Attention-deficit/hyperactivity disorder with obstructive sleep apnea: A treatment outcome study
Abstract
Background Children diagnosed with attention-deficit/hyperactivity disorder (ADHD), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) criteria, may also have obstructive sleep apnea (OSA), but it is unclear whether treating OSA has similar results as methylphenidate (MPH), a commonly used treatment for ADHD.Methods This study enrolled 66 school-age children, referred for and diagnosed with ADHD, and 20 healthy controls. Polysomnography (PSG) performed after ADHD diagnosis showed the presence of mild OSA. After otolaryngological evaluation, parents and referring physicians of the children could select treatment of ADHD with MPH, treatment of OSA with adenotonsillectomy or no treatment. Systematic follow-up was performed six months after initiation of treatment, or diagnosis if no treatment. All children had pre- and post-clinical interviews; pediatric, neurologic, psychiatric and neurocognitive evaluation; PSG; ADHD rating scale, child behavior checklist (CBCL) filled out by parents and teacher; test of variables of attention (TOVA); and the quality of life in children with obstructive sleep disorder questionnaire (OSA-18).Results ADHD children had an apnea-hypopnea index (AHI)>1<5 event/hour; 27 were treated with MPH, 25 had adenotonsillectomy, and 14 had no treatment. The surgical and MPH groups improved more than the non-treatment group. When comparing MPH to post-surgery, the PSG and questionnaire sleep variables, some daytime symptoms (including attention span) and TOVA subscales (impulse control, response time and total ADHD score) improved more in the surgical group than the MPH group. The surgical group had an ADHD total score of 21.16+/-7.13 on the ADHD rating scale (ADHD-RS) post-surgery compared to 31.52+/-7.01 pre-surgery (p=0.0001), and the inattention and hyperactivity subscales were also significantly lower (p=0.0001). Finally, the results were significantly different between surgically and MPH-treated groups (ADHD-RS p=0.007). The surgical group also had a TOVA ADHD score lower than -1.8 and close to those obtained in normal controls.Conclusion A low AHI score of >1 considered abnormal is detrimental to children with ADHD. Recognition and surgical treatment of underlying mild sleep-disordered breathing (SDB) in children with ADHD may prevent unnecessary long-term MPH usage and the potential side effects associated with drug intake.
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In children with diagnoses of ADHD and OSA, two prospective studies have demonstrated significant improvements in ADHD symptoms, including hyperactivity, following adenotonsillectomy.
“In children with diagnoses of ADHD and OSA, two prospective studies have demonstrated significant improvements in ADHD symptoms, including hyperactivity, following adenotonsillectomy (Chervin et al. 2006; Huang et al. 2007).”
From Associations of sleep disturbance with ADHD: implications for treatment (2015) · cites this paper as Huang et al. 2007
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 11,772 · see citing works
Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment
Barkley, R. A., & Poillion, M. J. (1994) · Behavioral Disorders · doi:10.1177/019874299401900205 · Cited by 4,632 · see citing works
Manual for the Wechsler intelligence scale for children
Wechsler, D. (1974) · Psychological Corp. eBooks · Cited by 1,303 · see citing works
Standards and Indications for Cardiopulmonary Sleep Studies in Children. American Thoracic Society
(1996) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.153.2.8564147 · Cited by 1,178 · see citing works
Clinical Practice Guideline: Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Pulmonology, S. O. P. (2002) · PEDIATRICS · doi:10.1542/peds.109.4.704 · Cited by 930 · see citing works
Snoring, sleep disturbance, and behaviour in 4-5 year olds.
Ali, N. J., Pitson, D., & Stradling, J. R. (1993) · Archives of Disease in Childhood · doi:10.1136/adc.68.3.360 · Cited by 881 · see citing works
Normal Polysomnographic Values for Children and Adolescents
Marcus, C. L., Omlin, K. J., Basinki, D. J., Bailey, S. L., Rachal, A. B., von Pechmann, W. S., Keens, T. G., & Ward, S. L. D. (1992) · American Review of Respiratory Disease · doi:10.1164/ajrccm/146.5_pt_1.1235 · Cited by 808 · see citing works
Clinical Predictors of Obstructive Sleep Apnea
Friedman, M., Tanyeri, H., La Rosa, M., Landsberg, R., Vaidyanathan, K., Pieri, S., & Caldarelli, D. (1999) · The Laryngoscope · doi:10.1097/00005537-199912000-00002 · Cited by 706 · see citing works
A manual of Standardized Terminology
Rechtschaffen, A. (1968) · Medical Entomology and Zoology · Cited by 632 · see citing works
Symptoms of Sleep Disorders, Inattention, and Hyperactivity in Children
Chervin, R. D., Dillon, J. E., Bassetti, C. L., Ganoczy, D. A., & Pituch, K. (1997) · SLEEP · doi:10.1093/sleep/20.12.1185 · Cited by 577 · see citing works
O'Brien, L. M., Holbrook, C. R., Mervis, C. Β., Klaus, C. J., Bruner, J. L., Raffield, T. J., Rutherford, J., Mehl, R. C., Wang, M., Tuell, A., et al. (2003) · PEDIATRICS · doi:10.1542/peds.111.3.554 · Cited by 541 · see citing works
Inattention, Hyperactivity, and Symptoms of Sleep-Disordered Breathing
