Association of Sleep Spindle Activity with executive functioning and intellectual ability in children and adolescents

Abstract Study Objectives Sleep spindles have been studied as an underlying mechanism of cognition. Prior research primarily relied on experimental studies of selective samples of healthy youth. We tested the relationship between spindle activity and cognition in youth from the general population. Methods 892 sleep EEGs from 9-hour polysomnography were leveraged from 456 typically developing children (median-8y), and 258 typically developing adolescents (median-16y) and youth with unmedicated psychiatric/behavioral disorders (89 children; 89 adolescents). Multivariable-adjusted linear regression models examined associations between sleep spindle density (SSD; number/minute) and peak spindle frequency (PSF; 10-16 Hz range) during N2 with Wechsler indices of processing speed, working memory, verbal, and non-verbal intelligence. We first analyzed typically developing and unmedicated psychiatric/behavioral youth, followed by an analysis of the 47 unmedicated ADHD subgroup. Results In typically developing children, higher SSD and PSF were associated with better working memory and verbal intelligence. In adolescents, higher SSD was associated with better working memory and non-verbal intelligence, while slower PSF was associated with better non-verbal intelligence. Longitudinally, higher childhood SSD was associated with better adolescent non-verbal intelligence among typically developing youth. In youth with unmedicated psychiatric/behavioral disorders, spindle–cognition associations were lost, except in ADHD, where higher childhood SSD and slower adolescent PSF supported working memory. Conclusion Sleep spindles may serve as a biomarker for neural and cognitive maturation, with developmental differences reflecting key brain maturational changes from childhood to adolescence. While altered in unmedicated psychiatric/behavioral disorders, lower-frequency spindles may provide a protective mechanism for working memory in adolescents with ADHD.