Moderate to severe obstructive sleep apnea was linked to lower academic grades and behavioral concerns expressed by parents and teachers. Students with moderate to severe OSA averaged a half-letter grade lower than those without sleep-disordered breathing, and none of the students with moderate to severe OSA had an "A" average. OSA was particularly associated with inattention and poor study skills in real-world situations. Participants were 163 children and adolescents, 10 to 17 years old.