Chervin, R. D., Archbold, K. H., Dillon, J. E., Panahi, P., Pituch, K. J., Dahl, R. E., & Guilleminault, C. (2002) · PEDIATRICS · doi:10.1542/peds.109.3.449 · Cited by 538 · see citing works
Self-citationQuality of Life for Children with Obstructive Sleep Apnea
Franco, R. A., Rosenfeld, R. M., & Rao, M. (2000) · Otolaryngology · doi:10.1067/mhn.2000.105254 · Cited by 513 · see citing works
A review of 50 children with obstructive sleep apnea syndrome
Guilleminault, C., Korobkin, R., & Winkle, R. A. (1981) · Lung · doi:10.1007/bf02713925 · Cited by 493 · see citing works
Self-citationSleep Disturbances in Children With Attention‐Deficit/Hyperactivity Disorder
CORKUM, P., TANNOCK, R., & MOLDOFSKY, H. (1998) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-199806000-00014 · Cited by 441 · see citing works
Guilleminault, C., Winkle, R. A., Korobkin, R., & Simmons, B. F. (1982) · European Journal of Pediatrics · doi:10.1007/bf01377349 · Cited by 404 · see citing works
Self-citationParental and Self-report of Sleep in Children With Attention-Deficit/Hyperactivity Disorder
Owens, J. A., Maxim, R., Nobile, C., McGuinn, M., & Msall, M. E. (2000) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.154.6.549 · Cited by 397 · see citing works
Sleep disordered breathing: Effects of adenotonsillectomy on behaviour and psychological functioning
Ali, N. J., Pitson, D., & Stradling, J. R. (1996) · European Journal of Pediatrics · doi:10.1007/bf02115629 · Cited by 367 · see citing works
The ADHD and Sleep Conundrum: A Review
OWENS, J. A. (2005) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/00004703-200508000-00011 · Cited by 349 · see citing works
Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment
Johnston, C. (1992) · Behaviour Research and Therapy · doi:10.1016/0005-7967(92)90012-6 · Cited by 298 · see citing works
Szatmári, P., OFFORD, D. R., & Boyle, M. H. (1989) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.1989.tb00235.x · Cited by 290 · see citing works
GREENHILL, L. L., SWANSON, J. M., VITIELLO, B., DAVIES, M., CLEVENGER, W., WU, M., ARNOLD, L. E., ABIKOFF, H. B., BUKSTEIN, O. G., CONNERS, C. K., et al. (2001) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200102000-00012 · Cited by 287 · see citing works
Hyperactivity and Polysomnographic Findings in Children Evaluated for Sleep-Disordered Breathing
Chervin, R. D., & Archbold, K. H. (2001) · SLEEP · doi:10.1093/sleep/24.3.313 · Cited by 263 · see citing works
Natural history of snoring and related behaviour problems between the ages of 4 and 7 years.
Ali, N. J., Pitson, D., & Stradling, J. R. (1994) · Archives of Disease in Childhood · doi:10.1136/adc.71.1.74 · Cited by 240 · see citing works
Validation of the ADHD Rating Scale as a clirlician administered and scored instrument
Faries, D. E., Yalcin, I., Harder, D. F., & Heiligenstein, J. H. (2001) · Journal of Attention Disorders · doi:10.1177/108705470100500204 · Cited by 183 · see citing works
Sleep Disturbance in Preschool-Aged Hyperactive and Nonhyperactive Children
Kaplan, B. J., McNicol, J., Conte, R., & Moghadam, H. K. (1987) · PEDIATRICS · doi:10.1542/peds.80.6.839 · Cited by 181 · see citing works
Konrad, K., Günther, T., Hanisch, C., & Herpertz‐Dahlmann, B. (2004) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/00004583-200402000-00015 · Cited by 179 · see citing works
Impact of Tonsillectomy and Adenoidectomy on Child Behavior
Goldstein, N. A., Post, J. C., Rosenfeld, R. M., & Campbell, T. F. (2000) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.126.4.494 · Cited by 174 · see citing works
Habitual Snoring, Intermittent Hypoxia, and Impaired Behavior in Primary School Children
Urschitz, M. S., Eitner, S., Guenther, A., Eggebrecht, E., Wolff, J., Urschitz‐Duprat, P. M., Schlaud, M., & Poets, C. F. (2004) · PEDIATRICS · doi:10.1542/peds.2003-1145-l · Cited by 173 · see citing works
Sleep Disturbances in Children with Attention Deficit Hyperactivity Disorder
O'Brien, L. M., Ivanenko, A., Crabtree, V. M., Holbrook, C. R., Bruner, J. L., Klaus, C. J., & Gozal, D. (2003) · Pediatric Research · doi:10.1203/01.pdr.0000072333.11711.9a · Cited by 172 · see citing works
Snoring Predicts Hyperactivity Four Years Later
Chervin, R. D., Ruzicka, D. L., Archbold, K. H., & Dillon, J. E. (2005) · SLEEP · doi:10.1093/sleep/28.7.885 · Cited by 167 · see citing works
Sleep Disordered Breathing: Surgical Outcomes in Prepubertal Children
Guilleminault, C., Li, K. K., Khramtsov, A., Pelayo, R., & Martinez, S. (2004) · The Laryngoscope · doi:10.1097/00005537-200401000-00024 · Cited by 149 · see citing works
Self-citationOvertoom, C. C. E., Verbaten, M. N., Kemner, C., Kenemans, J. L., van Engeland, H., Buitelaar, J. K., van der Molen, M. W., van der Gugten, J., Westenberg, H. G. M., Maes, R. A. A., et al. (2003) · Behavioural Brain Research · doi:10.1016/s0166-4328(03)00097-4 · Cited by 138 · see citing works
Parental Report of Sleep Problems in Children with Attentional and Learning Disorders
Marcotte, A. C., Thacher, P. V., Butters, M. A., Bortz, J. J., Acebo, C., & Carskadon, M. A. (1998) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/00004703-199806000-00005 · Cited by 127 · see citing works
Greenhill, L., Puig-Antich, J., Goetz, R., Hanlon, C., & Davies, M. (1983) · Sleep · doi:10.1093/sleep/6.2.91 · Cited by 121 · cited 1× · see citing works
“Several previously published neurophysiological studies show that children with ADHD often exhibit abnormal nocturnal sleep [6–13].”
