{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T16:41:50Z","timestamp":1778172110209,"version":"3.51.4"},"reference-count":52,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2024,9,18]],"date-time":"2024-09-18T00:00:00Z","timestamp":1726617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Understanding the long-term consequences of sleep-disordered breathing (SDB) in neonates is crucial. A lack of consensus on diagnostic and treatment thresholds has resulted in limited research in this area. Our study aims to describe the trajectory of SDB in a cohort of high-risk neonates and their respiratory and neurodevelopmental outcomes at 3 years of age, and explore the relationship between SDB during early infancy and neurocognitive outcomes. Methods: A retrospectively identified cohort of neonates with moderate\u2013severe SDB were prospectively followed at 3 years of age. Data collected included last polysomnography (PSG) parameters up to the age of 3 years and sleep physician\u2019s recommendations, duration of CPAP use, compliance with treatment, timing of SDB resolution, and neurodevelopmental outcomes. Univariate and multivariate logistic regression analyses were performed to evaluate the association between important respiratory and sleep breathing parameters with the developmental outcomes. Results: Eighty neonates were included. Respiratory and developmental outcomes were available for 58 (72.5%) and 56 (70%) patients, respectively. In most patients (47\/58, 81%), SDB had resolved by 3 years of age. Survival without major developmental delay was seen in 32\/56 (57%), but a significant proportion (21\/56, 37.5%) demonstrated global developmental delay. Following univariate analysis, primary diagnosis, apnoea\u2013hypopnoea index (AHI) at the time of last PSG and SDB outcome was significantly associated with developmental delay. However, these associations were not seen in multivariate analysis. Conclusions: Despite severity at baseline, SDB resolved in the majority of patients with time and treatment. Although statistically insignificant, logistic regression analysis identified some clinically important associations between neonatal SDB and neurodevelopmental outcomes.<\/jats:p>","DOI":"10.3390\/jcm13185527","type":"journal-article","created":{"date-parts":[[2024,9,19]],"date-time":"2024-09-19T03:34:20Z","timestamp":1726716860000},"page":"5527","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Respiratory and Neurodevelopmental Outcomes at 3 Years of Age of Neonates Diagnosed with Sleep-Disordered Breathing"],"prefix":"10.3390","volume":"13","author":[{"given":"Bhavesh","family":"Mehta","sequence":"first","affiliation":[{"name":"Department of Neonatology, The Children\u2019s Hospital at Westmead, Sydney, NSW 2145, Australia"},{"name":"Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8699-2175","authenticated-orcid":false,"given":"Karen","family":"Waters","sequence":"additional","affiliation":[{"name":"Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia"},{"name":"Department of Respiratory Medicine, The Children\u2019s Hospital at Westmead, Sydney, NSW 2145, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia"},{"name":"Department of Respiratory Medicine, The Children\u2019s Hospital at Westmead, Sydney, NSW 2145, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6828-1636","authenticated-orcid":false,"given":"Nadia","family":"Badawi","sequence":"additional","affiliation":[{"name":"Department of Neonatology, The Children\u2019s Hospital at Westmead, Sydney, NSW 2145, Australia"},{"name":"Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia"},{"name":"Cerebral Palsy Research Institute, Brain and Mind Institute, Sydney, NSW 2050, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.smrv.2009.10.006","article-title":"Sleep and memory in healthy children and adolescents\u2014A critical review","volume":"14","author":"Kopasz","year":"2010","journal-title":"Sleep Med. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S0272-5231(03)00024-8","article-title":"Obstructive sleep-disordered breathing in children: New controversies, new directions","volume":"24","author":"Carroll","year":"2003","journal-title":"Clin. Chest Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1513\/pats.200708-135MG","article-title":"Epidemiology of pediatric obstructive sleep apnea","volume":"5","author":"Lumeng","year":"2008","journal-title":"Proc. Am. Thorac. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1183\/13993003.00385-2015","article-title":"Obstructive Sleep Disordered Breathing in 2- to 18-Year-Old Children: Diagnosis and Management","volume":"47","author":"Kaditis","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.chc.2009.04.008","article-title":"The neurocognitive effects of sleep disruption in children and adolescents","volume":"18","year":"2009","journal-title":"Child Adolesc. Psychiatr. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.smrv.2005.11.003","article-title":"The contribution of intermittent hypoxia, sleep debt and sleep disruption to daytime performance deficits in children: Consideration of respiratory and non-respiratory sleep disorders","volume":"10","author":"Blunden","year":"2006","journal-title":"Sleep Med. