Six‐month follow‐up of children with obstructive sleep apnoea

Harvey, J. M. M.; O'Callaghan, MJ; Wales, Pat; Harris, Max; Masters, I. B.

doi:10.1046/j.1440-1754.1999.t01-1-00336.x

Cited by 25 publications

(19 citation statements)

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“…The clinical studies that demonstrated lingering effects of prior hypoxia, albeit on neurocognitive functions, involved intermittent recurrent hypoxia with the associated sleep disturbances in children (4,(7)(8)(9). In contrast, neither the present study, nor those by Bavis et al (10) and Okubo and Mortola (11,12) used an intermittent hypoxic pattern.…”

Section: Discussioncontrasting

confidence: 60%

“…Whereas adenotonsillectomy, a definitive treatment for sleep-disordered breathing associated with enlarged adenoids and/or tonsils, reverses the upper airway obstruction and many sleep-related symptoms in children, recent studies suggest that abnormalities in cardiorespiratory control, arousability, learning, and behavior can persist beyond the relief of such obstruction (4,(7)(8)(9). These studies have attributed the lingering dysfunctions to long-term central effects of prior hypoxemia associated with more severe obstructive sleep apnea.…”

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confidence: 99%

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Long-Term Recurrent Hypoxia in Developing Rat Attenuates Respiratory Responses to Subsequent Acute Hypoxia

2006

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Whereas definitive treatment of pediatric conditions associated with hypoxemia reverses many pathologic symptoms, some physiologic dysfunctions appear to persist. These abnormalities are attributed to long-lasting central effects of prior hypoxia. To investigate such effects in an animal model, male rats were exposed to FiO 2 ϭ 0.12 continuously for 7 h daily from postnatal day (p) 17 (representing early childhood) through p33 (representing adolescence), defined as recurrent hypoxia. Respiratory responses during and following 20 min FiO 2 ϭ 0.12 were measured on p35 and p47. To control for early weaning on p15 (normal weaning ϭ p21), male rats were weaned on either p15 or p21, raised in normoxia, and also tested for respiratory responsiveness to acute hypoxia. To assess sex differences, female rats were assigned to similar groups and protocols. Minute ventilation, respiratory frequency, tidal volume, and respiratory drive were measured in unsedated animals using whole-body plethysmography. After recurrent hypoxia, male rats displayed an attenuation of ventilation, frequency, and drive during hypoxia, and of all functions after hypoxia on both p35 and p47. There were no differences between test days during hypoxia, and greater attenuation of tidal volume and respiratory drive on p47 during recovery from hypoxia. Respiratory responses displayed no effect of sex on p35, and occasional effects of early weaning on p35 and p47. Thus, recurrent hypoxia produces long-lasting attenuation in respiratory responsiveness to subsequent acute hypoxia. Such long-lasting attenuation, if present in humans, may diminish the protection of children with a history of recurrent hypoxemia against future hypoxic events. H ypoxemia of varying duration, pattern, and timing is an important feature in many clinical conditions in pediatrics. A strong association or causality between hypoxemia and developmental, behavioral, and/or cognitive dysfunctions has been documented, primarily for sleep-disordered breathing and congenital heart disease (1). With regard to sleepdisordered breathing, the dysfunctions also include sleep fragmentation, diminished arousability, diminished responsiveness to respiratory chemical stimuli, fatigue, failure to thrive, hypertension, and cor pulmonale (2-6).Whereas adenotonsillectomy, a definitive treatment for sleep-disordered breathing associated with enlarged adenoids and/or tonsils, reverses the upper airway obstruction and many sleep-related symptoms in children, recent studies suggest that abnormalities in cardiorespiratory control, arousability, learning, and behavior can persist beyond the relief of such obstruction (4,7-9). These studies have attributed the lingering dysfunctions to long-term central effects of prior hypoxemia associated with more severe obstructive sleep apnea.It is important to establish in controlled animal studies whether there indeed are long-lasting effects of an antecedent hypoxia. It is also important to determine whether such effects, if present, are particular to a spe...