BackgroundSleep Behaviors and Disorders in Children and Adolescents Evaluated at Psychiatric Clinics
Simonds, J. F., & Párraga, H. C. (1984) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/00004703-198402000-00002 · Cited by 119 · see citing works
Sleep disorders in Taiwanese children with attention deficit/hyperactivity disorder
Huang, Y., Chen, N., Li, H., Wu, Y., Chao, C., & Guilleminault, C. (2004) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2004.00408.x · Cited by 114 · see citing works
Self-citationLong-Term Use of Stimulants in Children with Attention Deficit Hyperactivity Disorder
Hechtman, L. T., & Greenfield, B. J. (2003) · Pediatric Drugs · doi:10.2165/00148581-200305120-00002 · Cited by 109 · see citing works
Sleep Disturbances in Children with Attention-Deficit/Hyperactivity Disorder
Ring, A., Stein, D. J., Barak, Y., Teicher, A., Hadjez, J., Elizur, A., & Weizman, A. (1998) · Journal of Learning Disabilities · doi:10.1177/002221949803100607 · Cited by 108 · see citing works
Sleep Patterns in Hyperkinetic and Normal Children
Busby, K., Firestone, P., & Pivik, R. T. (1981) · SLEEP · doi:10.1093/sleep/4.4.366 · Cited by 105 · see citing works
A Prospective Study on the Surgical Outcomes of Children with Sleep-Disordered Breathing
Guilleminault, C., Li, K. K., Quo, S. D., & Inouye, R. N. (2004) · SLEEP · doi:10.1093/sleep/27.1.95 · Cited by 100 · see citing works
Self-citationO'Brien, L. (2003) · Sleep Medicine · doi:10.1016/s1389-9457(03)00071-6 · Cited by 97 · see citing works
Biederman, J., Quinn, D., Weiss, M., Markabi, S., Weidenman, M., Edson, K., Karlsson, G., Pohlmann, H., & Wigal, S. (2003) · Pediatric Drugs · doi:10.2165/00148581-200305120-00006 · Cited by 95 · see citing works
Weinberg, W. A., & Harper, C. R. (1993) · Neurologic Clinics · doi:10.1016/s0733-8619(18)30170-1 · Cited by 93 · see citing works
Avior, G., Fishman, G., Leor, A., Sivan, Y., Kaysar, N., & DeRowe, A. (2004) · Otolaryngology · doi:10.1016/j.otohns.2004.04.015 · Cited by 89 · see citing works
Sangal, R. B., Owens, J. A., & Sangal, J. M. (2005) · SLEEP · doi:10.1093/sleep/28.9.1143 · Cited by 85 · see citing works
Snoring, sleep disturbance, and behavior in 4-5 year olds.
Holmes, H. A. (1993) · Archives of Disease in Childhood · doi:10.1136/adc.69.2.265-a · Cited by 64 · see citing works
Attention Deficit Hyperactivity Disorder in Adults and Obstructive Sleep Apnea
Naseem, S., Chaudhary, B. A., & Collop, N. A. (2001) · CHEST Journal · doi:10.1378/chest.119.1.294 · Cited by 52 · see citing works
How Many Children with ADHD Have Sleep Apnea or Periodic Leg Movements on Polysomnography?
Chervin, R. D. (2005) · SLEEP · doi:10.1093/sleep/28.9.1041 · Cited by 42 · see citing works
Sleep REM latency in hyperkinetic boys
Khan, A. U. (1982) · American Journal of Psychiatry · doi:10.1176/ajp.139.10.1358 · Cited by 34 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Diamond, A. (2013) · Annual Review of Psychology · doi:10.1146/annurev-psych-113011-143750 · Cited by 13,268 · see citing works
“…& Cheng 2005), sad (Hirt et al. 2008, von Hecker & Meiser 2005), lonely (Baumeister et al. 2002, Cacioppo & Patrick 2008, Campbell et al. 2006, Tun et al. 2012), sleep deprived (Barnes et al. 2012, Huang et al. 2007), or not physically fit (Best 2010, Chaddock et al. 2011, Hillman et al. 2008).”
Sleep and mental disorders: a meta-analysis of polysomnographic research
Baglioni, C., Nanovska, S., Regen, W., Spiegelhalder, K., Feige, B., Nissen, C., Reynolds, C. F., & Riemann, D. (2016) · Psychological Bulletin · doi:10.1037/bul0000053 · Cited by 1,074 · see citing works
Sleep Disordered Breathing in Children in a General Population Sample: Prevalence and Risk Factors
Bixler, E. O., Vgontzas, A. N., Lin, H.-M., Liao, D., Calhoun, S. L., Vela‐Bueno, A., Fedok, F. G., Vlašić, V., & Graff, G. R. (2009) · SLEEP · doi:10.1093/sleep/32.6.731 · Cited by 685 · see citing works
Cortese, S., Faraone, S. V., Konofal, E., & Lecendreux, M. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181ac09c9 · Cited by 637 · see citing works
Associations of sleep disturbance with ADHD: implications for treatment
Hvolby, A. (2015) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-014-0151-0 · Cited by 339 · see citing works
Sedky, K., Bennett, D. S., & Carvalho, K. S. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.12.003 · Cited by 247 · see citing works
Konofal, É., Lecendreux, M., & Cortese, S. (2010) · Sleep Medicine · doi:10.1016/j.sleep.2010.02.012 · Cited by 249 · see citing works
“[57] and Dillon et al.”
