Neuropsychological and behavioral functioning in children with and without obstructive sleep apnea referred for tonsillectomy

Abstract

Adenotonsillectomy (AT) is among the most common pediatric surgical procedures and is performed as often for obstructive sleep apnea (OSA) as for recurrent tonsillitis. This study compared behavioral, cognitive, and sleep measures in 27 healthy control children recruited from a university hospital-based pediatric general surgery clinic with 40 children who had OSA (AT0OSA1) and 27 children who did not have OSA (AT0OSA2) scheduled for AT. Parental ratings of behavior, sleep problems, and snoring, along with specific cognitive measures (i.e., short-term attention, visuospatial problem solving, memory, arithmetic) reflected greater difficulties for AT children compared with controls. Differences between the AT0OSA2 and control groups were larger and more consistent across test measures than were those between the AT0OSA1 and control groups. The fact that worse outcomes were not clearly demonstrated for the AT0OSA1 group compared with the other groups was not expected based on existing literature. This counterintuitive finding may reflect a combination of factors, including age, daytime sleepiness, features of sleep-disordered breathing too subtle to show on standard polysomnography, and academic or environmental factors not collected in this study. These results underscore the importance of applying more sophisticated methodologies to better understand the salient pathophysiology of childhood sleep-disordered breathing. (JINS, 2008, 14, 571-581.)

Do Respiratory Cycle-Related EEG Changes or Arousals from Sleep Predict Neurobehavioral Deficits and Response to Adenotonsillectomy in Children?

“…2 Children without objective evidence for OSA on polysomnography, in comparison to those with OSA, showed at least as much neurobehavioral improvement after adenotonsillectomy. 9 A 22-item validated parental questionnaire scale for childhood OSA, contained within the Pediatric Sleep Questionnaire, predicted neurobehavioral outcomes as well or better than did standard polysomnographic measures. 10 In an effort to improve the predictive value of polysomnography, we developed a computer algorithm to demonstrate and quantify EEG changes that occur in synchrony with the average, non-apneic respiratory cycle.…”

The Relationship between Depressive Symptoms and Obstructive Sleep Apnea in Pediatric Populations: A Meta-Analysis

“…17 Thus, in addressing our first question (i.e., the extent of a relationship between depressive symptoms and OSA), studies needed to include both PSG and a depression assessment measure in both the OSA and comparison groups. Twenty-two published studies were initially identified: 11 were excluded: 4 due to lack of the use of PSG to detect OSA (one lacked PSG in the control group 18 ), [19][20][21][22] 4 for the absence of a depression measure, [23][24][25][26] 1 lacked a comparison group, 27 and 1 was excluded due to division of groups into snorers versus non-snorers, without assessing for OSA. 28 Eleven studies satisfied the inclusion criteria.…”

Behavioral Problems and Neurocognitive Functioning in Snoring School-Aged Children

“…6 The strongest associations for externalizing behaviors include hyperactivity, impulsivity, emotional lability, delinquency, conduct problems, aggressive behavior, and oppositional behavior. [7][8][9][10][11][12][13][14] Snoring children have also internalizing problems, showing more anxious/depressed mood, somatic complaints, withdrawal, thought problems, and social problems. [10][11][12][13][15][16][17][18] A few studies have used teacher reports, 6,7,19 showing that teachers report substantially fewer problems than parents.…”

“…15,17,19,[21][22][23] Less commonly reported deficits are in memory, visual-spatial ability, language skills, and sensomotor functions. 9,17 Despite these differences, it is notable that the mean Intelligence Quotient (IQ) and subtest scores for snoring children have usually been within the standardized normal range. 22 Poor academic performance has been found in snoring children, 8 as well as higher risk for academic underachievement even after snoring has resolved.…”

“…25 To our knowledge, studies widely investigating the association between snoring and both behavioral and neurocognitive implications are sparse. 9,10,15,17,20 The focus of the present study was in school-aged children and the aim was to assess the behavioral problems and neurocognitive functioning in snoring and nonsnoring children. Based on previous studies it was hypothesized that school-aged snoring children have elevated scores on problem behavior.…”