Hearing loss mediates executive function impairment in sleep-disordered breathing

Hill, Catherine M.; Bucks, Romola S.; Kennedy, Colin; Harrison, Dawn; Carroll, Annette; Upton, Nicolas; Hogan, Alexandra M.

doi:10.1016/j.sleep.2017.02.008

Cited by 10 publications

(6 citation statements)

References 29 publications

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“…It may also be important that we excluded children with hearing loss from the baseline assessments, a factor not routinely considered in studies of OSA and IQ, despite its demonstrable association with executive function in OSA. 19 Nonetheless, our primary analysis rejects the hypothesis that younger (preschool) children have improved global IQ after earlier intervention with adenotonsillectomy, nor were there improvements in BRIEF scores (parent-reported executive function).…”

Section: Secondary Outcomescontrasting

confidence: 50%

Cognition After Early Tonsillectomy for Mild OSA

et al. 2020

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OBJECTIVES: It remains uncertain whether treatment with adenotonsillectomy for obstructive sleep apnea in children improves cognitive function. The Preschool Obstructive Sleep Apnea Tonsillectomy and Adenoidectomy study was a prospective randomized controlled study in which researchers evaluated outcomes 12 months after adenotonsillectomy compared with no surgery in preschool children symptomatic for obstructive sleep apnea.METHODS: A total of 190 children (age 3-5 years) were randomly assigned to early adenotonsillectomy (within 2 months) or to routine wait lists (12-month wait, no adenotonsillectomy [NoAT]). Baseline and 12-month assessments included cognitive and behavioral testing, medical assessment, polysomnography, and audiology. The primary outcome was global IQ at 12-month follow-up, measured by the Woodcock Johnson III Brief Intellectual Ability (BIA). Questionnaires included the Pediatric Sleep Questionnaire, Parent Rating Scale of the Behavioral Assessment System for Children-II, and Behavior Rating Inventory of Executive Function, Preschool Version.RESULTS: A total of 141 children (75.8%) attended baseline and 12-month assessments, and BIA was obtained at baseline and 12-month follow-up for 61 and 60 participants in the adenotonsillectomy versus NoAT groups, respectively. No cognitive gain was found after adenotonsillectomy compared with NoAT, adjusted for baseline; BIA scores at 12-month follow-up were as follows: adenotonsillectomy, 465.46 (17.9) versus NoAT, 463.12 (16.6) (mean [SD]). Improvements were seen for polysomnogram arousals and apnea indices and for parent reports of symptoms (Pediatric Sleep Questionnaire), behavior (Behavior Assessment System for Children behavioral symptoms, P = .04), overall health, and daytime napping. CONCLUSIONS: Structured testing showed no treatment-attributable improvement in cognitive functioning of preschool children 12 months after adenotonsillectomy compared with NoAT. Improvements were seen after adenotonsillectomy in sleep and behavior by using polysomnogram monitoring and parental questionnaires.WHAT'S KNOWN ON THIS SUBJECT: Studies to evaluate changes in neurocognition after adenotonsillectomy for obstructive sleep apnea suggest that younger children may have potential for greater improvement. The previous study with a randomized design was in school-aged children.WHAT THIS STUDY ADDS: This randomized study of preschool children showed reduced frequency of day naps and confirmed polysomnographic and behavioral improvements after adenotonsillectomy compared with those still awaiting surgery, but our primary analysis showed no improvement in global IQ.

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Section: Secondary Outcomescontrasting

confidence: 50%

Cognition After Early Tonsillectomy for Mild OSA

et al. 2020

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“…The present findings show that children with SRBD differ from children without SRBD with regard to some general health factors such as hearing problems and enlarged tonsils. Although not statistically significant, these findings are in accord with previous publications and are probably originating in a shared etiology of adeno-tonsillar hypertrophy [ 44 , 45 ]. DaRocha et al showed that dental clinical parameters, including bruxism, mouth breathing, and history of tonsillectomy, were associated with higher PSQ scores [ 25 ].…”