Assessment and Management of Sleep Problems in Youths With Attention-Deficit/Hyperactivity Disorder
Cortese, S., Brown, T. E., Corkum, P. V., Gruber, R., O'Brien, L. M., Stein, M. A., Weiss, M. D., & Owens, J. A. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.06.001 · Cited by 241 · see citing works
Bourke, R., Anderson, V. A., Yang, J. S. C., Jackman, A. R., Killedar, A., Nixon, G. M., Davey, M. J., WALKER, A. M., Trinder, J. C., & Horne, R. S. C. (2011) · Sleep Medicine · doi:10.1016/j.sleep.2010.11.010 · Cited by 221 · see citing works
“The link between SDB and cognitive deficits is further strengthened by reports of improvement in function following treatment of SDB with adenotonsillectomy [27–30].”
BackgroundManoach, D. S., Pan, J. Q., Purcell, S., & Stickgold, R. (2015) · Biological Psychiatry · doi:10.1016/j.biopsych.2015.10.003 · Cited by 210 · see citing works
“Moreover, as has been shown in depression (7) and attention-deficit/hyperactivity disorder (4), treating sleep disturbances can improve symptoms and cognitive function.”
BackgroundSleep in attention-deficit/hyperactivity disorder in children and adults: Past, present, and future
Yoon, S. Y., Jain, U., & Shapiro, C. M. (2011) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2011.07.001 · Cited by 213 · see citing works
Huynh, N. T., Desplats, E., & Almeida, F. R. (2016) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.02.002 · Cited by 171 · see citing works
Walters, A. S., Silvestri, R., Zucconi, M., Chandrashekariah, R., & Konofal, É. (2008) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27356 · Cited by 167 · see citing works
Manoach, D. S., Demanuele, C., Wamsley, E. J., Vangel, M. G., Montrose, D. M., Miewald, J. M., Kupfer, D. J., Buysse, D. J., Stickgold, R., & Keshavan, M. S. (2014) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2014.00762 · Cited by 153 · see citing works
Lee, C., Hsu, W. ‐., Chang, W. ‐., Lin, M., & Kang, K. ‐. (2015) · Clinical Otolaryngology · doi:10.1111/coa.12549 · Cited by 149 · see citing works
Future Research Directions in Sleep and ADHD: Report of a Consensus Working Group
Owens, J., Gruber, R., Brown, T., Corkum, P., Cortese, S., O’Brien, L., Stein, M., & Weiss, M. (2013) · Journal of Attention Disorders · doi:10.1177/1087054712457992 · Cited by 143 · see citing works
“There is considerable overlap between the core features of ADHD and neurobehavioral and neurocognitive manifestations of sleep disorders such as obstructive sleep apnea and restless legs syndrome (Chervin et al., 2002a, 2002b; Cortese et al., 2005; Huang et al., 2007; Picchietti et al., 2007).”
BackgroundThe role of the circadian system in the etiology and pathophysiology of ADHD: time to redefine ADHD?
Bijlenga, D., Vollebregt, M. A., Kooij, J. J. S., & Arns, M. (2019) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-018-0271-z · Cited by 137 · see citing works
Pathogenesis of enuresis: Towards a new understanding
Nevéus, T. (2017) · International Journal of Urology · doi:10.1111/iju.13310 · Cited by 126 · see citing works
Screening of Pediatric Sleep-Disordered Breathing
Spruyt, K., & Gozal, D. (2012) · CHEST Journal · doi:10.1378/chest.11-3164 · Cited by 117 · see citing works
Perfect, M. M., Archbold, K. H., Goodwin, J. L., Levine‐Donnerstein, D., & Quan, S. F. (2013) · SLEEP · doi:10.5665/sleep.2536 · Cited by 111 · see citing works
Arns, M., & Kenemans, J. L. (2012) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2012.10.006 · Cited by 113 · see citing works
Owens, J. A. (2009) · Europe PMC (PubMed Central) · Cited by 107 · see citing works
Biochemoprevention for Dysplastic Lesions of the Upper Aerodigestive Tract
Papadimitrakopoulou, V. A. (1999) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.125.10.1083 · Cited by 104 · see citing works
Sleep Problems in the Child with Attention-Deficit Hyperactivity Disorder
Weiss, M. D., & Salpekar, J. A. (2010) · CNS Drugs · doi:10.2165/11538990-000000000-00000 · Cited by 101 · see citing works
Sleep disordered breathing in children.
Sinha, D., & Guilleminault, C. (2010) · PubMed · Cited by 100 · see citing works
Self-citationImproved Behavior and Sleep After Adenotonsillectomy in Children With Sleep-Disordered Breathing
Wei, J. L., Mayo, M. S., Smith, H. J., Reese, M., & Weatherly, R. A. (2007) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.133.10.974 · Cited by 96 · see citing works
Can the OSA-18 Quality-of-Life Questionnaire Detect Obstructive Sleep Apnea in Children?
Constantin, E., Tewfik, T. L., & Brouillette, R. T. (2009) · PEDIATRICS · doi:10.1542/peds.2009-0731 · Cited by 96 · see citing works
Sleep disorders and attention-deficit/hyperactivity disorder
Owens, J. A. (2008) · Current Psychiatry Reports · doi:10.1007/s11920-008-0070-x · Cited by 95 · see citing works
Mitchell, R. B., & Boss, E. F. (2009) · Developmental Neuropsychology · doi:10.1080/87565640903133657 · Cited by 95 · see citing works
Is Obstructive Sleep Apnea Associated with Adhd?
