title: Do respiratory cycle-related EEG changes or arousals from sleep predict neurobehavioral deficits and response to adenotonsillectomy in children?
abstract: OBJECTIVE
  Pediatric obstructive sleep apnea (OSA) is associated with hyperactive behavior, cognitive deficits, psychiatric morbidity, and sleepiness, but objective polysomnographic measures of OSA presence or severity among children scheduled for adenotonsillectomy have not explained why. To assess whether sleep fragmentation might explain neurobehavioral outcomes, we prospectively assessed the predictive value of standard arousals and also respiratory cycle-related EEG changes (RCREC), thought to reflect inspiratory microarousals.
  
  
  METHODS
  Washtenaw County Adenotonsillectomy Cohort II participants included children (ages 3-12 years) scheduled for adenotonsillectomy, for any clinical indication. At enrollment and again 7.2 ± 0.9 (SD) months later, children had polysomnography, a multiple sleep latency test, parent-completed behavioral rating scales, cognitive testing, and psychiatric evaluation. The RCREC were computed as previously described for delta, theta, alpha, sigma, and beta EEG frequency bands.
  
  
  RESULTS
  Participants included 133 children, 109 with OSA (apnea-hypopnea index [AHI] ≥ 1.5, mean 8.3 ± 10.6) and 24 without OSA (AHI 0.9 ± 0.3). At baseline, the arousal index and RCREC showed no consistent, significant associations with neurobehavioral morbidities, among all subjects or the 109 with OSA. At follow-up, the arousal index, RCREC, and neurobehavioral measures all tended to improve, but neither baseline measure of sleep fragmentation effectively predicted outcomes (all p > 0.05, with only scattered exceptions, among all subjects or those with OSA).
  
  
  CONCLUSIONS
  Sleep fragmentation, as reflected by standard arousals or by RCREC, appears unlikely to explain neurobehavioral morbidity among children who undergo adenotonsillectomy.
  
  
  BACKGROUND
  ClinicalTrials.gov, ID: NCT00233194.
authors.affiliation: Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI;
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.affiliation: Sleep Disorders Center and Division of Pediatric Otolaryngology, Department of Otolaryngology and Head and Neck Surgery, University of Michigan, Ann Arbor, MI;
authors.forename: Susan L
authors.initials: SL
authors.lastname: Garetz
authors.affiliation: Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI;
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Ruzicka
authors.affiliation: Division of Neuropsychology, Department of Psychiatry, University of Michigan, Ann Arbor, MI;
authors.forename: Elise K
authors.initials: EK
authors.lastname: Hodges
authors.affiliation: Division of Neuropsychology, Department of Psychiatry, University of Michigan, Ann Arbor, MI;
authors.forename: Bruno J
authors.initials: BJ
authors.lastname: Giordani
authors.affiliation: Department of Psychiatry, Central Michigan University, Mount Pleasant, MI;
authors.forename: James E
authors.initials: JE
authors.lastname: Dillon
authors.affiliation: Division of Behavioral and Developmental Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI;
authors.forename: Barbara T
authors.initials: BT
authors.lastname: Felt
authors.affiliation: Sleep Disorders Center and Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI;
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Hoban
authors.affiliation: Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI;
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Guire
authors.affiliation: Sleep Disorders Center, Department of Neurology, and Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI;
authors.forename: Louise M
authors.initials: LM
authors.lastname: O'Brien
authors.affiliation: Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Burns
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects*; D002648:Child; D002652:Child Behavior / Q000502:physiology; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D017286:Polysomnography; D011446:Prospective Studies; D012143:Respiratory Physiological Phenomena; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000503:physiopathology; D020921:Sleep Arousal Disorders / Q000209:etiology* / Q000503:physiopathology; D012892:Sleep Deprivation / Q000209:etiology / Q000503:physiopathology; D014068:Tonsillectomy / Q000009:adverse effects*
keywords: arousals; behavior; child; cognition; obstructive sleep apnea; polysomnography; respiratory cycle-related EEG changes; sleepiness