Section: Discussionsupporting

confidence: 92%

Sleep-Related Breathing Disorders in Children—Red Flags in Pediatric Care

Blumer

Eli

Kaminsky-Kurtz

et al. 2022

JCM

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Objectives: In recent years, we have witnessed a growing interest in pediatric sleep-related breathing disorders (SRBD). Although a Pediatric Sleep Questionnaire (PSQ) exists and was found reliable in screening SRBD in children, many of the children remain underdiagnosed. The aim of the present study was to define anamnestic and clinical findings that can serve as red flags indicating the presence of SRBD in children. Methods: 227 children aged 4–12 years old were evaluated with regard to the following parameters: (i) anamnestic variables (e.g., general state of health, oral habits, bruxism, esophageal reflux, sleep continuity, snoring); (ii) clinical parameters (e.g., oral mucosa, palate, tonsils, tongue, floor of the mouth, angle classification, gingival health, caries risk) and (iii) presence of SRBD (through the PSQ). Results: Significant differences between children with and without SRBD were observed regarding continuous sleep, developmental delay, mouth breathing, and snoring. Taking medications for ADHD increased the odds of SRBD in children by over seven times, non-continuous sleep increased the odds of SRBD by six times, mouth breathing increased the odds by almost five times, and snoring increased the odds by over three times. Conclusions: Child caregivers from various fields (dentists, orthodontists, pediatric physicians, school nurses) should actively inquire about disturbed sleep, medications for ADHD, snoring, and mouth breathing among their young patients. Initial screening through a few simple questions may help raise red flags that can assist in the early detection of SRBD in children and lead to proper diagnosis and treatment.

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“…In another study by Hill et al, an association was found between the degree of OSA and scores on the SDQ . Normal controls had a mean total SDQ score of 6.44, compared with 13.74 in habitual snorers.…”

Section: Discussionmentioning

confidence: 89%

“…In another study by Hill et al, an association was found between the degree of OSA and scores on the SDQ. 22 Normal controls had a mean total SDQ score of 6.44, compared with 13.74 in habitual snorers. When snorers were investigated with polysomnography, the authors could significantly correlate children with AHI > 5 with higher mean total SDQ score (16.54 ± 4.89), a difference not found significant when OSA was defined as AHI > 2.…”

Section: Discussionmentioning

confidence: 93%

Randomised trial showed no difference in behavioural symptoms between surgical methods treating paediatric obstructive sleep apnoea

et al. 2020

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Aim Our previous randomised controlled trial of children with obstructive sleep apnoea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillotomy (ATT) in improving nocturnal respiration and quality of life after 1 year. The aim of this report was to evaluate the effects on behavioural symptoms using the Strengths and Difficulties Questionnaire (SDQ). Methods Children between 2 and 6 years with OSA were randomised to ATT or ATE. Parents, blinded to method, answered the SDQ while their child underwent polysomnography before and 1 year after surgery. Differences between the total SDQ scores were analysed between the treatment groups. Results The SDQ was filled out in 87% of the cases preoperatively, and in 86% postoperatively. At follow‐up, the mean total SDQ score was 9.6 SD ± 5.1 in the ATE group (n = 31), and 8.2 ± 6.7 in the ATT group (n = 37), P = .09. The mean total SDQ score for all was preoperatively 10.6 ± 5.0, and postoperatively 8.8 ± 6.0, P = .0002. Conclusion There were no significant differences in SDQ scores between the groups at follow‐up, indicating that the more conservative ATT is a treatment option in paediatric OSA. The whole group of patients showed a significant improvement after surgery.

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Hearing loss mediates executive function impairment in sleep-disordered breathing

Abstract: In early childhood, conductive hearing loss mediates the relationship between SDB, irrespective of severity, and parent report of executive function but not behaviour. Treatment of hearing loss in pre-school SDB might improve executive function.

Cited by 10 publications

References 29 publications

Cognition After Early Tonsillectomy for Mild OSA

Cognition After Early Tonsillectomy for Mild OSA

Sleep-Related Breathing Disorders in Children—Red Flags in Pediatric Care

Randomised trial showed no difference in behavioural symptoms between surgical methods treating paediatric obstructive sleep apnoea

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