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Changes in Neuropsychological and Behavioral Functioning in Children with and without Obstructive Sleep Apnea Following Tonsillectomy

Published online by Cambridge University Press:  25 January 2012

Bruno Giordani ,
Elise K. Hodges ,
Kenneth E. Guire ,
Deborah L. Ruzicka ,
James E. Dillon ,
Robert A. Weatherly ,
Susan L. Garetz  and
Ronald D. Chervin
Bruno Giordani*
Affiliation:
Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
Elise K. Hodges
Affiliation:
Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
Kenneth E. Guire
Affiliation:
Biostatics Department, School of Public Health, University of Michigan, Ann Arbor, Michigan
Deborah L. Ruzicka
Affiliation:
Sleep Medicine, Neurology Department, University of Michigan, Ann Arbor, Michigan
James E. Dillon
Affiliation:
MDCHC/Corrections and Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
Robert A. Weatherly
Affiliation:
Department of Pediatrics, The University of Missouri Kansas City School of Medicine, Kansas City, Missouri
Susan L. Garetz
Affiliation:
Otorhinolaryngology Department, University of Michigan, Ann Arbor, Michigan
Ronald D. Chervin
Affiliation:
Sleep Medicine, Neurology Department, University of Michigan, Ann Arbor, Michigan
*
Correspondence and reprint requests to: Bruno Giordani, Neuropsychology Section, Department of Psychiatry, University of Michigan, Suite C, 2101 Commonwealth Blvd, Ann Arbor, MI 48105. E-mail: [email protected]
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Abstract

The most common treatment for sleep disordered breathing (SDB) is adenotonsillectomy (AT). Following AT, SDB resolves in most cases, and gains in cognitive and behavior scores are consistently reported, although persistent neuropsychological deficits or further declines also have been noted. This study presents results of the comprehensive 1-year follow-up neuropsychological examinations for children in the Washtenaw County Adenotonsillectomy Cohort I (95% return rate). After adjusting for normal developmental and practice-effect related changes in control children, significant improvements 1 year following AT were noted in polysomnography and sleepiness, as well as parental reports of behavior, although cognitive outcomes were mixed. Children undergoing AT with and without polysomnography-confirmed obstructive sleep apnea improved across a range of academic achievement measures, a measure of delayed visual recall, short-term attention/working memory, and executive functioning, along with parental ratings of behavior. On the other hand, measures of verbal abstraction ability, arithmetic calculations, visual and verbal learning, verbal delayed recall, sustained attention, and another measure of visual delayed recall demonstrated declines in ability, while other measures did not improve over time. These findings call into question the expectation that AT resolves most or all behavioral and cognitive difficulties in children with clinical, office-based diagnoses of SDB. (JINS, 2012, 18, 212–222)

Keywords

PolysomnographyNeuropsychologySleep-disordered breathingAdenotonsillectomyTonsillitisSnoring
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 2 , March 2012 , pp. 212 - 222
Copyright
Copyright © The International Neuropsychological Society 2012

