Sleep-disordered breathing is associated with impaired attention and neurocognitive deficits. We assessed the association of snoring and intermittent hypoxia with poor academic performance in third grade school children (1,144 children). Snoring frequency and intermittent hypoxia were investigated using parental questionnaire and nocturnal home pulse oximetry. Intermittent hypoxia was specified as desaturation events of 90% or less pulse oximeter saturation. Poor academic performance was defined as grade 4-6 on a six-point scale (i.e., approximately the lowest quintile grades) in mathematics, science, reading, spelling, and/or handwriting in the most recent school report. Snoring "always" was significantly associated with poor academic performance in mathematics (odds ratio; 95% confidence interval: 3.6; 1.3-10.1), science (4.3; 1.3-14.6), and spelling (3.5; 1.2-10.3). Snoring "frequently" was also significantly associated with poor academic performance in mathematics (2.4; 1.3-4.7) and spelling (2.0; 1.04-3.8). A significant relationship between snoring and poor academic performance was also found in children without intermittent hypoxia, whereas intermittent hypoxia did not show an independent association with poor academic performance. Thus, habitual snoring (i.e., snoring frequently or always) was associated with poor academic performance in these primary school children.

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We suggest that impaired behavior is a key feature of HS independent of intermittent hypoxia and improves when HS ceases.

ABSTRACT. Objective. Hypoxemia, often assessed via pulse oximetry, is associated with neurocognitive deficits in children. The best way to qualify hypoxemia, or which level of hypoxemia already affects cognition, is unknown.Methods. We assessed the association of pulse oximetry-derived variables that qualify hypoxemia with impaired academic performance in mathematics in a population-based cross-section of 995 primary school children who underwent overnight home recordings of motion-resistant new-generation pulse oximeter saturation (SpO 2 ). Impaired academic performance in mathematics was based on the last school report and defined as grade 4 to 6 on a 6-point scale (ie, approximately the lowest quintile grades).Results. Of 10 variables under study, only the nadir of the SpO 2 values was significantly associated with impaired performance. Categories of this variable representing mild (ie, 91%-93% SpO 2 ; odds ratio: 1.65; 95% confidence interval: 1.06 -2.56) and moderate hypoxemia (ie, <90% SpO 2 ; odds ratio: 2.28; 95% confidence interval: 1.30 -4.01) both were associated with impaired performance in mathematics.Conclusions. We suggest using the nadir of the SpO 2 values in an overnight study to qualify hypoxemia in future studies. This variable may predict neurocognitive deficits in school children. Mild hypoxemia, as yet widely considered benign, may already affect cognition in childhood. A dverse impacts of chronic or intermittent hypoxemia on development, behavior, cognition, and academic performance have been reported in many well-designed and controlled studies in children with sleep-disordered breathing 1-6 or congenital heart disease. [7][8][9][10][11] Data for other clinical conditions that result in chronic or intermittent hypoxemia are sparse. In some studies, adverse effects have been noted at even mild levels of oxygen desaturation. 1 Application of pulse oximetry to detect chronic or intermittent hypoxemia is a valid, reliable, and frequently used method. 12 Several variables that qualify chronic and intermittent hypoxemia can be derived from pulse oximetry and reference ranges used to identify abnormal clinical conditions. 13 However, it is yet unclear which pulse oximetry-derived variable best predicts neurocognitive impairments in children and which level of oxygen desaturation is already harmful. The mean and nadir arterial oxygen saturation measured by pulse oximetry (Spo 2 ) have been reported and shown to have some relationship to decreased intelligence, 5 impaired attention, 5 and hyperactive behavior. 1,6 We recently performed a study on the association between sleep-disordered breathing and impaired academic performance in primary school children. 14 As part of this study, children were examined for the presence of nocturnal chronic and intermittent hypoxemia using pulse oximetry. Only a weak association between intermittent hypoxemia and impaired academic performance in mathematics was found. 14 These results, however, were recently challenged: the inclusion of children with perhaps "a...

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This study investigated the functional contributions of the submentalis muscle to the coordination of feeding behavior in the leopard frog, Rana pipiens. Additionally, the anatomical origins of the motor neurons innervating this muscle are identified and described. The m. submentalis is a small muscle connecting the distal mandibular tips. Depending upon the anuran species studied, this muscle contributes to mandibular bending and the degree to which the tongue is protracted, or has little or no role in feeding biomechanics. High-speed videography was used to quantify feeding attempts before versus after bilateral denervation of the m. submentalis. Additionally, the terminal branch of the trigeminal nerve prior to innervating the m. submentalis was retrogradely labeled to identify the origins of motor neurons innervating the muscle. For the kinematic analyses, denervation of the submentalis resulted in significant increases in the time to maximum tongue protrusion, and the duration of tongue protrusion. Neither mandibular bending, nor tongue length variables differed significantly between normal conditions and deafferented conditions. However, when unsuccessful feeding attempts were quantified following the denervation, failed attempts were nearly always due to the tongue not reaching the prey. None of the unsuccessful feedings prior to denervation were due to inadequate tongue protrusion. Anatomical data show a much larger rostral-caudal distribution of the trigeminal motor neurons than previously described for anurans. These data suggest a larger role for the submentalis muscle in Rana than in previously studied anurans with long protrusible tongues, and suggests a feedback mechanism from the trigeminal nerve to the nerves coordinating tongue protraction and retraction.

Sleep-related hypoxia has adverse effects on cognition in children. Knowledge of factors contributing to sleep-related hypoxia is sparse. We aimed to identify demographic and clinical factors associated with mild (nadir arterial oxygen saturation 91-93%), moderate (nadir arterial oxygen saturation 3.9) sleep-related hypoxia in children. Parental questionnaires were distributed and overnight recordings of arterial oxygen saturation performed in a population-based cross-section of primary school children (n = 995). Associations were determined using unconditional logistic regression as well as unadjusted and adjusted odds ratios (OR), and their 95% confidence intervals (95% CI) calculated. Male sex, overweight (i.e., body mass index >or= 75th percentile), household smoking, symptoms of sleep-disordered breathing, a current respiratory tract infection, and histories of asthma and respiratory allergy were all significantly associated with sleep-related hypoxia. In multiple regression analysis, (i) overweight (OR, 95% CI: 2.7, 1.7-4.3) and a history of respiratory allergy (1.7, 1.1-2.7) were independent risk factors for mild sleep-related hypoxia, (ii) overweight (3.2, 1.7-5.8), a history of respiratory allergy (2.4, 1.4-4.4), and household smoking >10 cigarettes/day (1.8, 1.1-2.8) were independent risk factors for moderate sleep-related hypoxia, and (iii) overweight (2.3, 1.04-5.3), a history of respiratory allergy (2.5, 1.2-5.1), and a current respiratory tract infection (4.4, 2.0-9.8), were independent risk factors for recurrent sleep-related hypoxia. Our data suggest that overweight, passive smoking, respiratory allergies, and acute lung disease may independently contribute to sleep-related hypoxia in children.

As urges are associated with positive-social, negative-affective, and habitual situations, we developed a sound scale to assess urges in these situations. In Northeastern Germany in 2005/2006, a sample of 1,093 smoking adolescents from 7th to 10th grade, aged 12-18 years, was used. Reliability analysis and exploratory and confirmatory factor analyses were applied. A three-factorial structure of the final situational urge to smoke scale (SUS) was found. Internal consistency of the scale was high (α = .89). The SUS is a new internally consistent scale that assesses the urge to smoke in adolescents. Further research needs to examine its predictive validity. The study's limitations are noted.