Youssef, N. A., Ege, M. A., Angly, S. S., Strauss, J. L., & Marx, C. E. (2011) · Annals of Clinical Psychiatry · doi:10.1177/104012371102300309 · Cited by 94 · see citing works
Arns, M., van der Heijden, K. B., Arnold, L. E., & Kenemans, J. L. (2013) · Biological Psychiatry · doi:10.1016/j.biopsych.2013.02.010 · Cited by 93 · see citing works
Does abnormal sleep impair memory consolidation in schizophrenia?
Manoach, D. S. (2009) · Frontiers in Human Neuroscience · doi:10.3389/neuro.09.021.2009 · Cited by 91 · see citing works
“…Wright, 1993, but see, Kahn-Greene et al., 2007), and there is growing evidence that sleep disorders can trigger or aggravate a range of psychiatric conditions (Wehr et al., 1987; Ford and Kamerow, 1989; Breslau et al., 1996; Turek, 2005; Huang et al., 2007; Germain et al., 2008; Sateia, 2009).”
Mouth breathing: adverse effects on facial growth, health, academics, and behavior.
Jefferson, Y. (2010) · PubMed · Cited by 87 · see citing works
Contributions of a specialty clinic for children and adolescents with Down syndrome
Skotko, B. G., Davidson, E. J., & Weintraub, G. S. (2013) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.35795 · Cited by 81 · see citing works
“Kelly, 2007], attention deficit and hyperactivity disorder [Huang et al., 2007], school failure [Brouillette et al.”
BackgroundA critical review of research on executive functions in sport and exercise
Furley, P., Schütz, L.-M., & Wood, G. (2023) · International Review of Sport and Exercise Psychology · doi:10.1080/1750984x.2023.2217437 · Cited by 84 · see citing works
“…(Hirt et al., 2008; Von Hecker & Meiser, 2005), lonely (Baume-ister et al., 2002; Cacioppo & Patrick, 2008; Campbell et al., 2006, Tun et al., 2013), sleep deprived or tired (Barnes et al., 2012; Huang et al., 2007), or not physically fi t (Best, 2010; Chaddock et al., 2011; Hillman et al., 2008).”
Goffinski, A., Stanley, M. A., Shepherd, N., Duvall, N., Jenkinson, S. B., Davis, C., Bull, M. J., & Roper, R. J. (2015) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.36903 · Cited by 79 · see citing works
“, 2013], while attention-deficit hyperactivity disorder has been associated with pediatric OSA [Huang et al., 2007].”
Sleep-disordered breathing in children.
Li, H., & Lee, L. (2009) · PubMed · Cited by 76 · see citing works
Self-citationYılmaz, E. A., Sedky, K., & Bennett, D. S. (2013) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3178 · Cited by 76 · see citing works
“When excluding one study that included children previously diagnosed with attention deficit hyperactivity disorder, 34 the overall ES remained similar; 0.39 (95% CI = 0.18-0.60; p = 0.0002; see Figure 1 ).”
InfluentialUrbano, G. L., Tablizo, B. J., Moufarrej, Y., Tablizo, M. A., Chen, M. L., & Witmans, M. (2021) · Children · doi:10.3390/children8090824 · Cited by 71 · see citing works
“Hence, researchers suggest that surgical treatment of children with SDB and ADHD may prevent unnecessary long-term MPH use [36].”
BackgroundRosen, D. (2011) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0b013e32834ba9c0 · Cited by 71 · see citing works
Todd, C. A., Bareiss, A. K., McCoul, E. D., & Rodriguez, K. H. (2017) · Otolaryngology–Head and Neck Surgery · doi:10.1177/0194599817717480 · Cited by 68 · see citing works
“These subgroups included patients with allergic rhinitis,(10) Down syndrome and mucopolysaccharidosis,(14) obese children,(23,33) and attention-deficit/hyperactive disorder.(27) Other studies examined modified procedures, such as powered intracapsular tonsillotomy and adenoidectomy,(22,24,25) turbinate reduction with…”
BackgroundManagement of paediatric obstructive sleep apnoea: A systematic review and network meta‐analysis
Lin, S., Su, Y., Wu, Y., Chang, J. Z., & Tu, Y. (2019) · International Journal of Paediatric Dentistry · doi:10.1111/ipd.12593 · Cited by 68 · see citing works
Self-citationCorkum, P. V., Davidson, F., & MacPherson, M. (2011) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2011.03.004 · Cited by 67 · see citing works
Sleep, circadian rhythms, and schizophrenia
Cosgrave, J., Wulff, K., & Gehrman, P. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000419 · Cited by 60 · see citing works
Lecendreux, M., & Cortese, S. (2007) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.7.12.1799 · Cited by 58 · see citing works
Sleep patterns and the risk for ADHD: a review
Gruber, R. (2012) · Nature and Science of Sleep · doi:10.2147/nss.s31269 · Cited by 58 · see citing works
“Furthermore, research examining children with comorbid obstructive sleep apnea and ADHD 21,22 has demonstrated that treatment of the sleep disorder by adenotonsillectomy surgery results in significant improvements in attention and reduced hyperactivity.”
van Andel, E., Bijlenga, D., Vogel, S. W. N., Beekman, A. T. F., & Kooij, J. J. S. (2020) · Chronobiology International · doi:10.1080/07420528.2020.1835943 · Cited by 54 · see citing works
“Most of these studies have been conducted on children, where ADHD symptoms decreased after treatment of sleep problems (Corkum et al. 2016; Huang et al. 2007; Walters et al. 2000).”