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References

Ali, N.J., Pitson, D.J., Stradling, J.R. (1996). Sleep disordered breathing: Effects of adenotonsillectomy on behaviour and psychological functioning. European Journal of Pediatrics, 155, 56–62.CrossRefGoogle ScholarPubMed
Anderson, V., Catroppa, C. (2005). Recovery of executive skills following paediatric traumatic brain injury (TBI): A 2 year follow-up. Brain Injury, 19(6), 459–470.CrossRefGoogle ScholarPubMed
Avior, G., Fishman, G., Leor, A., Sivan, Y., Kaysar, N., Derowe, A. (2004). The effect of tonsillectomy and adenoidectomy on inattention and impulsivity as measured by the Test of Variables of Attention (TOVA) in children with obstructive sleep apnea syndrome. Otolaryngology–Head and Neck Surgery, 368, 367–371.CrossRefGoogle Scholar
Barkley, R.A. (1991). The ecological validity of laboratory and analogue assessment methods of ADHD. Journal of Child Psychology, 19, 149–178.Google ScholarPubMed
Beebe, D.W. (2006). Neurobehavioral morbidity associated with disordered breathing during sleep in children: A comprehensive review. Sleep, 29, 1115–1134.CrossRefGoogle ScholarPubMed
Boll, T.J. (1993). Children's Category Test. San Antonio, TX: The Psychological Corporation.Google Scholar
Chervin, R.D., Hedger, K.M., Dillon, J.E., Pituch, K.J. (2000). Pediatric Sleep Questionnaire (PSQ): Validity and reliability of scale for sleep-disordered breathing, snoring, sleepiness and behavioral problems. Sleep Medicine, 1, 21–32.CrossRefGoogle ScholarPubMed
Chervin, R.D., Ruzicka, D.L., Giordani, B.J., Weatherly, R.A., Dillon, J.E., Hodges, E.K., Guire, K.E. (2006). Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics, 117, e769–e778.CrossRefGoogle ScholarPubMed
Chervin, R.D., Weatherly, R.A., Garetz, S.L., Ruzicka, D.L., Giordani, B.J., Hodges, E.K., Guire, K.E. (2007). Pediatric Sleep Questionnaire: Prediction of sleep apnea and outcomes. Archives of Otolaryngology Head and Neck Surgery, 133, 216–222.CrossRefGoogle ScholarPubMed
Cohen, C.K. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Cohen, M.J. (1997). Children's Memory Scale. San Antonio, TX: The Psychological Corporation.Google Scholar
Conners, C.K. (1997). Conners’ Rating Scales – Revised: User's manual. North Tonawanda, NY: Multi-Health Systems, Inc.Google Scholar
Dillon, J.E., Blunden, S., Ruzicka, D.L., Guire, K.E., Champine, D., Weatherly, R.A., Chervin, R.D. (2007). DSM-IV diagnoses and obstructive sleep apnea in children before and 1 year after adenotonsillectomy. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1425–1436.CrossRefGoogle ScholarPubMed
Friedman, B., Hendeles-Amitai, A., Kosminsky, E., Lieberman, A., Friger, M., Tarasiuk, A. (2003). Adenotonsillectomy improves neurocognitive functioning in children with obstructive sleep apnea syndrome. Sleep, 26(8), 999–1005.CrossRefGoogle ScholarPubMed
Galland, B.C., Dawes, P.J., Tripp, E.G., Taylor, B.J. (2006). Changes in behavior and attentional capacity after adenotonsillectomy. Pediatric Research, 59(5), 711–716.CrossRefGoogle ScholarPubMed
Giordani, B., Hodges, E.K., Guire, K.E., Ruzicka, D.L., Dillon, J.E., Weatherly, R.A., Chervin, R.D. (2008). Neuropsychological and behavioral functioning in children with and without sleep-disordered breathing referred for tonsillectomy. Journal of the International Neuropsychological Society, 14(4), 571–581.CrossRefGoogle ScholarPubMed
Gozal, D. (1998). Sleep-disordered breathing and school performance in children. Pediatrics, 102(3 Pt 1), 616–620.CrossRefGoogle ScholarPubMed
Guilleminault, C., Eldridge, F.L., Simmons, F.B., Dement, W.C. (1976). Sleep apnea in eight children. Pediatrics, 58(1), 23–30.CrossRefGoogle ScholarPubMed
Guilleminault, C., Winkle, R., Korobkin, R., Simmons, B. (1982). Children and nocturnal snoring: Evaluation of the effects of sleep related respiratory resistive load and daytime functioning. European Journal of Pediatrics, 139(3), 165–171.CrossRefGoogle ScholarPubMed
Halbower, A.C., Degaonkar, M., Barker, P.B., Earley, C.J., Marcus, C.L., Smith, P.L., Mahone, E.M. (2006). Childhood obstructive sleep apnea associates with neuropsychological deficits and neuronal brain injury. Pubic Library of Science Medicine, 3(8), 1391–1402.Google ScholarPubMed
Hansen, D.E., Vandenberg, B. (2001). Cognitive effects of sleep apnea and narcolepsy in school age children. Sleep and Hypnosis, 3(2), 73–80.Google Scholar
Hill, C.M., Hogan, A.M., Onugha, N., Harrison, D., Cooper, S., McGrigor, V.J., Kirkham, F.J. (2006). Increased cerebral blood flow velocity in children with mild sleep-disordered breathing: A possible association with abnormal neuropsychological function. Pediatrics, 118(4), e1100–e1108.CrossRefGoogle ScholarPubMed
