Cognitive and behavioral effects of obstructive sleep apnea syndrome in children: a systematic literature review

Cardoso, Thiago da Silva Gusmão; Pompéia, Sabine; Miranda, Mônica Carolina

doi:10.1016/j.sleep.2017.12.020

Cited by 61 publications

(29 citation statements)

References 52 publications

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“…OSA is associated with a wide array of disorders, such as neurocognitive dysfunction and behavioral disturbances, which are characterized by hyperactivity, aggressive behavior, learning problems and concentration difficulties [88][89][90] . Failure to thrive 91 , cardiovascular complications with systolic and pulmonary hypertension 92,93 , and increased mortality rates 73 have also been reported for pediatric patients with OSA.…”

Section: Morbiditymentioning

confidence: 99%

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Fehrm

Nerfeldt

Browaldh

et al. 2020

JAMA Otolaryngol Head Neck Surg

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Section: Morbiditymentioning

confidence: 99%

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Fehrm

Nerfeldt

Browaldh

et al. 2020

JAMA Otolaryngol Head Neck Surg

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“…Obstructive sleep apnea syndrome (OSAS) causes partial obstruction (hypopnea) or total obstruction (apnea) of the upper airways during sleep, interfering with sleep stages and breathing patterns [ 1 ]. Common nocturnal manifestations of OSAS in children are mouth breathing, snoring, enuresis and profuse sweating, while daytime symptoms include hypersomnia, headaches, cognitive and behavioural disorders, poor academic performance, cardiovascular and metabolic disorders, failure to thrive, pulmonary and arterial hypertension and heart failure [ 2 , 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome

Chiner

Cánovas

Molina

et al. 2020

JCM

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The utility of home respiratory polygraphy (HRP) was assessed as an alternative to polysomnography (PSG) in the diagnosis of childhood obstructive sleep apnea syndrome (OSAS). PSG was indicated only in patients with concomitant disease or where HRP results were questionable. The follow-up period was 1 year. We recorded clinical and anthropometric data, physical examination findings, respiratory variables, severity level and choice of therapy. We assessed 121 children, 70 boys and 51 girls, with mean age 7 ± 4 years, mean body mass index (BMI) 19 ± 5 kg/m2, and mean BMI percentile 62 ± 38%. We included 104 HRP and 24 PSG recordings. Of the latter, 7 were preceded by HRP (false negatives) and 17 were indicated as the first-choice method owing to concomitant disease. Of the initial HRP recordings, 93% were technically valid. All technically valid HRPs and 96% of PSGs resulted in a diagnosis of OSAS (apnea-hypopnea index 9.5 ± 9.1/h). Thirty-three percent of cases were moderate and 22% severe. Apnea-hypopnea index showed no correlation with BMI or BMI percentile. Adenotonsillectomy was indicated in 93 patients (77%), conservative treatment in 17 (14%), and conservative treatment combined with CPAP/BiPAP in 11 (9%). There were no significant differences between children diagnosed by HRP and by PSG in terms of treatment choice. The prevalence of OSAS in our sample was 96.7%. In conclusion, when the probability of OSAS is high, HRP is usually sufficient for diagnosing the syndrome and establishing therapy in children. PSG is advisable in complex or questionable cases.

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“…1 The first line of treatment of childhood OSA is adenotonsillectomy. There is general agreement that children's behavior improves after treatment with adenotonsillectomy, 2 but impacts of treatment on intellectual function are less clear.…”

mentioning

confidence: 99%

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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Cognitive and behavioral effects of obstructive sleep apnea syndrome in children: a systematic literature review

Cited by 61 publications

References 52 publications

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Effectiveness of Adenotonsillectomy vs Watchful Waiting in Young Children With Mild to Moderate Obstructive Sleep Apnea

Home Respiratory Polygraphy is Useful in the Diagnosis of Childhood Obstructive Sleep Apnea Syndrome

Cognition After Early Tonsillectomy for Mild OSA

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