Neurobehavioral Implications of Habitual Snoring in Children

O’Brien, Louise M.; Mervis, Carolyn Β.; Holbrook, Cheryl R.; Bruner, Jennifer L.; Klaus, Carrie J; Rutherford, Jennifer; Raffield, Troy J.; Gozal, David

doi:10.1542/peds.114.1.44

Cited by 461 publications

(347 citation statements)

References 42 publications

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“…30 Previous studies have shown differences in the cognitive function of children with the obstructive sleep apnea syndrome, as compared with controls. 19,27,31 However, baseline cognitive scores of children with the obstructive sleep apnea syndrome fell within the normal range, a finding similar to that in the current study. Cognitive and behavioral abnormalities have been shown to be reduced after adenotonsillectomy in some, [24][25][26][27]29 but not all, 30 nonrandomized studies, with inconsistency in the reported effect after treatment.…”

Section: Discussionsupporting

confidence: 88%

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

Marcus

Moore

Rosen

et al. 2014

Survey of Anesthesiology

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229

438

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BACKGROUND-Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.

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Section: Discussionsupporting

confidence: 88%

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

Marcus

Moore

Rosen

et al. 2014

Survey of Anesthesiology

Self Cite

229

438

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“…OSA in adults and children alike results in numerous complications, including cognitive dysfunction (Findley et al 1986;Gozal 1998;Beebe et al 2003;Archbold et al 2004). Indeed in children, sleep-disordered breathing has been associated with reduced cognitive function and general intelligence, as well as neuroimaging-based evidence for prefrontal cortical abnormalities (Schechter 2002;Gottlieb et al 2004;O'Brien et al 2004;Halbower et al 2006); severity of apnea also correlates with worsened neuropsychological deficits (O'Brien et al 2004). A caveat to utilizing OSA as a means to study the impact of sleep fragmentation is the difficulty in distinguishing the effect of sleep loss from that of poor oxygenation or even obesity, which could independently impair developmental processes.…”

Section: Negative Impacts Of Disrupted Sleep During Mammalian Developmentioning

confidence: 99%

Sleep and Development in Genetically Tractable Model Organisms

Kayser

Biron

2016

Genetics

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Sleep is widely recognized as essential, but without a clear singular function. Inadequate sleep impairs cognition, metabolism, immune function, and many other processes. Work in genetic model systems has greatly expanded our understanding of basic sleep neurobiology as well as introduced new concepts for why we sleep. Among these is an idea with its roots in human work nearly 50 years old: sleep in early life is crucial for normal brain maturation. Nearly all known species that sleep do so more while immature, and this increased sleep coincides with a period of exuberant synaptogenesis and massive neural circuit remodeling. Adequate sleep also appears critical for normal neurodevelopmental progression. This article describes recent findings regarding molecular and circuit mechanisms of sleep, with a focus on development and the insights garnered from models amenable to detailed genetic analyses.

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“…ioral, and cardiovascular functions (5,7,8,11,13), the thresholds of disease severity that delineate the cost-benefit ratios for T&A, the primary line of treatment for pediatric SDB, are currently unknown. Thus, the recently published empirically based consensus guidelines that were developed for the treatment of SDB in children (12) do not mention any specific polysomnographic measures as firmly established criteria for T&A referral.…”

Section: Definition Of Abbreviationsmentioning

confidence: 99%

“…an AHI of more than 1 but less than 5 events/hour of sleep, even if such children are at risk for associated morbidity (13).…”

mentioning

confidence: 99%

Leukotriene Modifier Therapy for Mild Sleep-disordered Breathing in Children

Goldbart

Goldman

Veling

et al. 2005

Am J Respir Crit Care Med

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283

157

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Background: Children with mild sleep-disordered breathing (SDB), who may not be recommended for adenotonsillectomy, frequently exhibit neurocognitive and behavioral morbidity, and may benefit from alternative therapeutic interventions, such as leukotriene modifier therapy. Methods: Twenty-four children with SDB completed an open-label intervention study for 16 weeks with daily montelukast therapy. Sleep studies and adenoid size estimates from lateral X-ray films of the neck were obtained before and after treatment. In a parallel study, adenoid and tonsillar tissues from children with obstructive sleep apnea or recurrent throat infections were subjected to quantitative polymerase chain reaction, immunohistochemistry, and Western blotting for gene and protein expression of leukotriene receptors LT1-R and LT2-R, and for concentrations of LTB4 and LTC4/D4/E4. Results: Montelukast treatment induced significant reductions in adenoid size and respiratory-related sleep disturbances, which were absent in 16 children with SDB who did not receive treatment. LT1-R and LT2-R mRNA was similarly abundant in adenoid tissues, but increased LT1-R and LT2-R protein expression and higher levels of LTB4 and LTC4/D4/E4 emerged in children with obstructive sleep apnea. Conclusions: Oral therapy with a leukotriene modifier appears to be associated with improved breathing during sleep. Double-blind, placebo-controlled trials will be needed to corroborate current findings and solidly establish antiinflammatory strategies, such as leukotriene modifiers, as therapeutic alternatives in children with SDB too mild to justify referral for adenotonsillectomy.

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Neurobehavioral Implications of Habitual Snoring in Children

Abstract: PS seems to be associated with significant neurobehavioral deficits in a subset of children, possibly related to increased susceptibility to sleep fragmentation. Larger studies are urgently required because current guidelines for treatment of snoring in children may require reevaluation.

Cited by 461 publications

References 42 publications

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

Sleep and Development in Genetically Tractable Model Organisms

Leukotriene Modifier Therapy for Mild Sleep-disordered Breathing in Children

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