Cyclic alternating pattern in children with obstructive sleep apnea and its relationship with adenotonsillectomy, behavior, cognition, and quality of life

Abstract

Study Objectives To determine in children with obstructive sleep apnea (OSA) the effect of adenotonsillectomy on the cyclic alternating pattern (CAP) and the relationship between CAP and behavioral, cognitive, and quality-of-life measures. Methods CAP parameters were analyzed in 365 overnight polysomnographic recordings of children with mild-to-moderate OSA enrolled in the Childhood Adenotonsillectomy Trial (CHAT), randomized to either early adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). We also analyzed CAP in a subgroup of 72 children with moderate OSA (apnea-hypopnea index>10) that were part of the CHAT sample. Causal mediation analysis was performed to determine the independent effect of changes in CAP on selected outcome measures. Results At baseline, a higher number of A1-phases per hour of sleep was significantly associated with worse behavioral functioning (caregiver BRIEF GCE: ρ=0.24, P=0.042; caregiver Conners’ Rating Scale Global Index: ρ=0.25, P=0.036) and lower quality of life (OSA-18: ρ=0.27, P=0.022; PedsQL: ρ=-0.29, P=0.015) in the subgroup of children with moderate OSA, but not across the entire sample. At 7-months follow-up, changes in CAP parameters were comparable between the eAT and WWSC arms. CAP changes did not account for significant proportions of variations in behavioral, cognitive and quality-of-life performance measures at follow-up. Conclusions We show a significant association between the frequency of slow, high-amplitude waves with behavioral functioning as well as the quality-of-life in children with moderate OSA. Early adenotonsillectomy in children with mild-to-moderate OSA does not alter the microstructure of NREM sleep compared to watchful waiting after an approximately 7 month period of follow-up. Clinical Trial The study “A Randomized Controlled Study of Adenotonsillectomy for Children With Obstructive Sleep Apnea Syndrome” was registered at Clinicaltrials.gov (#NCT00560859).

Sleep microstructure in attention deficit hyperactivity disorder according to the underlying sleep phenotypes

“…On the other hand, children with ADHD with OSA had an increase of NREM instability, confirming similar findings in children with OSA (Hartmann et al, 2021; Miano et al, 2009, 2011). The increase of A1 subtypes reflects an increase of NREM instability, mostly characterized by slow wave activity rather than the faster activity of A2 and A3 subtypes, which is able to counteract respiratory events.…”

“…Obstructive breathing events increase non-rapid eye movement (NREM) sleep instability (CAP rate) in children with and without ADHD. The high level of obstructive (OSA)-related arousability seems to protect the cerebral cortex from intermittent hypoxia, paying the price of sleep fragmentation, which contributes to symptoms of ADHD (Hartmann, Bruni, Ferri, Redline, & Baumert, 2021;Miano et al, 2009Miano et al, , 2011. CAP analysis is recognized as a standard method to evaluate the level of arousability and stability of sleep (Terzano et al, 2002).…”

Sleep Disturbances in Chinese Children with Epilepsy: Associations with Behavioral Problems and Quality of Life

“…However, previous studies have reported that children with sleep-disordered breathing displayed worse behavioral functioning and lower QOL. 35 It is possible that sleep-disordered breathing symptoms can affect QOL initially, but behavioral functioning over time. A prior study showed that remission of sleep breathing symptoms after adenotonsillectomy frequently improved QOL in short time but did not improve behavioral outcomes.…”

The Effect of Adenotonsillectomy on Children’s Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art

“…Moreover, children with OSAS present behavioral disorders such as irritability, attention deficit, sleepiness or hyperactivity in contrast, emotional lability and aggressiveness [13,[25][26][27][28][29][30][31][32][33][34]. Neurocognitive deficits and delayed growth are related to hypoxemia micro awakenings and sleep fragmentation [35][36][37][38][39]. Kennedy et al in 2004 reported impaired memory, global intelligence and selective attention in patients with ≥3% oxygen desaturation in REM sleep [35].…”