(Press-News.org) ANN ARBOR, Mich. – Children with obstructive sleep apnea who had a common surgery to remove their tonsils and adenoids showed notable improvements in behavior, quality of life and other symptoms compared to those treated with "watchful waiting" and supportive care, according to a new study.
However, surprisingly, there was no difference between both groups in the primary study outcome, attention and executive functioning, as measured by formal neuropsychological tests. The research was published online today in the New England Journal of Medicine, in conjunction with a presentation at the American Thoracic Society annual meeting.
The study was conducted at seven hospitals outside Michigan, but University of Michigan Health System researchers helped design and lead it and are among the authors. Members of the U-M Sleep Disorders Center, they have studied linkages between sleep apnea and behavior, cognition, and mental health for nearly two decades.
The Childhood Adenotonsillectomy Trial (CHAT) studied 464 children, aged 5 to 9 years. It was the first randomized clinical trial of surgery for obstructive sleep apnea in children.
Ronald Chervin, M.D., M.S., a member of the Steering Committee for CHAT and a co-author on the new paper, notes that it was important to carry out a randomized, controlled trial to evaluate the impact of surgery. He notes that many studies have yielded promising evidence of associations, but not necessarily cause-and-effect, between childhood sleep apnea and suspected effects on the brain.
"A number of researchers have shown that in children, disruptive daytime behavior is linked to abnormal breathing during sleep, or the overall quality and quantity of sleep," he notes. "The role of the tonsils and adenoids in interfering with breathing during a child's sleep, and the impact of removing them, becomes much clearer with these results."
Obstructive sleep apnea, or OSA, is a condition of interrupted sleep and breathing caused by a narrowing in the throat or upper airway that worsens during sleep. The narrowing can result from enlarged tonsils and adenoids, obesity or other medical problems. Occurring in both adults and children, it has a higher prevalence in African-American and obese patients.
Adenotonsillectomy, the surgical removal of tonsils and adenoids, is the primary treatment for OSA in children. Over half a million U.S. children undergo the procedure annually. The study randomized 464 children to either receive surgery or watchful waiting with supportive care from 2007 to 2011. Nearly half the children were overweight or obese. All underwent a sleep study at an outpatient sleep center at baseline and after seven months of treatment. The study did not include patients with the most severe sleep apnea.
The primary outcome of the CHAT trial was the Attention/Executive Function Domain score in a formal test, the Developmental Neuropsychological Assessment, administered by licensed psychometricians. The study found no significant difference between the treatment groups in these test results.
The secondary outcomes included ratings from parents and teachers who completed questionnaires rating a child's behavior, sleepiness, quality of life, and executive functioning, including details about activities of daily living. For instance, adults rated the degree to which a child kept up with tasks, seemed to have hyperactive behavior, had angry outbursts or mood changes, got along with other children, planned ahead, worried frequently, or had trouble sleeping.
The children who had surgery had significantly greater improvements, compared to children in the watchful waiting group, in the secondary outcomes listed above. U-M's Bruno Giordani, PhD, who led a Neuropsychology Core for CHAT, noted that these benefits from surgery are not likely to have emerged solely due to parental expectations, as parents' ratings were consistent with those from the teachers.
Overall, both surgery and watchful waiting were safe in this clinical trial, according to U-M's Susan Garetz, M.D., who led a group of ear, nose, and throat surgeons who assisted with CHAT. Garetz interprets these results to mean that watchful waiting is a reasonable option for parents of some children with less severe OSAS who opt not to have surgery. However, clinicians should carefully monitor these children to ensure their condition does not worsen.
The CHAT trial, says Chervin, left many questions for further research. One in particular, he says, is whether OSA is definitely the cause for behavioral problems that children with OSA often experience. This is because the CHAT study only included children who had OSA. Furthermore, the severity of OSA did not predict the behavioral outcomes.
"Sleep medicine is a very new field, with many unanswered questions," concludes the study's first author, Carole L. Marcus, M.D., a sleep specialist and director of the Sleep Center at The Children's Hospital of Philadelphia. "For instance, we go to sleep each night, yet we don't even know truly understand the true purpose of sleep. But this study is a great first step in finding some of the answers."
INFORMATION:
The National Institutes of Health supported this study (grants HL083075, HL083239, RR024134, and RR024989). Susan Redline, M.D., M.P.H., of Brigham and Women's Hospital, Boston, is the principal investigator for the study.
In addition to Chervin, co-authors from University of Michigan were Bruno Giordani, Ph.D., Elise Hodges, Ph.D., both neuropsychologists in the U-M Department of Psychiatry; Susan Garetz, M.D., of the Department of Otolaryngology, Timothy Hoban, M.D. of the Department of Pediatrics. Deborah Ruzicka, R.N., Ph.D., served as a program manager. U-M investigators contributed to the study design, provided quality control core services, acted as the medical monitor, and assisted with analyses and interpretation of the results.
