years following a baseline study. At follow-up, children with SDB were grouped into Resolved and Unresolved. Resolution was defined as: obstructive apnea hypopnea index (OAHI) ≤1 event/h; no snoring detected on PSG; and no parental report of habitual snoring. 57% (20/35) of children with SDB received treatment, with SDB resolving in 60% (12/20). 43% (15/35) were untreated, of whom 40% (6/15) had spontaneous resolution of SDB. Cognitive reduced between baseline and follow-up, however this was not related to persistent disease, with no difference in cognitive outcomes between Resolved, Unresolved or Control groups. Behavioral functioning remained significantly worse in children originally diagnosed with SDB compared to control children, regardless of resolution. Change in OAHI did not predict cognitive or behavioral outcomes, however a reduction in nocturnal arousals, irrespective of full resolution, was associated with improvement in attention and aggressive behavior. These results suggest that resolution of SDB in preschool children has little effect on cognitive or behavioral outcomes over the long term. The association between sleep fragmentation and behavior appears independent of SDB, however may be moderated by concomitant SDB. This challenges the assumption that treatment of SDB will ameliorate associated cognitive and behavioural deficits and supports the possibility of a SDB phenotype.

Pediatric SDB is accompanied by predominantly acute brain changes in areas that regulate autonomic, cognitive, and mood functions, and chronic changes in frontal cortices essential for behavioral control. Interventions need to be keyed to address acute vs chronic injury.

Study Objectives: Preterm birth and fetal growth restriction (FGR) are both associated with risk of hypertension in adulthood. Mechanisms leading to this pathology are unclear. In children aged 5-12 years, who were born preterm and FGR, we used sleep as a tool to assess autonomic control with assessment of cardiovascular structure and function. Methods: Eighteen children born preterm and FGR, 15 children born preterm with appropriate birth weights for gestational age (AGA), and 20 AGA term-born children were studied. Children underwent overnight polysomnography with the addition of continuous noninvasive blood pressure (Finometer™). Spectral measures of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity were assessed and overnight urinary catecholamine levels measured. Echocardiographic studies (Vivid7, GE Healthcare) were performed and vascular compliance assessed (Miller Instruments™). Statistical comparisons were adjusted for age and body size. Results: Compared to term children, preterm AGA children had increased high frequency HRV (p < .05) and BPV (p < .05) during sleep, reflecting increased parasympathetic activation and blood pressure changes related to respiration. Preterm FGR children had smaller left ventricular lengths, ascending aorta, and left ventricular outflow tract diameter (p < .05 for all) and vascular compliance was positively correlated with gestational age (r 2 = 0.93, p < .05). Conclusions: FGR combined with preterm birth did not alter autonomic control but altered heart structure in children. In contrast, preterm birth alone altered autonomic control but had no change in heart structure. These changes in children born preterm and FGR may contribute, in part, to increased risk of cardiovascular disease later in life but by different mechanisms.

Study Objectives: Fetal growth restriction (FGR) occurs in up to 10% of pregnancies and is associated with increased risk of prematurity and neurodevelopmental impairment. FGR also alters sleep-state distribution in utero and maturation in infancy. Currently, limited data on the long-term associations of FGR and childhood sleep exist. Accordingly, we assessed the associations between preterm birth and FGR and sleep in children aged 5-12 years.Methods: Seventeen children born preterm and FGR, 15 children born preterm but appropriately grown (appropriate birth weight for gestational age [AGA]), and 20 term AGA children (controls) were studied using overnight polysomnography. Sleep macroarchitecture was assessed using standard criteria, and sleep microarchitecture was assessed using spectral analysis of the electroencephalogram (C4-M1) with total, δ (0.5-3.9 Hz), θ (4.0-7.9Hz), α (8.0-11.9 Hz), σ (12.0-13.9 Hz), and β power (14.0-30 Hz) calculated.Results: For sleep macroarchitecture, preterm FGR children had higher N2% compared with term AGA children (p < .05). Preterm AGA children had reduced total sleep time, NREM%, and sleep efficiency compared with term AGA children (p < .05 for all). For sleep microarchitecture, preterm FGR children had a higher amount of total, δ and α power compared with both groups (p < .05). Sigma and β power was lowest in the preterm AGA group compared with both groups (p < .05 for both).Conclusions: Prematurity and FGR were associated with altered sleep macro-and microarchitecture measures indicative of reduced sleep quantity and quality in childhood. As sleep disturbance can affect both behavior and neurodevelopment in children, sleep in FGR and preterm children warrants further investigation. Keywords: fetal growth restriction, preterm birth, pediatric, EEG spectral analysis, sleep. Statement of SignificanceFetal growth restriction (FGR) is a major obstetric complication affecting up to 10% of pregnancies leading to increased risk of preterm birth and neurodevelopmental impairment. FGR alters the development of sleep in fetal life and infancy; however, few studies have investigated the long-term impact on sleep. This novel study assessed both sleep macro-and microarchitecture in children born preterm and FGR. Being born preterm and FGR was associated with reduced sleep quality, whereas being born preterm with an appropriate birth weight for gestational age was associated with both reduced sleep quantity and quality. This study highlights the potential need for clinical follow-up of sleep and investigation of the effects of poor sleep on neurodevelopment in this population.

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SWA, a subtle measure of sleep disruption and sleep regulation, is associated with deficits in problem solving and sustained attention in children with SDB. As current mechanistic theories do not account for deficits observed in children with mild forms of SDB, this study provides a promising alternative.

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