0870 Cognitive, Psychological, and Developmental Outcomes of Children with Obstructive Sleep Apnea: A Systematic Review and Meta-Analysis

Abstract Introduction Pediatric obstructive sleep apnea (OSA) is a sleep-related breathing disorder marked by reduced or absent airflow despite ongoing effort to breathe. It affects children worldwide, with higher prevalence among those with obesity and neurodevelopmental disorders. Beyond cardiometabolic consequences, OSA has been increasingly linked to cognitive, psychological, and developmental challenges during critical stages of growth. This systematic review and meta-analysis synthesized existing evidence on cognitive, psychological, and developmental outcomes in children with OSA. Methods A total of 11,334 articles were identified through MEDLINE/PubMed, PsycINFO, and Embase. After screening, 404 underwent full-text review and 52 met eligibility criteria. Included studies focused on participants aged 0–18 with OSA diagnosed using American Academy of Sleep Medicine criteria. Standardized mean differences were calculated for cognitive outcomes (WISC), psychological outcomes (CBCL), and executive functioning (BRIEF). Results Across studies, pediatric OSA was associated with poorer verbal cognitive performance (WISC, effect size = –0.73, 95% CI: –1.11 to –0.36), greater behavioral and emotional problems (CBCL, effect size = 2.26, 95% CI: –0.29 to 4.81), and higher executive dysfunction (BRIEF, effect size = 1.90, 95% CI: 0.13 to 3.67). These findings highlight consistent links between OSA and adverse neurocognitive and psychosocial outcomes in children. Conclusion Pediatric OSA is associated with meaningful impairments in cognition, behavior, and executive function. These results emphasize the need for early screening and targeted interventions to mitigate long-term developmental and psychological consequences. Support (if any) This research was supported by the Intramural Research Program of the National Institutes of Health (NIH), including the NICHD and NIMH