Reference: Marcus et al, "A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea," New England Journal of Medicine, published online May 21, 2013.
END
Children with sleep apnea syndrome who have their tonsils and adenoids removed sleep better, are less restless and impulsive, and report a generally better quality of life, finds a new study funded by the National Institutes of Health. However, the study found cognitive abilities did not improve compared with children who did not have surgery, and researchers say the findings don't mean surgery is an automatic first choice.
The findings of the Childhood Adenotonsillectomy Trial (CHAT) will be presented May 21 at the American Thoracic Society 2013 meeting in Philadelphia. ...
Overweight and obese patients are significantly more likely than their normal-weight counterparts to repeatedly switch primary care doctors, a practice that disrupts continuity of care and leads to more emergency room visits, new Johns Hopkins research suggests.
The practice of "doctor shopping" among overweight patients may be a result of negative experiences with the health care system, whether that be off-putting comments by office staff, unsolicited weight loss advice by providers, or improperly sized medical equipment and office furniture, says Kimberly A. Gudzune, ...
Irvine, Calif., May 21, 2013 — Children with autism showed significant improvement after six months of simple sensory exercises at home using everyday items such as scents, spoons and sponges, according to UC Irvine neurobiologists.
They found that a treatment known as environmental enrichment led to notable gains in male subjects between the ages of 3 and 12. Results appear online in Behavioral Neuroscience.
Study co-authors Cynthia Woo and Michael Leon randomly assigned 28 boys to one of two groups, balanced for age and autism severity. For half a year, all subjects ...
COLUMBIA, Mo. — Cancers of all types become most deadly when they metastasize and spread tumors throughout the body. Once cancer has reached this stage, it becomes very difficult for doctors to locate and treat the numerous tumors that can develop. Now, researchers at the University of Missouri have found a way to create radioactive nanoparticles that target lymphoma tumor cells wherever they may be in the body. Michael Lewis, an associate professor of oncology in the MU College of Veterinary Medicine, says being able to target secondary tumors is vital to successfully ...
DURHAM, N.C. – An attack on glioblastoma brain tumor cells that uses a modified poliovirus is showing encouraging results in an early study to establish the proper dose level, researchers at Duke Cancer Institute report.
The treatment, developed at Duke and tested in an ongoing phase 1 study, capitalizes on the discovery that cancer cells have an abundance of receptors that work like magnets drawing the poliovirus, which then infects and kills the cells.
The investigational therapy, known as PVSRIPO, uses an engineered form of the virus that is lethal to cancer cells, ...
RICHLAND, Wash. – A new analysis shows that the nation's land and water resources could likely support the growth of enough algae to produce up to 25 billion gallons of algae-based fuel a year in the United States, one-twelfth of the country's yearly needs.
The findings come from an in-depth look at the water resources that would be needed to grow significant amounts of algae in large, specially built shallow ponds. The results were published in the May 7 issue of Environmental Science and Technology, published by the American Chemical Society.
"While there are many ...
Concerns continue to grow about the effects of climate change on fire. Wildfires are expected to increase 50 percent across the United States under a changing climate, over 100 percent in areas of the West by 2050 as projected by some studies. Of equal concern to scientists and policymakers alike are the atmospheric effects of wildfire emissions on climate.
A new article published in the journal Forest Ecology and Management by U.S. Forest Service scientists synthesizes recent findings on the interactions between fire and climate and outlines future research needs. Authored ...
The results of a new study led by George Washington University Professor Tianshu Li provide direct computational evidence that nucleation of ice in small droplets is strongly size-dependent, an important conclusion in understanding water's behavior at the nanoscale. The formation of ice at the nanoscale is a challenging, basic scientific research question whose answer also has important implications for climate research and other fields.
The crystallization of ice from supercooled water is generally initiated by a process called nucleation. Because of the speed and size ...
When infections occur in the body, stem cells in the blood often jump into action by multiplying and differentiating into mature immune cells that can fight off illness. But repeated infections and inflammation can deplete these cell populations, potentially leading to the development of serious blood conditions such as cancer. Now, a team of researchers led by biologists at the California Institute of Technology (Caltech) has found that, in mouse models, the molecule microRNA-146a (miR-146a) acts as a critical regulator and protector of blood-forming stem cells (called ...
DURHAM, N.C. -- Duke University engineers have developed a novel method for producing clean hydrogen, which could prove essential to weaning society off of fossil fuels and their environmental implications.
While hydrogen is ubiquitous in the environment, producing and collecting molecular hydrogen for transportation and industrial uses is expensive and complicated. Just as importantly, a byproduct of most current methods of producing hydrogen is carbon monoxide, which is toxic to humans and animals.
The Duke engineers, using a new catalytic approach, have shown in ...
