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. 2020 Apr;40(2):122-132.
doi: 10.14639/0392-100X-N0267.

Evaluation of neurocognitive abilities in children affected by obstructive sleep apnea syndrome before and after adenotonsillectomy

Domenico Testa  1 , Marco Carotenuto  2 , Francesco Precenzano  2 , Alessia Russo  1 , Anna Donadio  1 , Giuseppina Marcuccio  1 , Gaetano Motta  1
Affiliations

Evaluation of neurocognitive abilities in children affected by obstructive sleep apnea syndrome before and after adenotonsillectomy

Domenico Testa et al. Acta Otorhinolaryngol Ital. 2020 Apr.

Abstract

Valutazione delle abilità neurocognitive in bambini affetti da sindrome delle apnee ostruttive in sonno prima e dopo adenotonsillectomia.

Riassunto: La Sindrome delle Apnee Ostruttive del Sonno (OSAS, Obstructive Sleep Apnea Syndrome) è la forma più severa di Disturbo Respiratorio Sonno-correlato (SRDB, Sleep-related Disordered Breathing) ed è caratterizzata da russamento, apnee, e/o ipopnee associate a ipossia, ipercapnia, o ripetuti risvegli dal sonno (arousals). L’OSAS include tre categorie di morbidità: neurocomportamentali, cardiovascolari, disturbi della crescita somatica. Il gold standard per la diagnosi oggettiva di severità del SRDB ostruttivo è rappresentato dalla polisonnografia (PSG). L’indicazione al trattamento chirurgico nei bambini è la diagnosi di OSAS moderata-severa (indice di apnea-ipopnea > 5/h) e di OSAS lieve (indice di apnea-ipopnea 2-5/h) se sono presenti complicanze o comorbidità. Lo spettro intero di SRDB definiti mediante PSG (dal Russamento Primario all’OSAS severa) potrebbe correlare con deficit comportamentali, attentive e delle funzioni esecutive dovuti all’ipossia ed alla frammentazione del sonno: in alcuni casi, queste alterazioni possono mimare il Disturbo da deficit di Attenzione con Iperattività (ADHD, Attention Deficit Hyperactivity Disorder). Lo scopo di questa ricerca è stato quello di valutare le abilità visuopercettive e costruttive, i punteggi al Pediatric Sleep Questionnaire ed alla PSG prima e dopo l’intervento di adenotonsillectomia fornendo informazoni oggettive e soggettive. Abbiamo incluso in questo studio 59 bambini sottoposti a valutazione clinica otorinolaringoiatrica e neuropsichiatrica e poi al test di Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) ed ai genitori veniva chiesto di compilare il Pediaric Sleep Questionnaire (PSQ); ogni bambino veniva sottoposto a PSG. Dopo 6 mesi dall’intervento di adeotonsillectomia sono state ripetute tutte le valutazioni come al tempo 0. L’analisi statistica evidenzia risultati significativi al PSQ, VMI standard e visivo ed ai parametri polisonnografici se confrontati prima e dopo l’intervento chirurgico di adenotonsillectomia nei bambini affetti da OSAS moderata-severa. Questi risultati hanno mostrato il raggiungimento dei vantaggi terapeutici attraverso il miglioramento della qualità della vita dei bambini e dei loro genitori.

Keywords: OSAS; adenotonsillectomy; neuropsychological non-verbal skills; pediatric OSAS.

Plain language summary

Obstructive sleep apnoea syndrome (OSAS) is the most severe form of sleep-related disordered breathing (SRDB) and is characterised by snoring, apnoeas, and/or hypopnoeas associated to hypoxia, hypercarbia, or repeated arousals from sleep. OSAS has three major categories of morbidities: neurobehavioural, cardiovascular and somatic growth failure. The gold standard for objective diagnosis of obstructive-SRDB severity is polysomnography (PSG). The indication for surgical treatment in children is moderate-severe OSAS (AHI, apnoea hypopnoea index > 5/h) and in mild OSAS (AHI 2-5/h) with complications or morbidity. The entire spectrum of PSG-defined SRDB (ranging from Primary Snoring to severe OSAS) may correlate with behavioural, attentional and executive function deficits relating to hypoxia and sleep disruption: in some cases, these alterations may mimic attention deficit hyperactivity disorder (ADHD). The aim of this research was to evaluate visuoperceptual and constructional abilities, paediatric sleep questionnaire and polysomnographic scores before and 6 months after adenotonsillectomy with objective and subjective information. We included 59 children who underwent neuropsychiatric and otolaryngologist clinical evaluation and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI); children parents were asked to fill in the Paediatric Sleep Questionnaire (PSQ); each child underwent PSG. At 6 months after adenotonsillectomy, all patients were evaluated again. There is a significant difference in PSQ parameters, VMI standard, visual tests scores and PSG parameters before and after adenotonsillectomy in children affected by OSAS. These results showed the achievement of therapeutic benefits with improvement of the quality of life for both children and their parents.

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Figures

Figure 1.
Figure 1.
Enrollment and study flow.
Figure 2.
Figure 2.
Comparison of PSQ scores before and six months after adenotonsillectomy.
Figure 3.
Figure 3.
Comparison of VMI standard scores before and six months after adenotonsillectomy (statistically significant).
Figure 4.
Figure 4.
Comparison of VMI visual test scores before and six months after adenotonsillectomy (statistically significant).
Figure 5.
Figure 5.
Comparison of VMI motor test scores before and six months after adenotonsillectomy (not statistically significant).
See this image and copyright information in PMC

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