Interplay of Cognition, Emotion, and Behavior
It is important to note that cognitive challenges occur in the context
of other contextual and health variables.51 In
addition to effects of SDB on cognition, there is a large body of
research related to the effects of SDB on behavior, which is beyond the
scope of this article. For a systematic review of SDB and behavior the
reader is directed to da Silva Gusmão Cardoso, Pompèia, and
Miranda.52 However, because these intersections are an
important consideration, we address the relationship as pertinent to our
discussion on cognition. Previously, researchers suggested that
behavioral challenges might mediate the relationship between SDB and
cognitive functioning.21 Smith and
colleagues53 investigated the indirect effects of SDB
on cognition through behavior and reported that behavioral problems
mediated the relationship between SDB status and cognition. Therefore,
SDB status was related to greater behavioral problems, and greater
behavioral problems were related to cognitive
functioning.53 One notable limitation of this study
was that it did not control for SES or prematurity status, which are
often associated with SDB and cognitive performance.53
In addition to the interplay between cognition and behavior, studies
have researched relationships among SDB and emotion. While the broader
relationship between SDB and emotional problems in children is not the
focus of this paper, and the reader is directed to Liu, et
al54 for a comprehensive review regarding this topic,
we briefly describe the complex intersections of cognition, emotion, and
SDB. Stojek and colleagues55 investigated the
relationship among fitness, depression, and attention in children with
SDB and found that SDB directly mediated the relationship between
fitness and depression, such that less fitness was related to greater
SDB, which was in turn related to higher levels of
depression.55 In addition, the authors reported that
SDB mediated the relationship between fitness and attention, meaning
less fitness was associated with greater SDB, which was associated with
worse performance on attentional measures.55Additional research is needed to support ideas regarding the
intersection of SDB, cognition, emotion, and behavior.