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Cerebral blood flow velocity and cognition in children before and after adenotonsillectomy

Hogan, AM; Hill, CM; Harrison, D; Kirkham, FJ; (2008) Cerebral blood flow velocity and cognition in children before and after adenotonsillectomy. PEDIATRICS , 122 (1) 75 - 82. 10.1542/peds.2007-2540.

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Abstract

OBJECTIVE. The goal was to determine whether amelioration of sleep-disordered breathing through adenotonsillectomy would reduce middle cerebral artery velocity in parallel with improvements in cognition and behavior.METHODS. For 19 children ( mean age: 6 years) with mild sleep-disordered breathing, and 14 healthy, ethnically similar and age-similar, control subjects, parents repeated the Pediatric Sleep Questionnaire an average of 12 months after adenotonsillectomy. Children with sleep-disordered breathing underwent repeated overnight measurement of mean oxyhemoglobin saturation. Neurobehavioral tests that yielded significant group differences preoperatively were readministered. Middle cerebral artery velocity measurements were repeated with blinding to sleep study and neuropsychological results, and mixed-design analyses of variance were performed.RESULTS. The median Pediatric Sleep Questionnaire score significantly improved post-operatively, and there was a significant increase in mean overnight oxyhemoglobin saturation. The middle cerebral artery velocity decreased in the sleep-disordered breathing group postoperatively, whereas control subjects showed a slight increase. A preoperative group difference was reduced by the postoperative assessment, which suggests normalization of middle cerebral artery velocity in those with sleep-disordered breathing. The increase in mean overnight oxyhemoglobin saturation postoperatively was associated with a reduction in middle cerebral artery velocity in a subgroup of children. A preoperative group difference in processing speed was reduced postoperatively. Similarly, a trend for a preoperative group difference in visual attention was reduced postoperatively. Executive function remained significantly worse for the children with sleep-disordered breathing, compared with control subjects, although mean postoperative scores were lower than preoperative scores.CONCLUSIONS. Otherwise-healthy young children with apparently mild sleep-disordered breathing have potentially reversible cerebral hemodynamic and neurobehavioral changes.

Type: Article
Title: Cerebral blood flow velocity and cognition in children before and after adenotonsillectomy
DOI: 10.1542/peds.2007-2540
Keywords: sleep-disordered breathing, apnea, adenotonsillectomy, hypoxia, cerebral blood flow velocity, neurocognitive function, OBSTRUCTIVE SLEEP-APNEA, POSITIVE AIRWAY PRESSURE, VASCULAR-RESPONSE, HEALTHY HUMANS, AGED CHILDREN, HEMODYNAMICS, HYPOXIA, STROKE, PREVALENCE, MORBIDITY
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health > ICH Developmental Neurosciences Prog
URI: http://discovery.ucl.ac.uk/id/eprint/122808
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