Esophageal pressures, polysomnography, and neurobehavioral outcomes of adenotonsillectomy in children.
BACKGROUND
Esophageal pressure monitoring during polysomnography in children offers a gold-standard, “preferred” assessment for work of breathing, but is not commonly used in part because prospective data on incremental clinical utility are scarce. We compared a standard pediatric apnea/hypopnea index to quantitative esophageal pressures as predictors of apnea-related neurobehavioral morbidity and treatment response.


METHODS
Eighty-one children aged 7.8 ± 2.8 (SD) years, including 44 boys, had traditional laboratory-based pediatric polysomnography, esophageal pressure monitoring, multiple sleep latency tests, psychiatric evaluations, parental behavior rating scales, and cognitive testing, all just before clinically indicated adenotonsillectomy, and again 7.2 ± 0.8 months later. Esophageal pressures were used, along with nasal pressure monitoring and oronasal thermocouples, not only to identify respiratory events but also more quantitatively to determine the most negative esophageal pressure recorded and the percentage of sleep time spent with pressures lower than -10 cm H(2)O.


RESULTS
Both sleep-disordered breathing and neurobehavioral measures improved after surgery. At baseline, one or both quantitative esophageal pressure measures predicted a disruptive behavior disorder (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-defined attention-deficit/hyperactivity disorder, conduct disorder, or oppositional defiant disorder) and more sleepiness and their future improvement after adenotonsillectomy (each P < .05). The pediatric apnea/hypopnea index did not predict these morbidities or treatment outcomes (each P > .10). The addition of respiratory effort-related arousals to the apnea/hypopnea index did not improve its predictive value. Neither the preoperative apnea/hypopnea index nor esophageal pressures predicted baseline hyperactive behavior, cognitive performance, or their improvement after surgery.


CONCLUSIONS
Quantitative esophageal pressure monitoring may add predictive value for some, if not all, neurobehavioral outcomes of sleep-disordered breathing.
Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI. Electronic address: chervin@umich.edu.
Ronald D
RD
Chervin
Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI.
Deborah L
DL
Ruzicka
Sleep Disorders Center and Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.
Timothy F
TF
Hoban
Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI.
Judith L
JL
Fetterolf
Sleep Disorders Center and Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, MI.
Susan L
SL
Garetz
Department of Biostatistics, University of Michigan, Ann Arbor, MI.
Kenneth E
KE
Guire
Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI.
James E
JE
Dillon
Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.
Barbara T
BT
Felt
Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI.
Elise K
EK
Hodges
Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI.
Bruno J
BJ
Giordani
D000233:Adenoidectomy; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D015331:Cohort Studies; D004947:Esophagus / Q000502:physiology*; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D017063:Outcome Assessment, Health Care; D017286:Polysomnography; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology*; D014068:Tonsillectomy