Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis

Song, Sungjin A.; Tolisano, Anthony M.; Cable, Benjamin B.; Camacho, Macario

doi:10.1016/j.ijporl.2016.02.011

Cited by 39 publications

(27 citation statements)

References 35 publications

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“…6,7 Conversely, OSA has also been associated with cognitive and intellectual deficits as well as ADHD-like symptoms. 24 Such findings indicate that clinicians should be vigilant in excluding OSA among children with cognitive and intellectual deficits and ADHD or vice versa. A previous study conducted in Oman suggested that the prevalence rate of ADHD was 8.8% among 9-10-yearolds.…”

Section: Discussionmentioning

confidence: 99%

Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study

Al-Zaabi

Al-Adawi

Jaju

et al. 2019

Sultan Qaboos Univ Med J

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Objectives: This study aimed to evaluate cognitive and behavioural changes among 9–14-year-old Omani children with obstructive sleep apnoea (OSA) after an adenotonsillectomy (AT). Methods: This naturalistic observational study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2012 and December 2014. Omani children with adenotonsillar hypertrophy (ATH) underwent overnight polysomnography and those with confirmed OSA were scheduled for an AT. Cognitive and behavioural evaluations were performed using standardised instruments at baseline prior to the procedure and three months afterwards. Results: A total of 37 children were included in the study, of which 24 (65%) were male and 13 (35%) were female. The mean age of the males was 11.4 ± 1.9 years, while that of the females was 11.1 ± 1.5 years. Following the AT, there was a significant reduction of 56% in mean apnoea-hypopnoea index (AHI) score (2.36 ± 4.88 versus 5.37 ± 7.17; P <0.01). There was also a significant positive reduction in OSA indices, including oxygen desaturation index (78%), number of desaturations (68%) and number of obstructive apnoea incidents (74%; P <0.01 each). Significant improvements were noted in neurocognitive function, including attention/concentration (42%), verbal fluency (92%), learning/recall (38%), executive function (52%) and general intellectual ability (33%; P <0.01 each). There was a significant decrease of 21% in both mean inattention and hyperactivity scores (P <0.01 each). Conclusion: These results demonstrate the effectiveness of an AT in improving cognitive function and attention deficit hyperactivity disorder-like symptoms among children with ATH-caused OSA. Such changes can be observed as early as three months after the procedure.Keywords: Adenoidectomy; Obstructive Sleep Apnea; Cognitive Function; Behavior; Attention Deficit Hyperactivity Disorders; Children; Oman.

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Section: Discussionmentioning

confidence: 99%

Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study

Al-Zaabi

Al-Adawi

Jaju

et al. 2019

Sultan Qaboos Univ Med J

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“…Numerous interventional studies that did not include controls have reported improvements in various behavioral and cognitive outcomes following T&A [62,63]. One recent meta-analysis has suggested that T&A may only result in improvement of cognitive functioning in pre-school-aged children [64], though not all longitudinal studies have identified a relationship between improvement in AHI and cognitive or behavioral outcomes in this age group [65]. This may suggest permanent effects of early SDB, or the presence of an SDB-cognitive phenotype.…”

Section: Discussionmentioning

confidence: 99%

Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children

et al. 2017

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Objective Primary snoring (PS) and obstructive sleep apnea (OSA) not only affect the quality of sleep in a large number of young children, but have also been repeatedly associated with a variety of behavioral and cognitive problems. However, little is known about the potentially differing relationships of behavioral and cognitive pathology within the sleep disordered breathing (SDB) spectrum. Method This study examined data from an enriched for snoring community sample of 631 children aged between 4 and 10 years. Multivariate mixed models were used to assess the relationship between both snoring and the apnea–hypopnea index (AHI). Numerous cognitive and behavioral variables were used, while adjusting for several important demographic variables. These were followed by univariate analyses of individual measures and sensitivity analyses. Results Results indicated that snoring status is a significant predictor of general behavioral (p = 0.008) and cognitive (p = 0.013) domains, even after adjusting for baseline covariates and AHI severity. More frequent snoring was associated with poorer outcomes independent of AHI. However, AHI did not emerge as a significant predictor of the overall cognitive functioning domain (p = 0.377). Additionally, although AHI was a significant predictor of the general behavioral functioning domain (p = 0.008), the significance pattern and nature of its relationship with individual behavioral measures were inconsistent in post-hoc analyses. Conclusion The findings of this study suggest that general behavioral and cognitive function may decline with greater snoring severity. Further, snoring should not simply be assumed to represent a lower severity level of SDB, but should be examined as a potential predictor of relevant outcomes.

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“…This is extremely difficult to study, however, because it is very difficult to get accurate documentation on the IQ and cognitive skills of very young children. 33 Pharmacological interventions should be utilized only after a detailed evaluation has been done and behavioral techniques to adequately treat insomnia are in place. Currently, there are no Food and Drug Administration-(FDA-) approved pharmacological agents used to treat insomnia in children.…”

Section: Treatmentmentioning

confidence: 99%

Sleep in Autism

Maxwell-Horn

Malow

2017

Semin Neurol

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Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has increased in prevalence over the last several decades. A significant proportion of children with ASD have comorbid sleep disorders. The interplay between ASD and sleep is multifactorial and bidirectional. There is evidence for physiological differences in ASD that contribute to sleep problems, including sensory overresponsiveness (SOR) and abnormal melatonin production. Comorbidities associated with ASD (attention deficit hyperactivity disorder [ADHD], mood disorders) as well as medications used to treat these comorbidities often have effects on sleep architecture. In this article the authors discuss the etiology and manifestations of sleep disorders in children with ASD, as well as their clinical evaluation and treatment options.

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Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis

Cited by 39 publications

References 35 publications

Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study

Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study

Frequency of snoring, rather than apnea–hypopnea index, predicts both cognitive and behavioral problems in young children

Sleep in Autism

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