RESUMEN
OBJECTIVE: The reasons why adenotonsillectomy (AT) is less effective treating obese children with obstructive sleep apnea syndrome (OSAS) are not understood. Thus, the aim of the study was to evaluate how anatomical factors contributing to airway obstruction are affected by AT in these children. METHODS: Twenty-seven obese children with OSAS (age 13.0 ± 2.3 y, body mass index Z-score 2.5 ± 0.3) underwent polysomnography and magnetic resonance imaging of the head during wakefulness before and after AT. Volumetric analysis of the upper airway and surrounding tissues was performed using commercial software (AMIRA®). RESULTS: Patients were followed for 6.1 ± 3.6 mo after AT. AT improved mean obstructive apnea-hypopnea index (AHI) from 23.7 ± 21.4 to 5.6 ± 8.7 (P < 0.001). Resolution of OSAS was noted in 44% (12 of 27), but only in 22% (4 of 18) of those with severe OSAS (AHI > 10). AT increased the volume of the nasopharynx and oropharynx (2.9 ± 1.3 versus 4.4 ± 0.9 cm(3), P < 0.001, and 3.2 ± 1.2 versus 4.3 ± 2.0 cm(3), P < 0.01, respectively), reduced tonsils (11.3 ± 4.3 versus 1.3 ± 1.4 cm(3), P < 0.001), but had no effect on the adenoid, lingual tonsil, or retropharyngeal nodes. A small significant increase in the volume of the soft palate and tongue was also noted (7.3 ± 2.5 versus 8.0 ± 1.9 cm(3), P = 0.02, and 88.2 ± 18.3 versus 89.3 ± 24.4 cm(3), P = 0.005, respectively). CONCLUSIONS: This is the first report to quantify volumetric changes in the upper airway in obese children with OSAS after adenotonsillectomy showing significant residual adenoid tissue and an increase in the volume of the tongue and soft palate. These findings could explain the low success rate of AT reported in obese children with OSAS and are important considerations for clinicians treating these children.
Asunto(s)
Adenoidectomía , Obesidad/complicaciones , Apnea Obstructiva del Sueño/cirugía , Tonsilectomía , Adolescente , Niño , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Nasofaringe/patología , Obesidad/patología , Orofaringe/patología , Polisomnografía , Apnea Obstructiva del Sueño/patologíaRESUMEN
BACKGROUND: Children with obstructive sleep disordered breathing (OSDB) have both impaired cognitive performance and frequent movements during sleep. It is not known whether movements during sleep are related to cognitive function. METHODS: We studied 56 children with adenotonsillar hypertrophy suspected of having OSDB with actigraphy for six consecutive days and nights, followed by cognitive and performance tests. Attended polysomnography was performed on the seventh night. RESULTS: Slower reaction time correlated with both higher sum of all movements during Time in Bed (r(2)=0.19, p=0.001) and higher number of minutes with >5 movements/night (r(2)=0.23, p=0.0003). Low Vocabulary, Similarities and General Memory Index scores correlated with more consolidation of movements (consecutive minutes with >5 movements) (r(2)=0.16, p=0.002, r(2)=0.16, p=0.0026, respectively). Correlation with Vocabulary and Similarities scores improved when Time in Bed was added as an independently significant covariate (r(2)=0.25, p=0.0006, r(2)=0.27, p=0.00028, respectively). Actigraphy correlated with Vocabulary and Similarities scores as well as polysomnography. Other cognitive or behavioral scores were not correlated with actigraphy or polysomnography. Children with more consolidation of movements had higher values for log10(OAHI+1) (r(2)=0.38, p=0.000001). CONCLUSIONS: (1) Frequency of movement during sleep correlated with impaired vigilance while consolidation of movements correlated with impaired verbal and memory skills. (2) OAHI was associated with more consolidation of movements.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/etiología , Trastornos del Movimiento/etiología , Apnea Obstructiva del Sueño/complicaciones , Tonsilitis/complicaciones , Actigrafía , Tonsila Faríngea/patología , Atención , Niño , Cognición , Femenino , Humanos , Hipertrofia , Masculino , Memoria , Pruebas Neuropsicológicas , Tonsila Palatina/patología , Tiempo de Reacción , Apnea Obstructiva del Sueño/patología , Tonsilitis/patología , Aprendizaje VerbalRESUMEN
BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with cardiovascular morbidity and mortality, and increased sympathetic activity is considered to be a causative link in this association. Higher levels of sympathetic activity have been reported in children with OSAS. Sympathetic predominance is indicated on heart rate variability (HRV) analysis by increased heart rate (HR) and a higher ratio of low-frequency to high-frequency band power (LF/HF). Improvement in OSAS after adenotonsillectomy (AT) in children with OSAS could, therefore, be associated with reduced HR and reduced LF/HF. METHODS: Changes in HR and time and frequency components of HRV were retrospectively analyzed in 2-min epochs free of respiratory events during light, deep, and rapid-eye-movement (REM) sleep in children with OSAS who underwent polysomnography before and after AT. RESULTS: Eighteen children with OSAS, aged 4.9 ± 2.4 years (mean ± SD) were studied. After AT, the apnea-hypopnea index decreased from 31.9 ± 24.8 events/h to 4.1 ± 3.7 events/h. The HR decreased after AT in all stages of sleep (99.8 ± 16.9 beats/min to 80.7 ± 12.9 beats/min [light sleep]; 100.2 ± 15.4 beats/min to 80.5 ± 12.4 beats/min [deep sleep)]; and 106.9 ± 16.4 beats/min to 87.0 ± 12.1 beats/min [REM sleep]), as did the LF/HF (1.6 ± 2.7 to 0.6 ± 0.5 [light sleep]; 1.2 ± 1.6 to 0.5 ± 0.6 [deep sleep]; and 3.0 ± 5.4 to 1.4 ± 1.7 [REM sleep]). CONCLUSIONS: The proportion of sympathetic activity of the autonomic nervous system declines in children with OSAS after AT in association with improvement in sleep-disordered breathing.
Asunto(s)
Adenoidectomía , Frecuencia Cardíaca , Apnea Obstructiva del Sueño/fisiopatología , Tonsilectomía , Tonsila Faríngea/patología , Tonsila Faríngea/cirugía , Preescolar , Femenino , Humanos , Hipertrofia/complicaciones , Hipertrofia/cirugía , Masculino , Tonsila Palatina/patología , Tonsila Palatina/cirugía , Estudios Retrospectivos , Apnea Obstructiva del Sueño/complicacionesRESUMEN
OBJECTIVE: The purpose of this study was to determine if reduced time in bed as well as the degree of obstructive sleep-disordered breathing predicted the risk of impaired cognitive function in children with adenotonsillar hypertrophy suspected of having obstructive sleep-disordered breathing. DESIGN: We studied 56 children, aged 6 to 12 years, with adenotonsillar hypertrophy referred for suspected obstructive sleep-disordered breathing. Children were given a sleep diary and underwent wrist actigraphy for 6 consecutive days and nights. On day 7, the children were given general cognitive tests, memory tests, and continuous performance tests followed by attended polysomnography that night. Parents completed snoring and behavior questionnaires. RESULTS: Shorter mean time in bed for 6 nights and a history of nightly snoring were highly predictive of lower scores for the vocabulary and similarities cognitive function tests. Children who had a mean time in bed of 557 minutes and did not snore nightly were predicted to have vocabulary and similarities scores more than 1 standard deviation higher than children who had a mean time in bed of 521 minutes and snored nightly. Shorter mean time in bed and the log of the apnea hypopnea index also predicted lower vocabulary and similarities scores. Greater night to night variability in time in bed was significantly predictive of lower vocabulary and similarities scores, but variability was not as predictive as mean time in bed. Neither mean time in bed nor the coefficient of variation of time in bed predicted other cognitive or behavioral scores. CONCLUSIONS: Short or variable time in bed and nightly snoring or higher apnea hypopnea index predicted impaired vocabulary and similarities scores in children with adenotonsillar hypertrophy suspected of having obstructive sleep-disordered breathing. The degree of cognitive impairment attributable to short time in bed and obstructive sleep-disordered breathing is clinically very significant.
