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Cerebral blood flow velocity and cognition in children before and after adenotonsillectomy
Alexandra M Hogan1, Catherine M Hill, Dawn Harrison
1Developmental Brain-Behaviour Unit, Neurosciences Unit, University College London Institute of Child Health, London, England.
Insights
Adenotonsillectomy improved sleep-disordered breathing in children, normalizing cerebral blood flow and cognitive function. This suggests that mild sleep-disordered breathing can cause reversible changes in brain function.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Neuroimaging
Background:
- Sleep-disordered breathing (SDB) in children can impact neurodevelopment.
- Cerebral hemodynamics and cognitive functions may be affected by SDB.
Purpose of the Study:
- To investigate if adenotonsillectomy improves middle cerebral artery velocity (MCAv) in children with SDB.
- To assess the parallel changes in cognition and behavior following SDB amelioration.
Main Methods:
- 19 children with mild SDB and 14 controls underwent adenotonsillectomy (SDB group).
- Evaluated sleep quality (Pediatric Sleep Questionnaire), oxygen saturation, MCAv, and neurobehavioral tests pre- and post-surgery.
- Used mixed-design analyses of variance for comparisons.
Main Results:
- Adenotonsillectomy significantly improved SDB symptoms and overnight oxygen saturation.
- MCAv decreased in the SDB group post-surgery, contrasting with controls, indicating normalization.
- Cognitive improvements were observed in processing speed and visual attention, though executive function remained impaired.
Conclusions:
- Mild SDB in children can lead to reversible changes in cerebral blood flow and neurobehavior.
- Adenotonsillectomy may reverse these effects, highlighting the importance of treating SDB.
Objective:
The goal was to determine whether amelioration of sleep-disordered breathing through adenotonsillectomy would reduce middle cerebral artery velocity in parallel with improvements in cognition and behavior.
Methods:
For 19 children (mean age: 6 years) with mild sleep-disordered breathing, and 14 healthy, ethnically similar and age-similar, control subjects, parents repeated the Pediatric Sleep Questionnaire an average of 12 months after adenotonsillectomy. Children with sleep-disordered breathing underwent repeated overnight measurement of mean oxyhemoglobin saturation. Neurobehavioral tests that yielded significant group differences preoperatively were readministered. Middle cerebral artery velocity measurements were repeated with blinding to sleep study and neuropsychological results, and mixed-design analyses of variance were performed.
Results:
The median Pediatric Sleep Questionnaire score significantly improved postoperatively, and there was a significant increase in mean overnight oxyhemoglobin saturation. The middle cerebral artery velocity decreased in the sleep-disordered breathing group postoperatively, whereas control subjects showed a slight increase. A preoperative group difference was reduced by the postoperative assessment, which suggests normalization of middle cerebral artery velocity in those with sleep-disordered breathing. The increase in mean overnight oxyhemoglobin saturation postoperatively was associated with a reduction in middle cerebral artery velocity in a subgroup of children. A preoperative group difference in processing speed was reduced postoperatively. Similarly, a trend for a preoperative group difference in visual attention was reduced postoperatively. Executive function remained significantly worse for the children with sleep-disordered breathing, compared with control subjects, although mean postoperative scores were lower than preoperative scores.
Conclusions:
Otherwise-healthy young children with apparently mild sleep-disordered breathing have potentially reversible cerebral hemodynamic and neurobehavioral changes.