Hodges, E.K., Bloomfield, E., Coulas, T., Giordani, B. (2008). Cognitive and behavioral change after adenotonsillectomy in children with sleep-disordered breathing: A review. Minerva Psichiatrica, Italy, 49, 307–321.Google Scholar
Hogan, A.M., Hill, C.M., Harrison, D., Kirkham, F.J. (2008). Cerebral blood flow velocity and cognition in children before and after adenotonsillectomy. Pediatrics, 122(1), 75–82.CrossRefGoogle ScholarPubMed
Kohler, M.J., Lushington, K., Kennedy, J.D. (2010). Neurocognitive performance and behavior before and after treatment for sleep-disordered breathing in children. Nature and Science of Sleep, 2, 159–185.CrossRefGoogle ScholarPubMed
Kohler, M.J., Lushington, K., van den Heuvel, C.J., Martin, J., Pamula, Y., Kennedy, D. (2009). Adenotonsillectomy and neurocognitive deficits in children with sleep disordered breathing. PLoS One, 4(10), e7343, 1–8.CrossRefGoogle ScholarPubMed
Li, H.Y., Huang, Y.S., Chen, N.H., Fang, T.J., Lee, L.A. (2006). Impact of adenotonsillectomy on behavior in children with sleep-disordered breathing. Laryngoscope, 116(7), 1142–1147.CrossRefGoogle ScholarPubMed
Lundeborg, I., McAllister, A., Samuelsson, C., Ericsson, E., Hultcrantz, E. (2009). Phonological development in children with obstructive sleep-disordered breathing. Journal of Clinical Linguistics and Phonetics, 23(10), 751–761.CrossRefGoogle ScholarPubMed
Macey, P.M., Henderson, L.A., Macey, K.E., Alger, J.R., Frysinger, R.C., Woo, M.A., Harper, R.M. (2002). Brain morphology associated with obstructive sleep apnea. American Journal of Respiratory and Critical Care Medicine, 166(10), 1382–1387.CrossRefGoogle ScholarPubMed
Marcus, C.L., Loughlin, G.M. (1996). Obstructive sleep apnea in children. Seminars in Pediatric Neurology, 3, 23–38.CrossRefGoogle ScholarPubMed
Montgomery-Downs, H.E., Crabtree, V.M., Gozal, D. (2005). Cognition, sleep and respiration in at-risk children treated for obstructive sleep apnoea. European Respiratory Journal, 25, 336–342.CrossRefGoogle ScholarPubMed
Moré, E.E., Isern, F.S., Zumel, P.H., Gonzalez, A.E., Soler, E.M., Alcover, J.M.A. (2008). Clinical efficacy and polysomnography of adenotonsillectomy in the treatment of sleep-related respiratory disorders in children. Acta Otorrinolaringológica Española, 59(7), 325–333.Google Scholar
O'Brien, L.M., Holbrook, C.R., Mervis, C.B., Klaus, C.J., Bruner, J.L., Raffield, T.J., Gozal, D. (2003). Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics, 111(3), 554–563.CrossRefGoogle ScholarPubMed
O'Leary, D.S., Lovell, M.R., Sackellares, J.C., Berent, S., Giordani, B., Seidenberg, M., Boll, T.J. (1983). The effects of age of onset of partial and generalized seizures on neuropsychological performance in children. Journal of Nervous and Mental Disorders, 171, 624–629.CrossRefGoogle ScholarPubMed
Owens, J., Spirito, A., Marcotte, A.C., McGuinn, M., Berkelhammer, L. (2000). Neuropsychological and behavioral correlates of obstructive sleep apnea syndrome in children: A preliminary study. Sleep and Breathing, 4, 67–68.CrossRefGoogle ScholarPubMed
The Psychological Corporation (1992). Wechsler Individual Achievement Test. San Antonio, TX: Author.Google Scholar
The Psychological Corporation (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Author.Google Scholar
Rasmussen, L.S., Larsen, K., Houx, P., Skovgaard, L.T., Hanning, C.D., Moller, J.T., & the ISPOCD Group (2001). The assessment of postoperative cognitive function. Acta Anesthesiology Scandinavica, 45, 275–289.CrossRefGoogle ScholarPubMed
Richards, W., Ferdman, R.M. (2000). Prolonged morbidity due to delays in the diagnosis and treatment of obstructive sleep apnea in children. Clinical Pediatrics, 39(2), 103–108.CrossRefGoogle ScholarPubMed
Redline, S., Amin, R., Chervin, R.D., Garetz, S.L., Giordani, B., Marcus, C.L., Ellenberg, S. (2011). The Childhood Adenotonsillectomy Trial (CHAT): Rationale, design and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. Sleep, 34, 1509–1517.CrossRefGoogle Scholar
Rosen, C.L., Storfer-Isser, A., Taylor, H.G., Kirchner, H.L., Emancipator, J.L., Redline, S. (2004). Increased behavioral morbidity in school-aged children with sleep-disordered breathing. Pediatrics, 114, 44–49.CrossRefGoogle ScholarPubMed
Sanford, J.A., Turner, A. (1994). Integrated Visual and Auditory Continuous Performance Test manual. Richmond, VA: BrainTrain, Inc.Google Scholar
Tiffin, J. (1968). Purdue Pegboard examiner's manual. Rosemont, IL: London House.Google Scholar
Weatherly, R.A., Mai, E.F., Ruzicka, D.L., Chervin, R.D. (2003). Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: A survey of practice patterns. Sleep Medicine, 4(4), 297–307.CrossRefGoogle ScholarPubMed