Changes in Behavior and Attentional Capacity after Adenotonsillectomy

Galland, Barbara; Dawes, P. J. D.; Tripp, E. Gail; Taylor, B. J.

doi:10.1203/01.pdr.0000214992.69847.6f

Cited by 55 publications

(33 citation statements)

References 30 publications

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“…Learning, memory, and visuospatial skills 226 Kaemingk et al 33 Kennedy et al 34 Kurnatowski et al 227 Carvalho et al 228 III 1332 Objective measures of general intelligence, verbal skills affected by SDB Montgomery-Downs et al 50 Suratt et al 43 Friedman et al 26 II 45 Additive factors were SES and ethnicity 42 , 45 or BMI, 42 , 45 , 47 which contributed to findings of poor school performance in SDB Kaemingk et al 33 Ng et al 219 Perez-Chada et al 220 Shin et al 47 Urschitz 232 Kaemingk et al 33 Kennedy et al 34 Kurnatowski et al 227 O'Brien et al 233 Spruyt et al 234 Giordani et al 38 Halbower et al 28 233 Objective testing performed in all studies Perez-Chada et al 220 Honaker et al 235 Lundeborg et al 51 Suratt et al 43 III 236 Galland et al 237 Gottlieb et al 213 Hamasaki Uema et al 232 Kaemingk et al 33 Li et al 238 Mulvaney et al 32 Urschitz et al 229 Chervin et al 37 I 105 O'Brien et al 24 I 118 Visual and auditory attention and working memory. Executive functions are required for optimal school performance and are acquired through adolescence in developing children.…”

Section: Cognitive Deficitsmentioning

confidence: 99%

“…There were 9 recent level III or IV studies, most of which showed a correlation between the presence/ 40 Galland et al 237 Golan et al 239 Gottlieb et al 213 Johnson and Roth 45 LeBourgeois et al 230 Mitchell and Kelly 240 Owens et al 189 Roemmich et al 191 Urschitz et al 229 Montgomery 240 Mitchell and Kelly 241 Rudnick and Mitchell 242 Suratt et al 43 III 114 O'Brien et al 24 I 118 Behavior problems, general Goldstein et al 55 IV 1946 Behavior generally measured by using parent questionnaire Goldstein et al 243 Hogan et al 48 Li et al 238 Mitchell and Kelly 241 Mulvaney et al 32 Owens et al 189 Roemmich et al 191 Rosen et al 244 Rudnick and Mitchell 242 Tran et al 58 Wei et al 245 Aggression, oppositional and social problems…”

Section: Cardiovascular Effects Of Osasmentioning

confidence: 99%

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Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Marcus¹,

Brooks²,

Ward³

et al. 2012

Pediatrics

1,503

1,504

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OBJECTIVE: This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS). METHODS: The literature from 1999 through 2011 was evaluated. RESULTS AND CONCLUSIONS: A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.

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Section: Cognitive Deficitsmentioning

confidence: 99%

Section: Cardiovascular Effects Of Osasmentioning

confidence: 99%

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Marcus¹,

Brooks²,

Ward³

et al. 2012

Pediatrics

1,503

1,504

View full text Add to dashboard Cite

show abstract

“…11,13,46 The tests used in this study may also be suboptimal for detecting effects of AT; measures placing greater demands on sustained attention and novel problem solving may have been more sensitive to the effects of AT. 11,14,22,26,43,47 Although OSAS measures in the study were those routinely used in clinical settings and scored using rigorous approaches, alternative measures of OSAS or sleep disruption may also provide more sensitive indices of the effects of AT on sleep. 7,8,16,17,20,48 A secondary aim was to explore associations of baseline test scores …”