Asunto(s)
Trastornos del Conocimiento/etiología , Síndromes de la Apnea del Sueño/complicaciones , Sueño , Tonsila Faríngea/patología , Niño , Femenino , Humanos , Hipertrofia , Masculino , Tonsila Palatina/patología , Factores de TiempoRESUMEN
OBJECTIVE: The purpose of this study was to determine whether risks of impaired cognitive function could be predicted for children or groups of children with adenotonsillar hypertrophy who were suspected of having obstructive sleep-disordered breathing, from historical and polysomnographic variables used separately or in combination. METHODS: We studied 114 consecutive 6- to 12-year-old children with adenotonsillar hypertrophy, who were referred because of suspected obstructive sleep-disordered breathing, with questionnaires, assessment of tonsil size, general and memory cognitive tests, and attended polysomnography with the use of nasal pressure recording to detect flow. RESULTS: There were important significant relationships between snore group (snored every night versus less often), sleep efficiency, and race and 2 of 3 general cognitive tests (vocabulary and similarities). Significant but weaker relationships were observed between sleep latency and 2 memory indices (verbal memory and general memory) and between sleep efficiency and 2 behavior indices (attention-deficit/hyperactivity disorder summary and hyperactive-impulsive summary). The number of episodes of apnea and hypopnea per 1 hour of sleep predicted the vocabulary score as well as did the snore group, but it did not predict other tests as well as other variables. Tonsil size did not predict any cognitive or behavior score. Confidence intervals for group means were small, whereas prediction intervals for individual children were large. CONCLUSIONS: Risk of impaired cognitive function and behavior can be predicted from snoring history, sleep efficiency, sleep latency, and race but not tonsil size. The combination of snoring history and polysomnographic variables predicted impaired cognitive scores better than did either alone. The snoring history predicted more test scores than the number of episodes of apnea and hypopnea per 1 hour of sleep.
Asunto(s)
Tonsila Faríngea/patología , Trastornos del Conocimiento/etiología , Tonsila Palatina/patología , Apnea Obstructiva del Sueño/complicaciones , Niño , Conducta Infantil , Trastornos del Conocimiento/clasificación , Femenino , Humanos , Hipertrofia , Masculino , Polisomnografía , Valor Predictivo de las Pruebas , Factores de Riesgo , Apnea Obstructiva del Sueño/psicologíaRESUMEN
OBJECTIVE: To examine the effect of adenotonsillectomy (T&A) in children with obstructive sleep-disordered breathing on growth, hyperactivity, and sleep and waking motor activity. METHODS: We studied 54 children who were aged 6 to 12 years and had adenotonsillar hypertrophy and an obstructive apnea-hypopnea index of > or =1 before and 12 months after they all received adenotonsillectomy (T&A). We measured their height, weight, percentage overweight (patient BMI - BMI at 50th percentile)/BMI at 50th percentile x 100) and obtained a hyperactivity score from parent report on a standardized behavior questionnaire scale. A subset of 21 of these children were also studied for motor activity by wrist actigraphy for 7 consecutive days and nights before and 12 months after T&A. RESULTS: After T&A, mean obstructive apnea-hypopnea index decreased from 7.6 to 0.6. Height percentile did not change, but weight percentile increased; as a consequence, percentage overweight increased from 32.0% to 36.3%. Hyperactivity scores and total daily motor activity were reduced after T&A. From linear regression, the reduction in hyperactivity scores predicted an increase in percentage overweight. Reduced motor activity was correlated with increased percentage overweight. CONCLUSIONS: An increase in percentage overweight after T&A in children with obstructive sleep-disordered breathing is correlated to decreased child hyperactivity scores and to decreased measured motor activity in the subset studied. These associations suggest that the increase in overweight may be attributable to reductions in physical activity and fidgeting energy expenditure.