**10. Conclusions**

Motivational ability, planning, behavior modulation, ability to complete an action program, identification of functional strategies to achieve the goal, problem solving, flexibility, monitoring and self-assessment of behavior in relation to results, change of task, or behavior in the light of emerging information may be all impaired by nocturnal intermittent hypoxia also during the developmental age. The final effects of this impairment may be identified in such clinical condition mimicking other neurobehavioral symptoms, such as ADHD [34], while learning problems may be sustained by OSAS [91, 92], or in Fragile X syndrome [93], in epilepsy [94], and in EEG abnormalities [95], suggesting that the sleep screening may be considered as mandatory in neurodevelopmental disorders.

*Updates in Sleep Neurology and Obstructive Sleep Apnea*

interrelated. It is precisely the transversal nature and the structural complexity that characterizes them, associated with their slow development process, to explain why multiple neuropsychiatric disorders of the developmental age (pervasive developmental disorders, behavioral disorders, speech disorders, learning disorders, and disorders of the nonverbal area) present, with varying degrees of symptomatic severity, a common deficit for executive functioning. There are also motivated situations in which a deficiency of theirs manifests itself with clinical signs and symptoms that are often nuanced, nonspecific, and not immediately diagnostic (instability of behavior and emotionality, distractibility, difficulty in moving from one activity to another, and atypia communication). To this lively theoretical debate on what and what the EFs are, a new theoretical contribution has recently been added linked to the different types of cognitive and behavioral deficits that have emerged from injuries to the different areas of the prefrontal cortex, which has

allowed a further classification in hot and cold executive functions [63].

neuropsychological tests used in clinical practice (DLPFC) [66].

closely related and combined in different situations of daily life.

ally, all mental activities [63].

ADHD [72], and OSAS [73].

disorder [77].

The "hot" executive processes involve the emotional-emotional sphere and are associated with the activity of the ventromedial prefrontal cortex (VMPFC); the "cold" executive ones concern cognitive and nonemotional processing and are associated with the activity of the dorsolateral prefrontal cortex and can be measured by

The "hot" executive functions recall phenomena such as empathy, the theory of the mind, emotional, and affective regulation, which coordinate the cognitive with the emotional sphere in order to adequately address the primary impulses with socially acceptable strategies. The "cold" executive functions intervene in cognitive, abstract, and decontextualized tasks (problem solving, abstraction, planning, working memory, and elaboration of strategies). Despite this distinction, they are

In summary, the EFs are a particular set of cognitive operations activated in pursuit of objectives, responsible for planning, the ability to set goals, to classify, to know how to execute an order, to control and monitor one's behavior, to know how to order a series of activities in order to achieve a goal, and to manage, more gener-

These functions are modified in some pathological conditions such as posterior cranial fossa neoplasms [67], localized posttraumatic lesions to the frontal lobe [68], neurodegenerative syndromes (i.e. Parkinson's disease and Alzheimer's disease) [69, 70], cerebrovascular malformations (i.e. Moya-Moya syndrome) [71],

The close relationship between cognitive functions has long been known and sleep, with particular reference to disorders respirators for which it has been widely demonstrated in the developmental age the association with learning disorders and more generally with alterations of the cognitive performance [74] that appears in such subjects dominated by slowness in concept development [75, 76] which however do not seem to be related to degree of severity of the respiratory

Several studies have focused on the role of the frontal lobes as possible relay zones between the OSAS and the cognitive alterations [78, 79]; however, studies conducted on executive functions of subjects with OSAS have pay attention exclusively to adult-

In this context, the close interconnection between OSAS and alteration specifications charged to executive functions. Furthermore, as reported in other studies, the modified card sorting test (MCST) is related especially to changes in blood flow for the frontal and hippocampal regions [80]. These data reflect the conclusions of recent neuroimaging studies on subjects suffering from OSAS, which would present a level reduction of the gray substance of the fronto parietal regions and

hood [79], leaving aside the impact of this disease in the developmental age.

**164**
