title: Developmental delay in young children with sleep-disordered breathing before and after tonsil and adenoid surgery.
abstract: OBJECTIVE
  Our objective was to determine the developmental status of young children with sleep-disordered breathing (SDB) as measured by the Ages and Stages Questionnaire (ASQ-3) and to evaluate improvement after treatment.
  
  
  METHODS
  The ASQ-3 was completed at entry, 3 months and 6 months after adenotonsillectomy or adenoidectomy. The questionnaire consists of 30 items that assess five domains: communication, gross motor, fine motor, problem solving and personal-social. Domain scores were compared with normative values: abnormal ≥2 SDs and borderline ≥1 but <2 SDs below the mean.
  
  
  RESULTS
  80 children, mean (SD) age 3.0 (0.94) years, 62.5% male, 77.5% African American, were enrolled. Median (range) apnea-hypopnea index (AHI) was 12.6 (1.4-178.5). At entry, 22 (27.5%) children scored in the abnormal range in at least one developmental area and an additional 23 (28.8%) had at least one borderline score. A generalized linear model including gender, AHI, maternal education and prematurity showed that only prematurity was an independent predictor of at least one abnormal or borderline entry score (likelihood ratio test p < 0.001). Adjusting for covariates and excluding children with a history of prematurity, the prevalence of at least one abnormal or borderline score (based on 112 observations of 70 children) was estimated at 49% (95% CI [37, 62]) at baseline; 34% (95% CI [17, 56]) at 3 months; and 22% (95% CI [10, 41]) at 6 months. Post-hoc pairwise comparison of time points showed the baseline versus 6-month difference to be statistically significant (p = 0.015).
  
  
  CONCLUSIONS
  The 27.5% baseline prevalence of abnormal ASQ scores in children with SDB indicates it is a risk factor for developmental delay. Significant improvements in score classifications were found 6 months after surgery.
authors.affiliation: State University of New York Downstate Medical Center, Division of Pediatric Otolaryngology, 450 Clarkson Avenue, MSC 126, Brooklyn, NY 11203, USA. Electronic address: nira.goldstein@downstate.edu.
authors.forename: Nira A
authors.initials: NA
authors.lastname: Goldstein
authors.affiliation: State University of New York Downstate Medical Center, Division of Pediatric Otolaryngology, 450 Clarkson Avenue, MSC 126, Brooklyn, NY 11203, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gorynski
authors.affiliation: State University of New York Downstate Medical Center, Division of Pediatric Otolaryngology, 450 Clarkson Avenue, MSC 126, Brooklyn, NY 11203, USA.
authors.forename: Candice
authors.initials: C
authors.lastname: Yip
authors.affiliation: State University of New York Downstate Medical Center, Division of Pediatric Otolaryngology, 450 Clarkson Avenue, MSC 126, Brooklyn, NY 11203, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Harounian
authors.affiliation: State University of New York Downstate Medical Center, Division of Child Development, 450 Clarkson Avenue, MSC 49, Brooklyn, NY 11203, USA.
authors.forename: Harris
authors.initials: H
authors.lastname: Huberman
authors.affiliation: State University of New York Downstate Medical Center, Research Division, 450 Clarkson Avenue, MSC 7, Brooklyn, NY 11203, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Weedon
mesh_terms: D000233:Adenoidectomy; D002657:Child Development; D002675:Child, Preschool; D003142:Communication; D002658:Developmental Disabilities / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009048:Motor Skills; D010553:Personality Development; D017286:Polysomnography; D011340:Problem Solving; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000601:surgery*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy
keywords: Developmental delay; Neurocognition; Obstructive sleep apnea; Pediatrics; Sleep-disordered breathing