Neurocognitive deficits in children with polysomnographically confirmed obstructive sleep apnea: A systematic review and meta-analysis.

Background

Children with obstructive sleep apnea (OSA) frequently exhibit neurocognitive difficulties, but the magnitude and consistency of cognitive deficits have not been systematically quantified using polysomnographic criteria.

Objectives

To estimate the pooled magnitude of neurocognitive deficits in predominantly school-aged children (mean age approximately 5-12 years) with PSG-confirmed OSA versus healthy non-snoring controls.

Methods

Systematic review and random-effects meta-analysis (DerSimonian-Laird) following PRISMA 2020 guidelines. PubMed, Embase, Cochrane CENTRAL, and PsycINFO were searched from database inception to July 2026. Inclusion criteria required: (1) PSG-confirmed OSA (AHI ≥1 event/hour); (2) a directly enrolled non-snoring control group; (3) standardised neuropsychological assessment; (4) predominantly school-aged participants (mean age approximately 5-12 years); (5) ADHD excluded. The primary effect measure was Hedges' g.

Results

Six studies (n = 436; 249 OSA, 187 controls) met eligibility criteria. The pooled Hedges' g was 0.67 (95% CI: 0.44-0.90, p < 0.001), a moderate cognitive deficit. Between-study heterogeneity was low-to-moderate (I2 = 25%, Q = 6.69, df = 5, p = 0.24). Sensitivity analyses confirmed robustness: leave-one-out estimates ranged from g = 0.58 to 0.77 regardless of which study was excluded. Secondary outcomes showed impairment across executive function, working memory, intelligence, and phonological processing. With few studies, heterogeneity estimates should be interpreted cautiously.

Conclusions

PSG-confirmed OSA in school-aged children is associated with a moderate, relatively consistent neurocognitive deficit across diverse populations, test batteries, and severity strata. These findings support neurocognitive screening in children with OSA and a rationale for early intervention.