Long-Term Changes in Neurocognition and Behavior Following Treatment of Sleep Disordered Breathing in School-Aged Children

Biggs, Sarah Nichole; Vlahandonis, Anna; Anderson, Vicki; Bourke, Robert S.; Nixon, Gillian M.; Davey, Margot J; Horne, Rosemary Sylvia Claire

doi:10.5665/sleep.3312

Cited by 108 publications

(63 citation statements)

References 45 publications

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“…15,17,25 Changes in executive function were not significantly different between groups. 17,28 The literature precludes firmer conclusions because relatively few studies have been published comparing tonsillectomy with a nonsurgical intervention for OSDB. Most studies provided little to no clinical outcome data, focusing instead on intermediate outcomes like the AHI.…”

Section: Discussionmentioning

confidence: 99%

“…The 5 studies that included children whose OSDB was confirmed with PSG found that AHI scores improved more in children receiving a tonsillectomy than in those who did not undergo surgery (significant group differences in 3 studies). 15,17,25,27,28 Metaanalysis of 3 studies reporting outcomes that could be combined showed a 4.8-point improvement in AHI in children who underwent tonsillectomy compared with no surgery. 17,25,27 Sleep-related quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Scores on the CBC improved from baseline in both groups in 1 cohort study, with no significant group differences. 28 In the second study, scores were significantly better in the tonsillectomy group compared with the no tonsillectomy group at follow-up, but baseline measures were not reported. 25 CHAT investigators also used the Conners' rating scale to assess behavioral issues, including Effect size: -1.35 CGI, caregiver M-ESS, change from baseline G1: 52.5 ± 11.6 G1: -2.01 ± 4.7 G2: 52.6 ± 11.7 G2: 0.28 ± 4.1 CGI, teacher G1 versus G2: P < .01 G1: 56.4 ± 14.4…”

Section: Behavioral Outcomesmentioning

confidence: 99%

“…We also did not include studies addressing adenoidectomy alone or studies comparing tonsillectomy with adenoidectomy because the choice of procedure is likely driven by the indication for surgery; thus, 15,17 4.8-point improvement in AHI in tonsillectomy arms in meta-analysis. 1 Prospective cohort (38) 28 2 Retrospective cohort (94) 25,32 2 RCT (456) 15,17 Sleep-related quality of life…”

Section: Limitationsmentioning

confidence: 99%

“…1 Prospective cohort (38) 28 1 Retrospective cohort (32) 25 1 Prospective cohort (38) 28 Cognitive changes (IQ)…”

mentioning

confidence: 99%

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Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Chinnadurai¹,

Jordan²,

Sathe

et al. 2017

Pediatrics

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CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood. OBJECTIVE:To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB.DATA SOURCES: Medline, Embase, and the Cochrane Library. STUDY SELECTION:Two investigators independently screened studies against predetermined criteria. DATA EXTRACTION:Two investigators independently extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. Investigators synthesized data qualitatively and meta-analyzed apnea-hypopnea index (AHI) scores. RESULTS:We included 11 studies. Relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy. In 5 studies including children with polysomnography-confirmed OSDB, AHI scores improved more in children receiving tonsillectomy versus surgery. A meta-analysis of 3 studies showed a 4.8-point improvement in the AHI in children who underwent tonsillectomy compared with no surgery. Sleeprelated quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy. Changes in executive function were not significantly different. The length of follow-up in studies was generally <12 months. LIMITATIONS:Few studies fully categorized populations in terms of severity of OSDB; outcome measures were heterogeneous; and the durability of outcomes beyond 12 months is not known. CONCLUSIONS:Tonsillectomy can produce short-term improvement in sleep outcomes compared with no surgery in children with OSDB. Understanding of longer-term outcomes or effects in subpopulations is lacking.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Behavioral Outcomesmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

“…1 Prospective cohort (38) 28 1 Retrospective cohort (32) 25 1 Prospective cohort (38) 28 Cognitive changes (IQ)…”

mentioning

confidence: 99%

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Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Chinnadurai¹,

Jordan²,

Sathe

et al. 2017

Pediatrics

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Sleep profiles in children with down syndrome

Bassell

Phan

Leu

et al. 2015

American J of Med Genetics Pt A

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Down syndrome (DS) is the most common genetic cause of intellectual disability and results from an extra chromosome 21 (Trisomy 21). Sleep issues and/or obstructive sleep apnea (OSA) are assumed to be part of the DS phenotype with a high prevalence but are often under recognized. This cross-sectional study of children with DS examines the caregiver reported sleep behaviors of 108 children with DS, ranging in age from 1.50 to 13.40 years (mean = 5.18 years) utilizing a standardized assessment tool, the Children's Sleep Habit Questionnaire (CSHQ). The CSHQ revealed 76% of children with DS had sleep problems, which began at a young age, and continue to persist and may recur with increasing age. Furthermore, children with DS who undergone adenoid and tonsillectomy for OSA continued to have sleep problems suggesting that ongoing monitoring of sleep issues is needed in this population. Implications of sleep problems and recommended anticipatory guidance and intervention are discussed.

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