Preliminary evidence of behavioral and cognitive sequelae of obstructive sleep apnea in children

Lewin, Daniel; Rosen, Raymond C.; England, S. J.; Dahl, Ronald E.

doi:10.1016/s1389-9457(01)00070-3

Cited by 117 publications

(100 citation statements)

References 19 publications

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“…6,7,14,[16][17][18] Weaknesses in motor dexterity have also been reported in children with snoring or OSAS and adults with OSAS. 24,43,44 The present results offer support for small effects of treatment in these same domains.…”

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confidence: 98%

“…6 Little is known about the effects of these processes on brain development, but frontal, subcortical, hippocampal, and cerebellar regions are especially vulnerable. 7,11,17,44 Nonrandomized clinical trials of AT in children with OSAS or snoring have documented improved test performance after surgery. 8, 14, 19, 22 -26 Several of these studies found greater gains on tests of attention and executive function, visualmotor and spatial skills, nonverbal reasoning, or memory in children receiving AT for OSAS compared with controls, although others have failed to document these effects.…”

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confidence: 99%

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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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confidence: 98%

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confidence: 99%

Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea

et al. 2016

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“…The effect size was fairly consistent across studies, with the exception of a large negative effect size found in one study of only 7 patients. 18 Also of note, the ESs appeared to be lower among the 3 that had a comparison group, raising the possibility that some of the observed decrease in depressive symptoms could be related to regression to the mean or due to the effects of administering a measure of depressive symptoms over multiple time points, 73 highlighting the need for future studies to include comparison groups of children who did not receive adenotonsillectomy. Although the exact mechanism for this improvement is unclear, improved oxygenation and nighttime sleep might explain children's improvement in depressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…17 Thus, in addressing our first question (i.e., the extent of a relationship between depressive symptoms and OSA), studies needed to include both PSG and a depression assessment measure in both the OSA and comparison groups. Twenty-two published studies were initially identified: 11 were excluded: 4 due to lack of the use of PSG to detect OSA (one lacked PSG in the control group 18 ), [19][20][21][22] 4 for the absence of a depression measure, [23][24][25][26] 1 lacked a comparison group, 27 and 1 was excluded due to division of groups into snorers versus non-snorers, without assessing for OSA. 28 Eleven studies satisfied the inclusion criteria.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…Seventeen articles were identified, of which 9 were included in the metaanalysis. 18,34,[41][42][43][44][45][46][47] Of the 8 excluded studies, 2 were excluded due to lack of PSG, 48,49 one for the use of respiratory sinus arrhythmia rather than PSG, 50 and 5 due to lack of a depression measure. [51][52][53][54][55] In all 9 included studies, parents/caregivers were the source of children's depressive symptom ratings, with one also including teacher ratings.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

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The Relationship between Depressive Symptoms and Obstructive Sleep Apnea in Pediatric Populations: A Meta-Analysis

Yılmaz

Sedky

Bennett

2013

Journal of Clinical Sleep Medicine

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Background: A higher incidence of depressive disorders and symptoms has been suggested among children suffering from obstructive sleep apnea (OSA). Yet, the extent to which OSA is related to increased depression is unclear. Objectives: To evaluate (a) the relationship between depressive symptoms and OSA in pediatric populations, and (b) the effi cacy of adenotonsillectomy (AT) for decreasing depressive symptoms among children with OSA. Methods: A meta-analysis was conducted to assess the relationship between depressive symptoms and OSA, and the effi cacy of AT for decreasing depressive symptoms. Studies reporting depressive symptoms of children with OSA through January 2013 were included. Results: Eleven studies assessed depressive symptoms in both children diagnosed with OSA (n = 894) and a comparison group (n = 1,096). A medium relationship was found between depressive symptoms and OSA (Hedges' g = 0.43, 95% CI: 0.22-0.64; p = 0.0005). Addressing the second question, 9 studies (n = 379 children) examined depressive symptoms pre-and post-AT. A medium improvement in depressive symptoms was found at follow-up (Hedge's g = 0.41, 95% CI: 0.20-0.62; p ≤ 0.001). Conclusion: Our fi ndings suggest that depressive symptoms are higher among children with OSA. Therefore, patients with depressive symptomatology should receive screening for sleep disordered breathing. Treatment of OSA with AT might decrease clinical symptoms of depression, reduce pharmacotherapy, improve sleep patterns, and promote better health. Keywords: Sleep disordered breathing, obstructive sleep apnea, depression, depressive symptoms, meta-analysis Citation: Yilmaz E; Sedky K; Bennett DS. The relationship between depressive symptoms and obstructive sleep apnea in pediatric populations: a meta-analysis.

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