Clinical and Experimental Otorhinolaryngology

Korean Society of Otolaryngology-Head and Neck Surgery (대한이비인후과학회)
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Effect of Adenotonsillectomy on Attention in Korean Children With Sleep-Disordered Breathing

  • Kim, Min Jae (Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Bae, Sung Hee (Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Sung Min (Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Kang Hyun (Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Dong-Kyu (Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine)
  • Received : 2018.01.29
  • Accepted : 2018.03.07
  • Published : 2018.09.30
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Abstract

Objectives. Pediatric sleep-disordered breathing (SDB) is a common debilitating disorder that can adversely affect the attention and academic performance of school-age children. Unfortunately, only a few studies have examined the effect of SDB treatment on attention in pediatric populations. Therefore, the aim of this study was to prospectively investigate the effect of SDB treatment on attention in children. Methods. This study consecutively enrolled SDB children with adenotonsillar hypertrophy. All subjects underwent standard-of-care treatment (adenotonsillectomy or close observation) and were evaluated using a computerized comprehensive attention test at the initial visit. Comprehensive attention tests consisted of both sustained and divided attention tasks. Each completed task was assigned an attention score, which was based on the number of omission or commission errors. The comprehension attention test was repeated 1 year later. Results. A total of 171 children who underwent adenotonsillectomy and 32 children who did not undergo adenotonsillectomy were included in this study. At baseline, there was no significant difference according to the score of all type comprehension attention tests between children in the adenotonsillectomy group and in the observation group. One year after treatment, children in the adenotonsillectomy group had significantly improved scores in all attention tasks. Children in the observation group had only significant improvement in omission errors on sustained attention tasks. Meanwhile, the attention score based on commission errors of divided attention tasks was significantly worse than at baseline for those. Conclusion. Our study showed that adenotonsillectomy may be helpful in improving attention in children with SDB.

