Cognition, sleep and respiration in at-risk children treated for obstructive sleep apnoea

Abstract

Sleep-disordered breathing in children has been associated with cognitive impairment. The purpose of this study was to examine the impact of tonsillectomy and adenoidectomy (T&A) on sleep, respiration and cognitive function in children of pre-school age with obstructive sleep apnoea (OSA) from a low-income community population.Altogether, 19 children attending state-funded pre-school programmes underwent overnight polysomnography and cognitive assessment before and following surgical treatment for OSA; 19 matched controls were also assessed.Following T&A, OSA subjects' delta sleep increased, rapid eye movement sleep decreased, and respiratory and arousal indices improved. There were no significant differences in OSA subjects' post-operative sleep or respiratory measures compared to controls. Prior to T&A, cognitive scores were significantly lower in OSA subjects versus controls; following T&A, OSA subjects' scores improved compared to pre-operative scores and did not differ from those of matched controls.Following tonsillectomy and adenoidectomy, at-risk pre-schoolers recruited directly from the community showed normalised sleep and respiratory patterns and improved cognitive scores. These findings, in this uniquely vulnerable population, which is unlikely to seek evaluation and treatment for obstructive sleep apnoea, underscore the potential value of outreach screening programmes for sleep-disordered breathing, particularly among low-income groups of pre-school age.

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

“…[22][23][24][25][26][27][28][29][30] The plausibility of the obstructive sleep apnea syndrome contributing to cognitive deficits is supported by research showing impaired learning in juvenile rats exposed to intermittent hypoxemia 3 and by imaging studies showing cerebral neuronal injury in children with the syndrome. 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. 25,29,32 Previous studies have been limited by small samples, lack of randomization or appropriate controls, heterogeneous study groups, and sole reliance on parent questionnaires rather than including neuropsychological testing.…”

Cautionary notes on the undesirable secondary effects of long term orthopedic and ventilation mask therapy in the treatment of OSAS

“…Those students who had lower grades were more likely to have snored during early childhood than children with better academic performance. Just like the behavioral problems, cognitive p er forman ce improved in children who underwent adenotonsillectomy to treat obstructive sleep apnea 26 .…”

“…In one study, such children were 8 times more likely to develop cognitive problems compared to normal children. Academic performance often suffers in children with sleep-disordered breathing 26 . Gozal et al 14 studied over 1500 middle school children who were in the top 25% of their class and the bottom 25% of their class.…”

Sleep-disordered breathing in children: are we underestimating the problem?

“…In this issue of European Respiratory Journal, the study by MONTGOMERY-DOWNS et al [12] examines the impact of adenotonsillectomy for OSAS in pre-school-aged children from a lowincome community population. Previous studies have been restricted by small numbers of children from a wide age range who were referred because of a sleep disturbance.…”