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.ijporl.2005.11.012","article-title":"Growth failure and sleep disordered breathing: A review of the literature","volume":"70","author":"Bonuck","year":"2006","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.chest.2019.02.011","article-title":"OSA and cardiovascular risk in pediatrics","volume":"156","author":"Smith","year":"2019","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1076\/1380-3395(200010)22:5;1-9;FT554","article-title":"Behavior and neurocognitive performance in children aged 5\u201310 years who snore compared to controls","volume":"22","author":"Blunden","year":"2000","journal-title":"J. Clin. Exp. Neuropsychol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1093\/sleep\/28.7.885","article-title":"Snoring predicts hyperactivity four years later","volume":"28","author":"Chervin","year":"2005","journal-title":"Sleep"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1542\/peds.112.4.870","article-title":"Symptoms of sleep-disordered breathing in 5-year-old children are associated with sleepiness and problem behaviors","volume":"112","author":"Gottlieb","year":"2003","journal-title":"Pediatrics"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1002\/ppul.21534","article-title":"Impaired behavioral and neurocognitive function in preschool children with obstructive sleep apnea","volume":"47","author":"Landau","year":"2012","journal-title":"Pediatr. Pulmonol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1164\/rccm.201510-2099OC","article-title":"Effect of Sleep-disordered Breathing Severity on Cognitive Performance Measures in a Large Community Cohort of Young School-aged Children","volume":"194","author":"Hunter","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2147\/NSS.S6934","article-title":"Neurocognitive performance and behavior before and after treatment for sleep-disordered breathing in children","volume":"2","author":"Kohler","year":"2010","journal-title":"Nat. Sci. Sleep"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"71","DOI":"10.5665\/sleep.3310","article-title":"Treatment outcomes of adenotonsillectomy for children with obstructive sleep apnea: A prospective longitudinal study","volume":"37","author":"Huang","year":"2014","journal-title":"Sleep"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2366","DOI":"10.1056\/NEJMoa1215881","article-title":"A randomized trial of adenotonsillectomy for childhood sleep apnea","volume":"368","author":"Marcus","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"77","DOI":"10.5665\/sleep.3312","article-title":"Long-term changes in neurocognition and behavior following treatment of sleep disordered breathing in school-aged children","volume":"37","author":"Biggs","year":"2014","journal-title":"Sleep"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e002639","DOI":"10.1136\/bmjpo-2024-002639","article-title":"Clinical characteristics, associated comorbidities and hospital outcomes of neonates with sleep disordered breathing: A retrospective cohort study","volume":"8","author":"Mehta","year":"2024","journal-title":"BMJ Paediatr. Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3390\/neurolint16030039","article-title":"Obstructive Sleep Apnea in Pregnancy: A Comprehensive Review of Maternal and Fetal Implications","volume":"16","author":"Maniaci","year":"2024","journal-title":"Neurol. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.5664\/jcsm.7968","article-title":"Current Practice Patterns in the Diagnosis and Management of Sleep-Disordered Breathing in Infants","volume":"15","author":"Kombathula","year":"2019","journal-title":"J. Clin. Sleep Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e000979","DOI":"10.1136\/bmjpo-2020-000979","article-title":"Survey of the practices of neonatologists in managing neonates believed to be at high risk of sleep disordered breathing","volume":"5","author":"Mehta","year":"2021","journal-title":"BMJ Paediatr. Open"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.5664\/jcsm.6804","article-title":"Neurodevelopmental outcomes at two years of age for premature infants diagnosed with neonatal obstructive sleep apnea","volume":"13","author":"Bandyopadhyay","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1002\/ppul.24266","article-title":"Sleep-disordered breathing is common among term and near term infants in the NICU","volume":"54","author":"Meerkov","year":"2019","journal-title":"Pediatr. Pulmonol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.5664\/jcsm.5176","article-title":"AASM Scoring Manual Version 2.2 Updates: New Chapters for Scoring Infant Sleep Staging and Home Sleep Apnea Testing","volume":"11","author":"Berry","year":"2015","journal-title":"J. Clin. Sleep Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"665","DOI":"10.5664\/jcsm.6576","article-title":"AASM Scoring Manual Updates for 2017 (Version 2.4)","volume":"13","author":"Berry","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"429","DOI":"10.5664\/jcsm.5600","article-title":"The visual scoring of sleep in infants 0 to 2 months of age","volume":"12","year":"2016","journal-title":"J. Clin. Sleep Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"230121","DOI":"10.1183\/16000617.0121-2023","article-title":"An update on diagnosis and management of obstructive sleep apnoea in the first 2 years of life","volume":"33","author":"Polytarchou","year":"2024","journal-title":"Eur. Respir. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.5664\/jcsm.8066","article-title":"Reevaluating Norms for Childhood Obstructive Sleep Apnea","volume":"15","author":"Brooks","year":"2019","journal-title":"J. Clin. Sleep Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1542\/peds.2005-1067","article-title":"Polysomnographic characteristics in normal preschool and early school-aged children","volume":"117","author":"Gulliver","year":"2006","journal-title":"Pediatrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.jsmc.2009.04.007","article-title":"Pediatric Polysomnography","volume":"4","author":"Beck","year":"2009","journal-title":"Sleep Med. Clin."