Sleep-Related Respiratory Disruption is Associated with Altered Spindle Morphology and Poorer Attention in Children

Study Objectives

To determine whether sleep-related respiratory disruption is associated with regionally specific alterations in sleep spindle topography and whether hypopnea-sensitive spindle features are associated with attentional performance in children.

Methods

We recorded overnight high-density EEG in children across a wide range of respiratory disruption severity. Slow and fast spindle metrics were extracted per channel, and channel-wise regression models characterized topographic associations with hypopnea index (HI). Cluster-based permutation testing controlled for multiple comparisons. Hierarchically defined regions of interest were tested as predictors of attentional performance on the Test of Variables of Attention (TOVA).

Results

Canonical slow-anterior and fast-posterior spindle organization was detectable across the cohort. Two HI-related topographic effects survived cluster-based permutation correction: higher HI was associated with shortened anterior fast spindle duration and with slower anterior slow spindle peak frequency. In cognitive models, anterior fast spindle duration was the strongest and most consistent predictor of attentional performance, associated with higher signal detection sensitivity, fewer omission errors, and fewer commission errors. By contrast, slow spindle peak frequency showed no attentional associations.

Conclusions

Pediatric respiratory disruption is associated with regionally specific alterations in spindle morphology rather than global spindle reduction. Shortened anterior fast spindle duration showed convergent respiratory and attentional associations, suggesting that localized spindle integrity may provide a neurophysiological marker of cognitive vulnerability in pediatric sleep-disordered breathing beyond conventional clinical respiratory metrics.

Highlights

• Higher hypopnea index was associated with shortened anterior fast spindle duration and slower anterior slow spindle peak frequency

• Anterior fast spindle duration predicted attentional performance in children

• Respiratory disruption may impair attention by disrupting thalamocortical spindle activity

Statement of Significance

Children with sleep-disordered breathing can show neurocognitive difficulties that are not well explained by standard respiratory indices alone. This study uses high-density EEG to show that hypopnea burden is associated with regionally specific alterations in sleep spindle morphology, particularly shortened anterior fast spindle duration, rather than a global reduction in spindle occurrence. Anterior fast spindle duration was also the spindle feature most consistently associated with attentional performance. These findings suggest that localized spindle morphology may provide a sleep-neurophysiological readout of cognitive vulnerability in pediatric sleep-disordered breathing. Longitudinal and treatment studies are needed to determine whether spindle duration changes with respiratory improvement and whether such changes track cognitive recovery.