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Adenotonsillectomy May Improve Cognition in Children With Sleep-Disordered Breathing


Treating mild sleep-disordered breathing (SDB) via adenotonsillectomy in children can lead to improvements in cerebral blood flow and cognition, according to a report in the July issue of Pediatrics.

"Perhaps subtle behavioral changes that are known to occur in children who snore, may be reversible with amelioration of snoring," Dr. Fenella J. Kirkham told Reuters Health.

Dr. Kirkham from University College London Institute of Child Health, England and colleagues assessed middle cerebral artery blood flow velocity (MCAV) and cognitive and behavioral data in 19 children with snoring (mild SDB) who underwent adenotonsillectomy. They were compared with 14 similar, healthy control subjects.

Parental reports of snoring and oximetry values improved after adenotonsillectomy, the investigators report, and MCAV that was increased preoperatively approached values seen in normal children postoperatively.

Processing speed and visual attention scores were higher postoperatively, the researchers note, whereas control children showed slight decreases over time.

"I must stress that the improvements in processing speed and visual attention were subtle, and require confirmation in larger sample sizes," Dr. Kirkham said. "A direct relationship between snoring, cerebral blood flow reactivity and neuropsychology is not demonstrated, but the co-occurrence of changes is of interest and requires further investigation."

Behavior measures remained significantly worse in mild SDB children after adenotonsillectomy than those in control children, though they were numerically better after the procedure.

Children who showed the greatest increase in mean overnight oxygen saturation after surgery also showed the greatest reduction toward normal in MCAV, the investigators say, and the available evidence suggested greater MCAV reduction in children with higher initial apnea/hypopnea index scores.

"Children with subtle derangement in oxygen levels (mild hypoxia) and sleep quality (both associated with sleep disordered breathing) often don't come into the radar of neuropsychologists, but may benefit from monitoring," Dr. Kirkham explained, "particularly if there is an opportunity to reduce long-term cognitive deficit, or even reduce the potential for the child growing into a cognitive-behavioral deficit later in life."

Pediatrics 2008;122:75-82.





Reviewed by Ramaz Mitaishvili, MD
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