Apolipoprotein E (<scp>APOE</scp>) Genotype and Cognitive Outcomes of Snoring in a Large Cohort of Adolescents

ABSTRACT Objective The objective of this study is to investigate whether apolipoprotein E (APOE) ε4 genotype is associated with lower cognitive performance in children with habitual snoring and to determine if APOE could stratify children with snoring by their risk for adverse cognitive outcomes. Methods We performed a secondary analysis of the Adolescent Brain Cognitive Development (ABCD) dataset, which included approximately 12,000 children aged 9–10 years recruited between June 2016 and October 2018, with follow‐up data from years 1 and 3. Cognitive performance was assessed using the National Institutes of Health Toolbox (NIH‐TB) Cognitive Battery. Snoring frequency was evaluated using the Sleep Disorders Scale for Children and categorized as none, non‐habitual (&lt; 3 nights/week), or habitual (≥ 3 times/week). APOE genotypes were identified using Plink 2.0. Linear mixed effects models examined interaction effects between APOE genotypes, time, and snoring on age‐adjusted Crystallized Cognition Composite scores, adjusting for demographic and clinical variables. Secondary outcomes included other NIH‐TB domain scores. Results Of 11,725 children (52.2% female) in year 1, 6.9% were habitual snorers. APOE genotype distribution was 69.8% ε3ε3, 2.7% ε3ε4/ε4ε3, and 27.5% ε4ε4. No significant interaction effects were found between genotype and snoring or between genotype, snoring, and time. Significantly, the APOE genotype did not modify the relationship between the frequency of snoring and the NIH‐TB Crystallized Composite score, either at a single point or over time. Conclusion APOE genotype was not associated with worsening cognition in habitually snoring children over time. More extended follow‐up periods may be necessary to detect potential chronic cognitive decline in this population. Level of Evidence 3.