Journal of the International Neuropsychological Society

Research Article

Neuropsychological and behavioral functioning in children with and without obstructive sleep apnea referred for tonsillectomy

BRUNO GIORDANIa1 c1, ELISE K. HODGESa1, KENNETH E. GUIREa2, DEBORAH L. RUZICKAa3, JAMES E. DILLONa4, ROBERT A. WEATHERLYa5, SUSAN L. GARETZa5 and RONALD D. CHERVINa3

a1 Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

a2 Biostatics Department, School of Public Health, University of Michigan, Ann Arbor, Michigan

a3 Sleep Medicine, Neurology Department, University of Michigan, Ann Arbor, Michigan

a4 MDCHC/Corrections and Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

a5 Otorhinolaryngology Department, University of Michigan, Ann Arbor, Michigan

Abstract

Adenotonsillectomy (AT) is among the most common pediatric surgical procedures and is performed as often for obstructive sleep apnea (OSA) as for recurrent tonsillitis. This study compared behavioral, cognitive, and sleep measures in 27 healthy control children recruited from a university hospital-based pediatric general surgery clinic with 40 children who had OSA (AT/OSA+) and 27 children who did not have OSA (AT/OSA−) scheduled for AT. Parental ratings of behavior, sleep problems, and snoring, along with specific cognitive measures (i.e., short-term attention, visuospatial problem solving, memory, arithmetic) reflected greater difficulties for AT children compared with controls. Differences between the AT/OSA− and control groups were larger and more consistent across test measures than were those between the AT/OSA+ and control groups. The fact that worse outcomes were not clearly demonstrated for the AT/OSA+ group compared with the other groups was not expected based on existing literature. This counterintuitive finding may reflect a combination of factors, including age, daytime sleepiness, features of sleep-disordered breathing too subtle to show on standard polysomnography, and academic or environmental factors not collected in this study. These results underscore the importance of applying more sophisticated methodologies to better understand the salient pathophysiology of childhood sleep-disordered breathing. (JINS, 2008, 14, 571–581.)

(Received April 20 2007)

(Revised March 16 2008)

(Accepted March 17 2008)

Correspondence:

c1 Correspondence and reprint requests to: Bruno Giordani, Neuropsychology Section, Department of Psychiatry, University of Michigan, Suite C, 2101 Commonwealth Blvd., Ann Arbor, MI 48105-0716. E-mail: giordani@umich.edu