BackgroundCalhoun, S. L., Mayes, S. D., Vgontzas, A. N., Tsaoussoglou, M., Shifflett, L. J., & Bixler, E. O. (2009) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27491 · Cited by 54 · see citing works
BROCKMANN, P. E., V, Bertrand, P. J., Pardo, T., Jaime Cerda, L., Reyes, B., & Holmgren, N. L. (2012) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2012.05.028 · Cited by 54 · see citing works
Pediatric Obstructive Sleep Apnea Syndrome
Alexander, N. S., & Schroeder, J. W. (2013) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2013.04.009 · Cited by 51 · see citing works
Um, Y. H., Hong, S., & Jeong, J. (2017) · Clinical Psychopharmacology and Neuroscience · doi:10.9758/cpn.2017.15.1.9 · Cited by 52 · see citing works
Wu, J., Gu, M., Chen, S., Chen, W., Ni, K., Xu, H., & Li, X. (2017) · Medicine · doi:10.1097/md.0000000000008281 · Cited by 52 · see citing works
“The incidence of ADHD is about 3 to 7% in United States[19] and 8.4% to 11.7% in Taiwan, China.”
BackgroundInfluentialAbuse-Deterrent and Tamper-Resistant Opioid Formulations
Schneider, J. P., Matthews, M. L., & Jamison, R. N. (2010) · CNS Drugs · doi:10.2165/11584260-000000000-00000 · Cited by 51 · see citing works
Wei, J. L., Bond, J., Mayo, M. S., Smith, H. J., Reese, M., & Weatherly, R. A. (2009) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archoto.2009.74 · Cited by 49 · see citing works
“Another study showed that among children diagnosed as having ADHD with PSG-confirmed mild OSA, those who underwent adenotonsillectomy demonstrated greater improvement than the medically treated group based on an apnea-hypopnea index, an ADHD rating scale, a child behavior checklist, a test of variable attention, and a…”
MethodTsai, M.-H., Hsu, J., & Huang, Y. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0711-4 · Cited by 50 · see citing works
Self-citationSleep in Children With Attention-Deficit/Hyperactivity Disorder
Cortese, S., Faraone, S. V., Konofal, É., & Lecendreux, M. (2009) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/chi.0b013e3181ae09c9 · Cited by 47 · see citing works
Non‐pharmacological management of problematic sleeping in children with developmental disabilities
Spruyt, K., & Curfs, L. (2014) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.12623 · Cited by 44 · see citing works
“A study by Huang et al.(101) allowed for the selection of treatment by the child or caregiver.”
MethodSleep deprivation and accidental fall risk in children
Boto, L. R., Crispim, J. N., de Melo, I. S., Juvandes, C., Rodrigues, T., Azeredo, P., & Ferreira, R. (2011) · Sleep Medicine · doi:10.1016/j.sleep.2011.04.010 · Cited by 43 · see citing works
“In children, however, sleep deprivation does not seem to lead to excessive daytime sleepiness, but rather to hyperactivity and attention deficit disorder [3,7,12].”
BackgroundAmiri, S., Fakhim, S. A., Lotfi, A., Bayazian, G., Sohrabpour, M., & Hemmatjoo, T. (2015) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2015.05.015 · Cited by 40 · see citing works
Botchway-Commey, E. N., Godfrey, C., Anderson, V. A., & Catroppa, C. (2018) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000446 · Cited by 39 · see citing works
Friedman, N. R. (2007) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27022 · Cited by 39 · see citing works
Excessive Daytime Sleepiness in Patients With ADHD—Diagnostic and Management Strategies
Bioulac, S., Micoulaud-Franchi, J., & Philip, P. (2015) · Current Psychiatry Reports · doi:10.1007/s11920-015-0608-7 · Cited by 36 · see citing works
Attention-deficit/Hyperactivity Disorder and Sleep Disorders in Children
Tsai, M.-H., & Huang, Y. (2010) · Medical Clinics of North America · doi:10.1016/j.mcna.2010.03.008 · Cited by 38 · see citing works
Self-citationQuan, S. F., Zhao, Q., Sherrill, D. L., & Goodwin, J. L. (2008) · The Open Epidemiology Journal · doi:10.2174/1874297100801010001 · Cited by 38 · see citing works
“Treatment for SDB can result in significant improvement in behavior and cognitive performance [5-7].”
BackgroundCognitive and behavioral aspects of Smith–Lemli–Opitz syndrome
Diaz‐Stransky, A., & Tierney, E. (2012) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.31342 · Cited by 35 · see citing works
Bannink, N., Maliepaard, M., Raat, H., Joosten, K., & Mathijssen, I. (2011) · Journal of Developmental and Behavioral Pediatrics · doi:10.1097/dbp.0b013e318206d5e3 · Cited by 28 · see citing works
Silva, D. T., Colvin, L., Hagemann, E., Stanley, F. J., & Bower, C. I. (2014) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-014-0545-8 · Cited by 35 · see citing works
“Improvement of psychosocial behaviours [39] and ADHD symptoms was noted following adenotonsillectomy [40], which was also confirmed in a systematic review of the literature from January 1966 to June 2010 [22].”