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Section: Discussioncontrasting

confidence: 60%

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confidence: 99%

Long-Term Recurrent Hypoxia in Developing Rat Attenuates Respiratory Responses to Subsequent Acute Hypoxia

2006

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“…However, it is well documented that as many as 80% of children have polysomnographically determined improved breathing during sleep and resolution of SRBD after A/T (25,26), and our results would suggest from subjective measures that up to 60% improved depending on the breathing item chosen. Others have also shown significant improvements of many polysomnographic-derived variables (6,27,28). A recent study evaluating polysomnographic data before and a few months after surgery showed significant improvements in all respiratory parameters with a greater improvement in the respiratory disturbance index in non-REM compared with REM sleep and significant improvements in the arousal index (29).…”

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confidence: 97%

Changes in Behavior and Attentional Capacity after Adenotonsillectomy

et al. 2006

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ABSTRACT:The objective of this study was to quantify behavioral and attention capacity changes in children aged 4 -11 y before and 3 mo after adenotonsillectomy (A/T). Overnight cardiorespiratory recordings were performed in 61 "behaviorally normal" children 1 wk before A/T. Tests of sustained attention using visual and auditory continuous performance tests (CPT) were completed by children 1 wk before and 3 mo after A/T. Behavioral Assessment Scales for Children (BASC) and a sleep questionnaire were completed by the parent/s at these same times. Results from overnight cardiorespiratory recordings showed that the children had mild sleeprelated breathing disorders (SRBD) preoperatively with a mean apnea/hypopnea index of 3.0/h and a movement awakening index of 2.5/h. The majority had parent-perceived sleep and breathing difficulties that significantly improved post-A/T. BASC T scores for externalizing and internalizing behaviors improved post-A/T, e.g., behavioral symptom index mean pre-A/T was 56.2 (95% confidence interval, 52.8 -59.6) compared with 50.9 (48.5-53.5) post-A/T. Some measures indicative of impulsivity and attentiveness obtained from the visual CPT before surgery, improved post-A/T, but no change was observed in any auditory CPT measures. Our data confirm improvements in subjective measures of sleep problems in children treated for SRBD and strengthen the notion of treating the disorder, not only related to the obvious clinical condition but also to the underlying sleep problems and adverse effects on daytime behavior and attention. (1), with snoring, difficulty breathing, apnea, and persistent mouth breathing that ranges from primary snoring, through upper airways resistance syndrome, to OSA. The most common treatment for children with adenotonsillar hypertrophy or recurrent tonsillitis is A/T. This has been shown to result in clinical improvement in the majority of cases. In severe cases involving OSA, failure to treat can be associated with serious morbidity such as failure to thrive and systemic hypertension, and pulmonary hypertension with or without cor pulmonale can develop (1).SRBD have been linked to daytime behavioral problems, predominantly those associated with hyperactivity, aggression, and inattention (2-4), and poorer performance on tests of memory and intelligence (5). At short-term follow-up after treatment, significant improvements in children's vigilance and behavior in areas of aggression, inattention, impulsivity and hyperactivity (6,7), and quality of life (8) have been reported. Also reported are short-term improvements in several cognitive factors such as perceptual closure, inference, organization, visual and auditory short-term memory, ability to solve problems and think analytically (9), and learning 1 y after treatment for a SRBD in poor academic achievers (10).The main physiologic characteristics during sleep for children with SRBD are intermittent hypoxemia associated with frequent apneas, hypopneas and sleep fragmentation due to frequent arousals, awakenings, and a red...

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“…1-15 Improvements in behavior and learning after treatment for SDB suggest that these deficits may be partially reversible. 2,4,6,9,[16][17][18] Unfortunately, many of the previous studies supporting this relationship are subject to methodologic criticisms, including (1) failure to account for the children's background characteristics;…”

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confidence: 99%

Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing

et al. 2004

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Six‐month follow‐up of children with obstructive sleep apnoea

Abstract: Surgical intervention improves sleep behaviour in children though not temperament or development.

Cited by 25 publications

References 14 publications

Long-Term Recurrent Hypoxia in Developing Rat Attenuates Respiratory Responses to Subsequent Acute Hypoxia

Long-Term Recurrent Hypoxia in Developing Rat Attenuates Respiratory Responses to Subsequent Acute Hypoxia

Changes in Behavior and Attentional Capacity after Adenotonsillectomy

Increased Behavioral Morbidity in School-Aged Children With Sleep-Disordered Breathing

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