Taylor H Gerry, Bowen Susan R, Beebe Dean W, Hodges Elise, Amin Raouf, Arens Raanan, Chervin Ronald D, Garetz Susan L, Katz Eliot S, Moore Reneé H, Morales Knashawn H, Muzumdar Hiren, Paruthi Shalini, Rosen Carol L, Sadhwani Anjali, Thomas Nina Hattiangadi, Ware Janice, Marcus Carole L, Ellenberg Susan S, Redline Susan, Giordani Bruno
Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
Pediatrics. 2016 Aug;138(2). doi: 10.1542/peds.2015-4458.
Research reveals mixed evidence for the effects of adenotonsillectomy (AT) on cognitive tests in children with obstructive sleep apnea syndrome (OSAS). The primary aim of the study was to investigate effects of AT on cognitive test scores in the randomized Childhood Adenotonsillectomy Trial.
Children ages 5 to 9 years with OSAS without prolonged oxyhemoglobin desaturation were randomly assigned to watchful waiting with supportive care (n = 227) or early AT (eAT, n = 226). Neuropsychological tests were administered before the intervention and 7 months after the intervention. Mixed model analysis compared the groups on changes in test scores across follow-up, and regression analysis examined associations of these changes in the eAT group with changes in sleep measures.
Mean test scores were within the average range for both groups. Scores improved significantly (P < .05) more across follow-up for the eAT group than for the watchful waiting group. These differences were found only on measures of nonverbal reasoning, fine motor skills, and selective attention and had small effects sizes (Cohen's d, 0.20-0.24). As additional evidence for AT-related effects on scores, gains in test scores for the eAT group were associated with improvements in sleep measures.
Small and selective effects of AT were observed on cognitive tests in children with OSAS without prolonged desaturation. Relative to evidence from Childhood Adenotonsillectomy Trial for larger effects of surgery on sleep, behavior, and quality of life, AT may have limited benefits in reversing any cognitive effects of OSAS, or these benefits may require more extended follow-up to become manifest.
研究显示，腺样体扁桃体切除术（AT）对阻塞性睡眠呼吸暂停综合征（OSAS）患儿认知测试的影响证据不一。本研究的主要目的是在随机化儿童腺样体扁桃体切除术试验中调查AT对认知测试分数的影响。
年龄在5至9岁、患有OSAS且无长时间氧合血红蛋白饱和度下降的儿童被随机分配至接受支持性护理的观察等待组（n = 227）或早期AT组（eAT，n = 226）。在干预前和干预后7个月进行神经心理学测试。混合模型分析比较了两组在随访期间测试分数的变化，回归分析检验了eAT组中这些变化与睡眠指标变化之间的关联。
两组的平均测试分数均在平均范围内。eAT组在随访期间的分数改善幅度显著大于观察等待组（P <.05）。这些差异仅在非言语推理、精细运动技能和选择性注意的测量中发现，且效应量较小（科恩d值，0.20 - 0.24）。作为AT对分数产生相关影响的额外证据，eAT组测试分数的提高与睡眠指标的改善相关。
在无长时间饱和度下降的OSAS患儿中，观察到AT对认知测试有微小且有选择性的影响。相对于儿童腺样体扁桃体切除术试验中关于手术对睡眠、行为和生活质量有更大影响的证据，AT在逆转OSAS的任何认知影响方面可能益处有限，或者这些益处可能需要更长时间的随访才能显现。