BackgroundSome Infants With Down Syndrome Spontaneously Outgrow Their Obstructive Sleep Apnea
Rosen, D. (2010) · Clinical Pediatrics · doi:10.1177/0009922810378037 · Cited by 34 · see citing works
Huang, Y., Jan, & Yang, C. (2011) · Psychology Research and Behavior Management · doi:10.2147/prbm.s14055 · Cited by 30 · see citing works
Self-citationChanges in the oral and nasal microbiota in pediatric obstructive sleep apnea
Zhang, X., Li, X., Xu, H., Fu, Z., Wang, F., Huang, W., Wu, K., Li, C., Liu, Y., Zou, J., et al. (2023) · Journal of Oral Microbiology · doi:10.1080/20002297.2023.2182571 · Cited by 29 · see citing works
Attention Deficit/Hyperactivity Disorder in Adults with Sleep Apnea
Oğuztürk, Ö., Ekici, M. S., Çimen, D., Ekici, A., & Şentürk, E. (2012) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-012-9331-2 · Cited by 29 · see citing works
Chang, C.-H., Chen, S.-J., & Liu, C. (2017) · PLoS ONE · doi:10.1371/journal.pone.0181430 · Cited by 26 · see citing works
Anand, V., Shukla, G., Gupta, N., Gupta, A., Sapra, S., Gulati, S., Pandey, R. M., Pandey, S., & Kabra, M. (2020) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2020.10.007 · Cited by 25 · see citing works
Sleep-disordered breathing in children with Down syndrome: Usefulness of home polysomnography
BROCKMANN, P. E., V, Damiani, L. F., Nuñez, F., Moya, A., Pincheira, E., Paul, M. A., & C, M. L. (2016) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2016.01.030 · Cited by 25 · see citing works
“The consequences of untreated OSA may result in serious problems including poor academic performance [7,8], behavioral problems [9], hyperactivity [10], attention difficulties [11], and worsening of mental function [10].”
BackgroundJeon, Y. J., Song, J., Ahn, J.-C., Kong, I. G., Kim, J.-W., Park, G., & Won, T. (2016) · Clinical and Experimental Otorhinolaryngology · doi:10.21053/ceo.2015.00584 · Cited by 25 · see citing works
“It has been suggested that proper treatment of SDB may improve attention deficit hyperactivity disorder (ADHD) in a subset of children [3].”
BackgroundSabuncuoğlu, O. (2013) · Medical Hypotheses · doi:10.1016/j.mehy.2012.12.017 · Cited by 25 · see citing works
“comorbid SDB were compared for the effects of methylphenidate treatment and adenotonsillectomy [61].”
BackgroundGuilleminault, C., & Sullivan, S. S. (2014) · Enliven Pediatrics and Neonatal Biology · doi:10.18650/2379-5824.11001 · Cited by 24 · see citing works
Self-citationApnea-hypopnea indices and snoring in children diagnosed with ADHD: a matched case-control study
Galland, B. C., Tripp, E. G., Gray, A. R., & Taylor, B. J. (2010) · Sleep And Breathing · doi:10.1007/s11325-010-0357-0 · Cited by 24 · see citing works
“The criteria for the apnea-hypopnea index (AHI) was set at a low cutoff score of >1; this is relevant clinically in ADHD [15] and considered elevated based on the International Classification of Sleep Disorders criteria (ICSD) [16].”
BackgroundMethodTreatment alternatives for sleep-disordered breathing in the pediatric population
Halbower, A. C., McGinley, B. M., & Smith, P. L. (2008) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0b013e3283130f80 · Cited by 22 · see citing works
Attention Deficit/Hyperactivity Disorder and Sleep in Children
Herman, J. H. (2015) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2015.02.003 · Cited by 21 · see citing works
Murata, E., Mohri, I., Kato-Nishimura, K., Iimura, J., Ogawa, M., Tachibana, M., Ohno, Y., & Taniike, M. (2017) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2017.04.012 · Cited by 21 · see citing works
Barclay, N. L., & Gregory, A. M. (2013) · Current topics in behavioral neurosciences · doi:10.1007/7854_2013_239 · Cited by 21 · see citing works
“Evidence for a potential causal link between SDB and ADHD comes from the finding that pharmacological/ surgical treatment of SDB and sleep apnea often improves symptoms of inattention and hyperactivity (Chervin et al. 2002; Huang et al. 2007).”
BackgroundIdentification of different clinical faces of obstructive sleep apnea in children
Wu, Y., Feng, G., Xu, Z., Li, X., Li, Z., Ge, W., & Ni, X. (2019) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2019.109621 · Cited by 20 · see citing works
Self-citationLin, C.-F. J., Ho, N., Hsu, W.-L., Lin, C.-H., Wang, Y., & Wang, Y. (2024) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.11310 · Cited by 21 · see citing works
Predicting poor school performance in children suspected for sleep-disordered breathing
BROCKMANN, P. E., V, Schlaud, M., Poets, C. F., & Urschitz, M. S. (2015) · Sleep Medicine · doi:10.1016/j.sleep.2015.03.021 · Cited by 19 · see citing works
“Sleep-disordered breathing (SDB), among other socioeconomic and biological factors, may be associated with neurocognitive impairment (NCI) as evidenced by poor school performance (PSP) [1,2], inattentive and hyperactive behavior [3,4], and other externalizing behavioral problems in children [5,6].”
BackgroundSomuk, B. T., Bozkurt, H., Göktaş, G., Demir, O., Gürbüzler, L., & Eyibilen, A. (2015) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2015.08.003 · Cited by 19 · see citing works
van Andel, E., Bijlenga, D., Vogel, S. W. N., Beekman, A. T. F., & Kooij, J. J. S. (2022) · Journal of Biological Rhythms · doi:10.1177/07487304221124659 · Cited by 18 · see citing works
“Several studies in children support this notion, as ADHD symptoms decreased after treatment of specific sleep disorders (Corkum et al., 2016; Huang et al., 2007; Walters et al., 2000).”
BackgroundAu, C. T., Chan, K. C. C., Lee, D. L. Y., Leung, N. M. W., Chow, S. M. W., Chow, J. S., Wing, Y. K., & Li, A. M. (2021) · Respirology · doi:10.1111/resp.14050 · Cited by 18 · see citing works
Unbiased Categorical Classification of Pediatric Sleep Disordered Breathing
Spruyt, K., Verleye, G., & Gozal, D. (2010) · SLEEP · doi:10.1093/sleep/33.10.1341 · Cited by 18 · see citing works
Prevalence of sleep problems in Smith‐Lemli‐Opitz syndrome
Żarowski, M., Vendrame, M., Irons, M., & Kothare, S. V. (2011) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.34021 · Cited by 17 · see citing works
“amelioration of ADHD symptoms has been observed after adequate OSA treatment [Huang et al., 2007].”
