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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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