Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA.
J Int Neuropsychol Soc. 2012 Mar;18(2):212-22. doi: 10.1017/S1355617711001743. Epub 2012 Jan 25.
The most common treatment for sleep disordered breathing (SDB) is adenotonsillectomy (AT). Following AT, SDB resolves in most cases, and gains in cognitive and behavior scores are consistently reported, although persistent neuropsychological deficits or further declines also have been noted. This study presents results of the comprehensive 1-year follow-up neuropsychological examinations for children in the Washtenaw County Adenotonsillectomy Cohort I (95% return rate). After adjusting for normal developmental and practice-effect related changes in control children, significant improvements 1 year following AT were noted in polysomnography and sleepiness, as well as parental reports of behavior, although cognitive outcomes were mixed. Children undergoing AT with and without polysomnography-confirmed obstructive sleep apnea improved across a range of academic achievement measures, a measure of delayed visual recall, short-term attention/working memory, and executive functioning, along with parental ratings of behavior. On the other hand, measures of verbal abstraction ability, arithmetic calculations, visual and verbal learning, verbal delayed recall, sustained attention, and another measure of visual delayed recall demonstrated declines in ability, while other measures did not improve over time. These findings call into question the expectation that AT resolves most or all behavioral and cognitive difficulties in children with clinical, office-based diagnoses of SDB.
睡眠呼吸障碍（SDB）最常见的治疗方法是腺样体扁桃体切除术（AT）。AT 后，大多数情况下 SDB 得到解决，并且一致报告认知和行为评分的提高，尽管也注意到持续的神经心理学缺陷或进一步下降。本研究报告了在安阿伯县腺样体扁桃体切除术队列 I（95%的回归率）中儿童进行全面的 1 年随访神经心理学检查的结果。在调整了对照组儿童正常发育和练习效应相关变化后，发现 AT 后 1 年，多导睡眠图和嗜睡以及父母报告的行为均有显著改善，尽管认知结果参差不齐。接受 AT 治疗且无多导睡眠图证实阻塞性睡眠呼吸暂停的儿童在一系列学业成绩衡量标准、延迟视觉回忆、短期注意力/工作记忆和执行功能方面以及父母对行为的评价方面均有所改善。另一方面，言语抽象能力、算术计算、视觉和言语学习、言语延迟回忆、持续注意力和另一种视觉延迟回忆能力的衡量标准显示能力下降，而其他衡量标准并没有随着时间的推移而提高。这些发现对 AT 解决临床、基于办公室诊断的 SDB 儿童的大多数或所有行为和认知困难的期望提出了质疑。