MethodAutism spectrum disorders, attention deficit/hyperactivity disorder, and sleep disorders
Ming, X., & Walters, A. S. (2009) · Current Opinion in Pulmonary Medicine · doi:10.1097/mcp.0b013e3283319a9a · Cited by 17 · see citing works
Effect of adenotonsillectomy on ADHD symptoms of children with adenotonsillar hypertrophy.
Dadgarnia, M. H., Baradaranfar, M., Fallah, R., Atighechi, S., Ahsani, A. H., & Baradaranfar, A. (2012) · PubMed · Cited by 16 · see citing works
Soylu, E., Soylu, N., Yıldırım, Y. S., Sakallıoğlu, Ö., Polat, C., & Orhan, İ. (2013) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2013.08.020 · Cited by 16 · see citing works
Severe Hypothyroidism Presenting as Obstructive Sleep Apnea
Rosen, D. (2010) · Clinical Pediatrics · doi:10.1177/0009922809351093 · Cited by 16 · see citing works
Current Trends in Pediatric Orthodontics: A Comprehensive Review
Koaban, A., Alharbi, S., Al-Shehri, A. Z., Al-Shamri, B. S., Aburazizah, M. F., Al-Qahtani, G. H., Alwusaybie, L. H., Alkhalifa, L., Al-Saad, M. M., Al-Nehab, A. A., et al. (2024) · Cureus · doi:10.7759/cureus.68537 · Cited by 18 · see citing works
“It may present as aggressive behaviors or contribute to symptoms of ADHD [146,147].”
BackgroundAndersson, H., & Sonnesen, L. (2018) · European Archives of Paediatric Dentistry · doi:10.1007/s40368-018-0330-3 · Cited by 14 · see citing works
“Consideration may be given to whether the differences found in sleepiness between the two groups were caused by ADHD or SDB/OSA and this may further emphasise the importance of the differential diagnosis between ADHD and SDB/OSA in children.”
BackgroundInfluentialKalaskar, R. R., Bhaje, P., Kalaskar, A., & Faye, A. (2021) · International Journal of Clinical Pediatric Dentistry · doi:10.5005/jp-journals-10005-1987 · Cited by 13 · see citing works
“The remaining 35 items were then grouped into eight subscales as following sleep domains: (1) Bedtime resistance, (2) sleep onset delay, (3) sleep duration, (4) sleep anxiety, (5) night wakings, (6) parasomnias, (7) sleepdisordered breathing, and (8) daytime sleepiness.”
Schoenfelder, E. N., Tran, N., Wholly, D., Kuhn, M., Stein, M. A., Mendoza, J. A., Ola, C., Sasser, T. R., & Tandon, P. S. (2023) · Journal of Attention Disorders · doi:10.1177/10870547231168332 · Cited by 12 · see citing works
“Prior studies demonstrate that treating sleep problems, which are commonplace for youth with ADHD (Yürümez & Kılıç, 2016), including through parent-focused sleep hygiene interventions, improves ADHD-related functioning (Huang et al., 2007; Sciberras et al., 2020; Weiss et al., 2006).”
BackgroundHolty, J.-E. C., & Guilleminault, C. (2012) · Seminars in Orthodontics · doi:10.1053/j.sodo.2011.10.014 · Cited by 12 · see citing works
Self-citationLundahl, A., & Nelson, T. D. (2014) · Journal of Health Psychology · doi:10.1177/1359105314544991 · Cited by 12 · see citing works
“However, treatment of disrupted sleep patterns results in significant improvements in both attention and hyperactivity and often leads to the discontinuation of ADHD stimulant medications (Fidan and Fidan, 2008; Guilleminault et al., 1981; Huang et al., 2007).”
Background
- Authors
- Huang, Y.-S., Guilleminault, C., Li, H.-Y., Yang, C.-M., Wu, Y.-Y., & Chen, N.-H.
- Affiliations
- Chang Gung Memorial Hospital (TW)
- Stanford University (US)
- National Chengchi University (TW)
- Corresponding author
- Guilleminault, Christian
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2007-01
- Volume
- 8
- Issue
- 1
- Pages
- 18-30
- ISSN
- 1389-9457 (ISSN-L)
- OpenAlex
- W2130844643
- Cited by
- 202
- References
- 51
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 11 · 2023: 6 · 2022: 11 · 2021: 6 · 2020: 6 · 2019: 11 · 2018: 5 · 2017: 8 · 2016: 14 · 2015: 10 · 2014: 17 · 2013: 16 · 2012: 20
- FWCI
- 5.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Science Council
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- attention deficit hyperactivity disorder, obstructive sleep apnea, adenotonsillectomy, methylphenidate, sleep-disordered breathing, apnea-hypopnea index, children, treatment outcomes, inattention, hyperactivity, quality of life, polysomnography, Test of Variables of Attention, ADHD Rating Scale, Child Behavior Checklist, OSA-18
- MeSH terms
- Adenoidectomy, Adenoids, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Disruptive, Impulse Control, and Conduct Disorders, Male, Methylphenidate, Surveys and Questionnaires, Reaction Time, Severity of Illness Index, Sleep Apnea Syndromes, Tonsillectomy, Tonsillitis, Observer Variation, Polysomnography, Sleep Apnea, Obstructive, Diagnostic and Statistical Manual of Mental Disorders
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