Keywords

Acknowledgement

Supported by : Hallym University

References

  1. Rosen CL, Storfer-Isser A, Taylor HG, Kirchner HL, Emancipator JL, Redline S. Increased behavioral morbidity in school-aged children with sleep-disordered breathing. Pediatrics. 2004 Dec;114(6):1640-8. https://doi.org/10.1542/peds.2004-0103
  2. Chervin RD, Archbold KH, Dillon JE, Panahi P, Pituch KJ, Dahl RE, et al. Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics. 2002 Mar;109(3):449-56. https://doi.org/10.1542/peds.109.3.449
  3. Lande MB, Hooper SR, Batisky DL, Kupferman JC, Szilagyi PG, Samuels JA, et al. Sleep disordered breathing as measured by SRBD-PSQ and neurocognition in children with hypertension. Am J Hypertens. 2015 Apr;28(4):552-8. https://doi.org/10.1093/ajh/hpu180
  4. Galland B, Spruyt K, Dawes P, McDowall PS, Elder D, Schaughency E. Sleep disordered breathing and academic performance: a meta-analysis. Pediatrics. 2015 Oct;136(4):e934-46. https://doi.org/10.1542/peds.2015-1677
  5. Galland BC, Dawes PJ, Tripp EG, Taylor BJ. Changes in behavior and attentional capacity after adenotonsillectomy. Pediatr Res. 2006 May;59(5):711-6. https://doi.org/10.1203/01.pdr.0000214992.69847.6f
  6. Mitchell RB, Boss EF. Pediatric obstructive sleep apnea in obese and normal-weight children: impact of adenotonsillectomy on quality-of-life and behavior. Dev Neuropsychol. 2009;34(5):650-61. https://doi.org/10.1080/87565640903133657
  7. Li HY, Huang YS, Chen NH, Fang TJ, Lee LA. Impact of adenotonsillectomy on behavior in children with sleep-disordered breathing. Laryngoscope. 2006 Jul;116(7):1142-7. https://doi.org/10.1097/01.mlg.0000217542.84013.b5
  8. Friedman M, Ibrahim H, Bass L. Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg. 2002 Jul;127(1):13-21. https://doi.org/10.1067/mhn.2002.126477
  9. Kim SY, Lee WH, Rhee CS, Lee CH, Kim JW. Regrowth of the adenoids after coblation adenoidectomy: cephalometric analysis. Laryngoscope. 2013 Oct;123(10):2567-72. https://doi.org/10.1002/lary.23984
  10. Kim DK, Rhee CS, Yun PY, Kim JW. Adenotonsillar hypertrophy as a risk factor of dentofacial abnormality in Korean children. Eur Arch Otorhinolaryngol. 2015 Nov;272(11):3311-6. https://doi.org/10.1007/s00405-014-3407-6
  11. Kim SJ, Lee YJ, Cho SJ, Cho IH, Lim W, Lim W. Relationship between weekend catch-up sleep and poor performance on attention tasks in Korean adolescents. Arch Pediatr Adolesc Med. 2011 Sep;165(9): 806-12. https://doi.org/10.1001/archpediatrics.2011.128
  12. Kim DK, Rhee CS, Han DH, Won TB, Kim DY, Kim JW. Treatment of allergic rhinitis is associated with improved attention performance in children: the Allergic Rhinitis Cohort Study for Kids (ARCO-Kids). PLoS One. 2014 Oct;9(10):e109145. https://doi.org/10.1371/journal.pone.0109145
  13. Kim SJ, Lee YJ, Jang JH, Lim W, Cho IH, Cho SJ. The relationship between psychotic-like experiences and attention deficits in adolescents. J Psychiatr Res. 2012 Oct;46(10):1354-8. https://doi.org/10.1016/j.jpsychires.2012.07.002
  14. Gozal D, Pope DW Jr. Snoring during early childhood and academic performance at ages thirteen to fourteen years. Pediatrics. 2001 Jun; 107(6):1394-9. https://doi.org/10.1542/peds.107.6.1394
  15. Montgomery-Downs HE, Jones VF, Molfese VJ, Gozal D. Snoring in preschoolers: associations with sleepiness, ethnicity, and learning. Clin Pediatr (Phila). 2003 Oct;42(8):719-26. https://doi.org/10.1177/000992280304200808
  16. Urschitz MS, Guenther A, Eggebrecht E, Wolff J, Urschitz-Duprat PM, Schlaud M, et al. Snoring, intermittent hypoxia and academic performance in primary school children. Am J Respir Crit Care Med. 2003 Aug;168(4):464-8. https://doi.org/10.1164/rccm.200212-1397OC
  17. Aljadeff G, Gozal D, Bailey-Wahl SL, Burrell B, Keens TG, Ward SL. Effects of overnight supplemental oxygen in obstructive sleep apnea in children. Am J Respir Crit Care Med. 1996 Jan;153(1):51-5. https://doi.org/10.1164/ajrccm.153.1.8542162
  18. Gozal D, Kheirandish-Gozal L. Sleep apnea in children: treatment considerations. Paediatr Respir Rev. 2006;7 Suppl 1:S58-61. https://doi.org/10.1016/j.prrv.2006.04.174
  19. Kennedy JD, Blunden S, Hirte C, Parsons DW, Martin AJ, Crowe E, et al. Reduced neurocognition in children who snore. Pediatr Pulmonol. 2004 Apr;37(4):330-7. https://doi.org/10.1002/ppul.10453
  20. Meltzer EO, Blaiss MS, Derebery MJ, Mahr TA, Gordon BR, Sheth KK, et al. Burden of allergic rhinitis: results from the pediatric allergies in America survey. J Allergy Clin Immunol. 2009 Sep;124(3 Suppl):S43-70. https://doi.org/10.1016/j.jaci.2009.05.013
  21. Chay OM, Goh A, Abisheganaden J, Tang J, Lim WH, Chan YH, et al. Obstructive sleep apnea syndrome in obese Singapore children. Pediatr Pulmonol. 2000 Apr;29(4):284-90. https://doi.org/10.1002/(SICI)1099-0496(200004)29:4<284::AID-PPUL8>3.0.CO;2-D
  22. Verhulst SL, Schrauwen N, Haentjens D, Suys B, Rooman RP, Van Gaal L, et al. Sleep-disordered breathing in overweight and obese children and adolescents: prevalence, characteristics and the role of fat distribution. Arch Dis Child. 2007 Mar;92(3):205-8. https://doi.org/10.1136/adc.2006.101089
  23. Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull. 1997 Jan;121(1):65-94. https://doi.org/10.1037/0033-2909.121.1.65
  24. Stins JF, Tollenaar MS, Slaats-Willemse DI, Buitelaar JK, Swaab-Barneveld H, Verhulst FC, et al. Sustained attention and executive functioning performance in attention-deficit/hyperactivity disorder. Child Neuropsychol. 2005 Jun;11(3):285-94. https://doi.org/10.1080/09297040490916938
  25. Miller J. Divided attention: evidence for coactivation with redundant signals. Cogn Psychol. 1982 Apr;14(2):247-79. https://doi.org/10.1016/0010-0285(82)90010-X
  26. Corbetta M, Miezin FM, Dobmeyer S, Shulman GL, Petersen SE. Selective and divided attention during visual discriminations of shape, color, and speed: functional anatomy by positron emission tomography. J Neurosci. 1991 Aug;11(8):2383-402. https://doi.org/10.1523/JNEUROSCI.11-08-02383.1991
  27. Taylor HG, Bowen SR, Beebe DW, Hodges E, Amin R, Arens R, et al. Cognitive effects of adenotonsillectomy for obstructive sleep apnea. Pediatrics. 2016 Aug;138(2). pii: e20154458. https://doi.org/10.1542/peds.2015-4458
  28. Abreu CB, Fuchs SC, Pascoto GR, Weber R, Guedes MC, Pignatari SS, et al. Effect of adenotonsillectomy on visual attention tests among children with sleep-disordered breathing: a controlled prospective cohort study. Clin Otolaryngol. 2013 Dec;38(6):487-93. https://doi.org/10.1111/coa.12192
  29. Kohler MJ, Lushington K, van den Heuvel CJ, Martin J, Pamula Y, Kennedy D. Adenotonsillectomy and neurocognitive deficits in children with sleep disordered breathing. PLoS One. 2009 Oct;4(10): e7343. https://doi.org/10.1371/journal.pone.0007343
  30. Brouillette RT. Adenotonsillectomy in childhood obstructive sleep apnea syndrome improves polysomnographic measures of breathing and sleep, but not attention and executive function. J Pediatr. 2013 Nov;163(5):1530-1.

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