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Slow wave activity and executive dysfunction in children with sleep disordered breathing



This study aimed to examine slow wave activity (SWA), a marker of homeostatic regulation, as a potential mechanism linking sleep disordered breathing (SDB) with executive dysfunction in children.


Executive function domains of working memory, spatial planning, information processing, and sustained attention were assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB) in children (N = 40; 5–12 years) referred for clinical diagnosis of SDB. Polysomnography records of non-snoring, age-matched controls (N = 34) were retrospectively examined for comparison of SWA. Power spectral analysis of the delta wave determined SWA. Group differences in sleep, respiratory, and SWA outcomes were examined. Mean CANTAB scores were compared to standardized norms and correlated against SWA.


Children with SDB showed increased SWA compared to non-snoring controls and scored < 25th percentile for planning accuracy, speed of mental processing, and task efficiency, when compared against population norms. Increasing severity of SDB was associated with an increased difficulty in solving complex tasks and time on task performance. SWA was associated with performance on tasks of early problem solving and efficiency during sustained attention.


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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The authors wish to thank all the children and their parents who participated in this study and the staff of the Melbourne Children’s Sleep Centre.


The National Health and Medical Research Council of Australia provided financial support in the form of Project funding (Application 1139620) and the Victorian Government’s Operational Infrastructure Support Program provided financial support to the Hudson Institute of Medical Research. The sponsors had no role in the design or conduct of this research.

Author information

Correspondence to Sarah N. Biggs.

Ethics declarations

The Monash University and Monash Health Human Research Ethics Committees granted ethical approval for this project. Written informed consent and verbal assent was obtained. No monetary incentive was provided for participation.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Christiansz, J.A., Lappin, C.R., Weichard, A.J. et al. Slow wave activity and executive dysfunction in children with sleep disordered breathing. Sleep Breath 22, 517–525 (2018).

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  • Slow wave activity
  • Executive function
  • Obstructive sleep apnea
  • Children
  • Snoring