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Sleep-Disordered Breathing, Behavior, and Cognition in Children Before and After Adenotonsillectomy

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Chervin, Ronald D., Ruzicka, Deborah L., Giordani, Bruno J., Weatherly, Robert A., Dillon, James E., Hodges, Elise K., Marcus, Carole L., Guire, Kenneth E.·2006·Pediatrics
DOI 10.1542/peds.2005-1837PMC PMC1434467
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Abstract

OBJECTIVES. Most children with sleep-disordered breathing (SDB) have mild-to-moderate forms, for which neurobehavioral complications are believed to be the most important adverse outcomes. To improve understanding of this morbidity, its long-term response to adenotonsillectomy, and its relationship to polysomnographic measures, we studied a series of children before and after clinically indicated adenotonsillectomy or unrelated surgical care. METHODS. We recorded sleep and assessed behavioral, cognitive, and psychiatric morbidity in 105 children 5.0 to 12.9 years old: 78 were scheduled for clinically indicated adenotonsillectomy, usually for suspected SDB, and 27 for unrelated surgical care. One year later, we repeated all assessments in 100 of these children. RESULTS. Subjects who had an adenotonsillectomy, in comparison to controls, were more hyperactive on well-validated parent rating scales, inattentive on cognitive testing, sleepy on the Multiple Sleep Latency Test, and likely to have attention-deficit/hyperactivity disorder (as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) as judged by a child psychiatrist. In contrast, 1 year later, the 2 groups showed no significant differences in the same measures. Subjects who had an adenotonsillectomy had improved substantially in all measures, and control subjects improved in none. However, polysomnographic assessment of baseline SDB and its subsequent amelioration did not clearly predict either baseline neurobehavioral morbidity or improvement in any area other than sleepiness. CONCLUSIONS. Children scheduled for adenotonsillectomy often have mild-to-moderate SDB and significant neurobehavioral morbidity, including hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness, all of which tend to improve by 1 year after surgery. However, the lack of better correspondence between SDB measures and neurobehavioral outcomes suggests the need for better measures or improved understanding of underlying causal mechanisms.

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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 Chervin et al. 2006

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Authors
Chervin, R. D., Ruzicka, D. L., Giordani, B. J., Weatherly, R. A., Dillon, J. E., Hodges, E. K., Marcus, C. L., & Guire, K. E.
Affiliations
  • University of Michigan (US)
  • Neuropsychology Section
  • University of Kansas (US)
  • Children's Hospital of Philadelphia (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2006-04-01
Volume
117
Issue
4
Pages
e769-e778
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2005-1837
PMC
PMC1434467
OpenAlex
W2028620799
Cited by
477
References
51
Citations by year
2026: 10 · 2025: 15 · 2024: 15 · 2023: 10 · 2022: 24 · 2021: 19 · 2020: 20 · 2019: 20 · 2018: 20 · 2017: 18 · 2016: 24 · 2015: 23 · 2014: 36 · 2013: 35 · 2012: 29
FWCI
21.43
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (HL80941, R01HL080941)
  • National Institute of Neurological Disorders and Stroke (NS02009, K02NS002009)
  • National Center for Research Resources (RR00042, M01RR000042)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD38461, R01HD038461)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Keywords
sleep-disordered breathing, adenotonsillectomy, pediatric obstructive sleep apnea, neurobehavioral outcomes, attention deficit hyperactivity disorder, hyperactivity, inattention, excessive daytime sleepiness, polysomnography, surgical outcomes, children
MeSH terms
Adenoidectomy, Attention Deficit Disorder with Hyperactivity, Child, Child Behavior, Child, Preschool, Cognition, Female, Follow-Up Studies, Humans, Male, Surveys and Questionnaires, Sleep Stages, Tonsillectomy, Polysomnography, Sleep Apnea, Obstructive

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