Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea

被引：48

作者：

Taylor, H. Gerry ^{[1
]}

Bowen, Susan R. ^{[1
]}

Beebe, Dean W. ^{[2
]}

Hodges, Elise ^{[3
]}

Amin, Raouf ^{[2
]}

Arens, Raanan ^{[6
,7
]}

Chervin, Ronald D. ^{[4
,5
]}

Garetz, Susan L. ^{[8
,9
]}

Katz, Eliot S. ^{[10
]}

Moore, Renee H. ^{[11
]}

Morales, Knashawn H. ^{[12
]}

Muzumdar, Hiren ^{[13
]}

Paruthi, Shalini ^{[14
]}

Rosen, Carol L. ^{[1
]}

Sadhwani, Anjali ^{[15
]}

Thomas, Nina Hattiangadi ^{[16
]}

Ware, Janice ^{[15
]}

Marcus, Carole L. ^{[17
,18
]}

Ellenberg, Susan S. ^{[12
,19
]}

Redline, Susan

Giordani, Bruno ^{[3
]}

机构：

[1] Case Western Reserve Univ, Rainbow Babies & Childrens Hosp, Sch Med, Univ Hosp Case Med Ctr,Dept Pediat, Cleveland, OH 44106 USA

[2] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Cincinnati, OH 45229 USA

[3] Univ Michigan, Dept Psychiat & Psychol, Ann Arbor, MI 48109 USA

[4] Univ Michigan, Dept Neurol, Ann Arbor, MI USA

[5] Univ Michigan, Sleep Disorders Ctr, Ann Arbor, MI 48109 USA

[6] Childrens Hosp Montefiore, Dept Pediat, Bronx, NY USA

[7] Albert Einstein Coll Med, Montefiore Med Ctr, Bronx, NY 10467 USA

[8] Univ Michigan, Dept Otolaryngol Head & Neck Surg, Ctr Hlth, Ann Arbor, MI 48109 USA

[9] Univ Michigan, Ctr Hlth, Sleep Disorders Ctr, Ann Arbor, MI 48109 USA

[10] Boston Childrens Hosp, Dept Pediat, Boston, MA USA

[11] Emory Univ, Rollins Sch Publ Hlth, Dept Biostat & Bioinformat, Atlanta, GA 30322 USA

[12] Univ Penn, Sch Med, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA

[13] Univ Pittsburgh, Childrens Hosp Pittsburgh, Dept Pediat, Pittsburgh, PA 15213 USA

[14] St Louis Univ, Cardinal Glennon Childrens Med Ctr, Dept Pediat, St Louis, MO USA

[15] Harvard Med Sch, Boston Childrens Hosp, Boston, MA USA

[16] Childrens Hosp Philadelphia, Neuropsychol & Assessment Grp, Dept Child & Adolescent Psychiat & Behav Sci, Philadelphia, PA 19104 USA

[17] Childrens Hosp Philadelphia, Dept Pediat, Sleep Ctr, Philadelphia, PA 19104 USA

[18] Brigham & Womens Hosp, Dept Med, 75 Francis St, Boston, MA 02115 USA

[19] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Boston, MA USA

来源：

PEDIATRICS | 2016年 / 138卷 / 02期

基金：

美国国家卫生研究院;

关键词：

QUALITY-OF-LIFE; NEUROCOGNITIVE FUNCTION; PRESCHOOL-CHILDREN; BEHAVIOR; DEFICITS; TONSILLECTOMY; SYMPTOMS; TRIAL; TERM;

D O I：

10.1542/peds.2015-4458

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

OBJECTIVE: Research reveals mixed evidence for the effects of adenotonsillectomy (AT) on cognitive tests in children with obstructive sleep apnea syndrome (OSAS). The primary aim of the study was to investigate effects of AT on cognitive test scores in the randomized Childhood Adenotonsillectomy Trial. METHODS: Children ages 5 to 9 years with OSAS without prolonged oxyhemoglobin desaturation were randomly assigned to watchful waiting with supportive care (n = 227) or early AT (eAT, n = 226). Neuropsychological tests were administered before the intervention and 7 months after the intervention. Mixed model analysis compared the groups on changes in test scores across follow-up, and regression analysis examined associations of these changes in the eAT group with changes in sleep measures. RESULTS: Mean test scores were within the average range for both groups. Scores improved significantly (P < .05) more across follow-up for the eAT group than for the watchful waiting group. These differences were found only on measures of nonverbal reasoning, fine motor skills, and selective attention and had small effects sizes (Cohen's d, 0.20-0.24). As additional evidence for AT-related effects on scores, gains in test scores for the eAT group were associated with improvements in sleep measures. CONCLUSIONS: Small and selective effects of AT were observed on cognitive tests in children with OSAS without prolonged desaturation. Relative to evidence from Childhood Adenotonsillectomy Trial for larger effects of surgery on sleep, behavior, and quality of life, AT may have limited benefits in reversing any cognitive effects of OSAS, or these benefits may require more extended follow-up to become manifest.

引用

页数：11

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