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.