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/ppul.20236","article-title":"Polysomnographic values in children 2\u20139 years old: Additional data and review of the literature","volume":"40","author":"Traeger","year":"2005","journal-title":"Pediatr. Pulmonol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.chest.2020.08.020","article-title":"Positive Airway Pressure for the Treatment of OSA in Infants","volume":"159","author":"Cielo","year":"2021","journal-title":"Chest"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e1056","DOI":"10.1542\/peds.2010-0856","article-title":"Physiologic and clinical benefits of noninvasive ventilation in infants with Pierre Robin sequence","volume":"126","author":"Leboulanger","year":"2010","journal-title":"Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1097\/01.prs.0000475799.07597.23","article-title":"Continuous Positive Airway Pressure for Upper Airway Obstruction in Infants with Pierre Robin Sequence","volume":"137","author":"Amaddeo","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1002\/lary.23685","article-title":"Analysis of outcomes in treatment of obstructive sleep apnea in infants","volume":"123","author":"Robison","year":"2013","journal-title":"Laryngoscope"},{"key":"ref_36","first-page":"6","article-title":"Long-term Non-Invasive Ventilation in Infants: A Systematic Review and Meta-Analysis","volume":"12","author":"Bedi","year":"2018","journal-title":"Front. Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e442","DOI":"10.1542\/peds.2005-1634","article-title":"Adherence to and effectiveness of positive airway pressure therapy in children with obstructive sleep apnea","volume":"117","author":"Marcus","year":"2006","journal-title":"Pediatrics"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1016\/j.jpeds.2011.04.013","article-title":"Patterns of continuous positive airway pressure adherence during the first 3 months of treatment in children","volume":"159","author":"Nixon","year":"2011","journal-title":"J. Pediatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1093\/sleep\/26.8.1010","article-title":"Improving pediatric compliance with positive airway pressure therapy: The impact of behavioral intervention","volume":"26","author":"Koontz","year":"2003","journal-title":"Sleep"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1002\/ppul.23169","article-title":"Polysomnography for the diagnosis of sleep disordered breathing in children under 2 years of age","volume":"50","author":"DeHaan","year":"2015","journal-title":"Pediatr. Pulmonol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1136\/thx.2009.120220","article-title":"Natural history and predictors for progression of mild childhood obstructive sleep apnoea","volume":"65","author":"Li","year":"2010","journal-title":"Thorax"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.ijporl.2016.01.012","article-title":"Polysomnography results in pediatric patients with mild obstructive sleep apnea: Adenotonsillectomy vs watchful waiting","volume":"83","author":"Trosman","year":"2016","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1002\/ppul.22867","article-title":"Obstructive sleep apnea in infancy: A 7-year experience at a pediatric sleep center","volume":"49","author":"Ramgopal","year":"2014","journal-title":"Pediatr. Pulmonol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Gaza, K., Gustave, J., Rani, S., Strang, A., and Chidekel, A. (2023). Polysomnographic characteristics and treatment modalities in a referred population of children with trisomy 21. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.1109011"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"109968","DOI":"10.1016\/j.ijporl.2020.109968","article-title":"Obstructive sleep apnea in children with down syndrome\u2014Prevalence and evaluation of surgical treatment","volume":"133","author":"Nerfeldt","year":"2020","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Biggs, S.N., Walter, L.M., Jackman, A.R., Nisbet, L.C., Weichard, A.J., Hollis, S.L., Davey, M.J., Anderson, V., Nixon, G.M., and Horne, R.S. (2015). Long-Term Cognitive and Behavioral Outcomes following Resolution of Sleep Disordered Breathing in Preschool Children. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139142"},{"key":"ref_47","first-page":"72","article-title":"Obstructive Sleep Apnoea: Children are not little Adults","volume":"21","author":"Alsubie","year":"2017","journal-title":"Paediatr. Respir. Rev."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s00408-020-00342-5","article-title":"Evaluation and Management of Children with Obstructive Sleep Apnea Syndrome","volume":"198","author":"Bitners","year":"2020","journal-title":"Lung"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1177\/019459989411100512","article-title":"Clinical diagnosis of pediatric obstructive sleep apnea validated by polysomnography","volume":"111","author":"Goldstein","year":"1994","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.jash.2017.12.010","article-title":"Severe obstructive sleep apnea in children with elevated blood pressure","volume":"12","author":"Hinkle","year":"2018","journal-title":"J. Am. Soc. Hypertens."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.sleep.2011.03.023","article-title":"Snoring and cognitive development in infancy","volume":"12","author":"Piteo","year":"2011","journal-title":"Sleep Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"919","DOI":"10.5665\/sleep.3660","article-title":"Impact of sleep and breathing in infancy on outcomes at three years of age for children with cleft lip and\/or palate","volume":"37","author":"Smith","year":"2014","journal-title":"Sleep"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/18\/5527\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:58:58Z","timestamp":1760111938000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/18\/5527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,18]]},"references-count":52,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["jcm13185527"],"URL":"https:\/\/doi.org\/10.3390\/jcm13185527","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,18]]}}}