Impact of Tonsillectomy and Adenoidectomy on Child Behavior

Goldstein, Nira A.; Post, J. Christopher; Rosenfeld, Richard M.; Campbell, Thomas F.

doi:10.1001/archotol.126.4.494

Cited by 148 publications

(129 citation statements)

References 23 publications

(32 reference statements)

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“…In a study involving 36 children, Goldstein et al showed a prevalence of 28% of emotional and behavioral problems 18 , and this is in agreement with the findings of the present study. The limitations of this study include small samples and a lack of a healthy children control group.…”

Section: Discussionsupporting

confidence: 93%

Avaliação comportamental em crianças com disturbios obstrutivos do sono

Uema

Vidal

Fujita

et al. 2006

Rev. Bras. Otorrinolaringol.

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Ai m: The purpose of this study was to evaluate the behavior in children with obstructive sleep disorder. Study design: Prospective study. Material and method: Children's parents (4 to 18 years old) completed the CBCL4/18 (Child Behavior Checklist) in the period of January to July 2005. Results: In the group, 12 (60%) were males and 8 (40%) females; the total problem score was abnormal in 5 children (25%); introversion was affected in 2 children (10%); extroversion in 5 children (25%). The scales of individual syndromes were abnormal in between 0 and 20% of patients. The individual scales most frequently affected were: total competency (20%), somatic complaints (10%), social problems (10%) and aggressive behavior (10%). Discussion: This study demonstrates high prevalence (25%) of abnormal behavior. Although widely reported as a common complication of pediatric OSAS, behavioral and neurocognitive disorders have mostly been inferred in several cases and studies. There are few recent studies using standardized assessment to evaluate these alterations. Our study presents preliminary results of the behavior of children with obstructive sleep disorders.

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Section: Discussionsupporting

confidence: 93%

Avaliação comportamental em crianças com disturbios obstrutivos do sono

Uema

Vidal

Fujita

et al. 2006

Rev. Bras. Otorrinolaringol.

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“…Goldstein et al 55 IV 450 All showed behavior improvement except Davis et al 49 Goldstein et al 243 Long-term behavior improvement in Mitchell et al 53 Hogan et al 48 Li et al 238 Roemmich et al 191 Tran et al 58 Wei et al 245 Mitchell et al 53 Davis et al 49 Aggression, oppositional, and social problems 54 Long-term improvements ≥1 y 52 , 53 Goldstein et al 55 Sohn et al 56 Silva and Leite 57 Tran et al 58 Chervin et al 37 I 105 Long-term improvements at 1 y Sleep quality Constantin et al 54 IV 590 Improved in both studies Wei et al 245 …”

Section: Areas For Future Researchmentioning

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%

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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“…However, it is well documented that as many as 80% of children have polysomnographically determined improved breathing during sleep and resolution of SRBD after A/T (25,26), and our results would suggest from subjective measures that up to 60% improved depending on the breathing item chosen. Others have also shown significant improvements of many polysomnographic-derived variables (6,27,28). A recent study evaluating polysomnographic data before and a few months after surgery showed significant improvements in all respiratory parameters with a greater improvement in the respiratory disturbance index in non-REM compared with REM sleep and significant improvements in the arousal index (29).…”

mentioning

confidence: 97%

Changes in Behavior and Attentional Capacity after Adenotonsillectomy

et al. 2006

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ABSTRACT:The objective of this study was to quantify behavioral and attention capacity changes in children aged 4 -11 y before and 3 mo after adenotonsillectomy (A/T). Overnight cardiorespiratory recordings were performed in 61 "behaviorally normal" children 1 wk before A/T. Tests of sustained attention using visual and auditory continuous performance tests (CPT) were completed by children 1 wk before and 3 mo after A/T. Behavioral Assessment Scales for Children (BASC) and a sleep questionnaire were completed by the parent/s at these same times. Results from overnight cardiorespiratory recordings showed that the children had mild sleeprelated breathing disorders (SRBD) preoperatively with a mean apnea/hypopnea index of 3.0/h and a movement awakening index of 2.5/h. The majority had parent-perceived sleep and breathing difficulties that significantly improved post-A/T. BASC T scores for externalizing and internalizing behaviors improved post-A/T, e.g., behavioral symptom index mean pre-A/T was 56.2 (95% confidence interval, 52.8 -59.6) compared with 50.9 (48.5-53.5) post-A/T. Some measures indicative of impulsivity and attentiveness obtained from the visual CPT before surgery, improved post-A/T, but no change was observed in any auditory CPT measures. Our data confirm improvements in subjective measures of sleep problems in children treated for SRBD and strengthen the notion of treating the disorder, not only related to the obvious clinical condition but also to the underlying sleep problems and adverse effects on daytime behavior and attention. (1), with snoring, difficulty breathing, apnea, and persistent mouth breathing that ranges from primary snoring, through upper airways resistance syndrome, to OSA. The most common treatment for children with adenotonsillar hypertrophy or recurrent tonsillitis is A/T. This has been shown to result in clinical improvement in the majority of cases. In severe cases involving OSA, failure to treat can be associated with serious morbidity such as failure to thrive and systemic hypertension, and pulmonary hypertension with or without cor pulmonale can develop (1).SRBD have been linked to daytime behavioral problems, predominantly those associated with hyperactivity, aggression, and inattention (2-4), and poorer performance on tests of memory and intelligence (5). At short-term follow-up after treatment, significant improvements in children's vigilance and behavior in areas of aggression, inattention, impulsivity and hyperactivity (6,7), and quality of life (8) have been reported. Also reported are short-term improvements in several cognitive factors such as perceptual closure, inference, organization, visual and auditory short-term memory, ability to solve problems and think analytically (9), and learning 1 y after treatment for a SRBD in poor academic achievers (10).The main physiologic characteristics during sleep for children with SRBD are intermittent hypoxemia associated with frequent apneas, hypopneas and sleep fragmentation due to frequent arousals, awakenings, and a red...

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Impact of Tonsillectomy and Adenoidectomy on Child Behavior

Cited by 148 publications

References 23 publications

Avaliação comportamental em crianças com disturbios obstrutivos do sono

Avaliação comportamental em crianças com disturbios obstrutivos do sono

Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome

Changes in Behavior and Attentional Capacity after Adenotonsillectomy

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