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confidence: 99%

Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea

et al. 2016

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OBJECTIVE: Research reveals mixed evidence for the effects of adenotonsillectomy (AT) on cognitive tests in children with obstructive sleep apnea syndrome (OSAS). The primary aim of the study was to investigate effects of AT on cognitive test scores in the randomized Childhood Adenotonsillectomy Trial. METHODS:Children ages 5 to 9 years with OSAS without prolonged oxyhemoglobin desaturation were randomly assigned to watchful waiting with supportive care (n = 227) or early AT (eAT, n = 226). Neuropsychological tests were administered before the intervention and 7 months after the intervention. Mixed model analysis compared the groups on changes in test scores across follow-up, and regression analysis examined associations of these changes in the eAT group with changes in sleep measures. RESULTS:Mean test scores were within the average range for both groups. Scores improved significantly (P < .05) more across follow-up for the eAT group than for the watchful waiting group. These differences were found only on measures of nonverbal reasoning, fine motor skills, and selective attention and had small effects sizes (Cohen's d,. As additional evidence for AT-related effects on scores, gains in test scores for the eAT group were associated with improvements in sleep measures. CONCLUSIONS:Small and selective effects of AT were observed on cognitive tests in children with OSAS without prolonged desaturation. Relative to evidence from Childhood Adenotonsillectomy Trial for larger effects of surgery on sleep, behavior, and quality of life, AT may have limited benefits in reversing any cognitive effects of OSAS, or these benefits may require more extended follow-up to become manifest. 1 The prevalence of OSAS is ~1% to 6%, with higher rates in African Americans and children from families of lower socioeconomic status. 2 -4 Children with untreated OSAS are at risk for adverse outcomes ranging from daytime sleepiness and compromised cardiovascular health to behavior problems and impairments in cognition and academic performance. 5 -11 Problems in behavior and emotional regulation are common in children with OSAS compared with healthy controls, but evidence for adverse effects of OSAS on children's cognitive abilities is more mixed. 6 Some studies fail to find differences between children with OSAS and healthy controls, 12,13 and those that do report variable associations of measures of sleep disturbance with cognitive test scores. 7, 14 -18 Similarly, studies of outcomes of adenotonsillectomy (AT) in children with OSAS indicate variable benefits on such tests, with little evidence for associations of these effects with the severity of OSAS and sleep disruption. 8, 13, 14, 16, 19 -26 In the recently completed multicenter Childhood Adenotonsillectomy Trial (CHAT), children with OSAS without prolonged oxyhemoglobin desaturation assigned to early AT (eAT) improved more than those assigned to watchful waiting with supportive care (WWSC) on key secondary outcomes. 27 -29 Specifically, the eAT group improved more tha...

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“…(6)(7)(8)(9)(10)(11)(12) Identification of children at high risk for SDB and its associated morbidities is particularly important given the growing body of evidence that treatment with adenotonsillectomy may improve quality of life and neurocognitive function. (5,(13)(14)(15)(16)(17) Preterm infants are especially vulnerable both to SDB and its sequelae. In a Finnish cohort study, very low birth weight infants were shown to have a two-fold risk of SDB as young adults.…”

mentioning

confidence: 99%

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

Hibbs

Johnson

Rosen

et al. 2008

The Journal of Pediatrics

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Objectives-Previously published data from the Cleveland Children's Sleep and Health Study (CCSHS) demonstrated that preterm infants are especially vulnerable both to sleep disordered breathing (SDB) and its neurocognitive sequelae at age 8-11 years. In this analysis, we aimed to identify the components of the neonatal medical history associated with childhood SDB among children born prematurely.Study design-This analysis focuses on the 383 children in the population-based CCSHS cohort who were born <37 weeks gestational age and who had technically acceptable sleep studies performed at ages 8-11 years (92% of all preterm children). Logistic regression was used to evaluate the associations between candidate perinatal and neonatal risk factors and the presence of childhood SDB by sleep study.Results-Twenty-eight preterm children (7.3%) met the definition for SDB at age 8-11 years. Having a single mother and mild maternal pre-eclampsia were strongly associated with SDB in unadjusted and race-adjusted models. Unadjusted analyses also identified xanthine use and CPR and/ or intubation in the delivery room as potential risk-factors for SDB. We did not find a significant link between traditional markers of severity of neonatal illness --such as gestational age, birth weight, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), or duration of ventilation --and childhood SDB at school age.Conclusions-These results represent a first step in identifying prenatal and neonatal characteristics which place preterm infants at higher risk for childhood SDB. The strong association between mild pre-eclampsia and childhood SDB underscores the importance of research aimed at understanding in utero risk factors for neurorespiratory development. Corresponding Author: Anna Maria Hibbs, MD, MSCE, Division of Neonatology, Rainbow Babies & Children's Hospital, 11100 Euclid Avenue, Suite 3100, Cleveland, email: annamaria.hibbs@case.edu. Edited by AJ and WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (1) Furthermore, the association between sleep disordered breathing (SDB) and childhood cognitive impairment is stronger in preterm than term infants. (8) The mechanisms by which prematurity predisposes children to SDB are unknown. The association may be mediated by altered development of the lungs, airway, or nervous system. In this analysis, we aimed to identify the components of the prenatal and neonatal medical history associated with SDB occurring in children in the CCSHS studied at ages 8-11 years who had been born prematurely. NIH Public Access METHODSThe CCSHS is a po...

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Changes in Behavior and Attentional Capacity after Adenotonsillectomy

Cited by 55 publications

References 30 publications

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea

Prenatal and Neonatal Risk Factors for Sleep Disordered Breathing in School-Aged Children Born Preterm

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