Alteraciones cognitivas y conductuales tras adenoamigdalectomía en el síndrome de apnea del sueño

Pharmacological interventions for pediatric obstructive sleep apnea (OSA): Network meta-analysis

IMPORTANCE

Pediatric obstructive sleep apnea (OSA) is a common disease that can have significant negative impacts on a child's health and development. A comprehensive evaluation of different pharmacologic interventions for the treatment of OSA in children is still lacking.

OBJECTIVE

This study aims to conduct a comprehensive systematic review and network meta-analysis of pharmacological interventions for the management of obstructive sleep apnea in pediatric population.

DATA SOURCES

PubMed, Web of Science, Embase, The Cochrane Library, and CNKI were searched from 1950 to November 2022 for pediatric OSA.

STUDY SELECTION

Multiple reviewers included Randomized controlled trials (RCTs) concerning drugs on OSA in children.

DATA EXTRACTION AND SYNTHESIS

Multiple observers followed the guidance of the PRISMA NMA statement for data extraction and evaluation. Bayesian network meta-analyses(fixed-effect model) were performed to compare the weighted mean difference (WMD), logarithmic odds ratios (log OR), and the surface under the cumulative ranking curves (SUCRA) of the included pharmacological interventions. Our protocol was registered in PROSPERO website (CRD42022377839).

MAIN OUTCOME(S) AND MEASURE(S)

The primary outcomes were improvements in the apnea/hypopnea index (AHI), while secondary outcomes included adverse events and the lowest arterial oxygen saturation (SaO2).

RESULTS

17 RCTs with a total of 1367 children with OSA aged 2-14 years that met the inclusion criteria were eventually included in our systematic review and network meta-analysis. Ten drugs were finally included in the study. The results revealed that Mometasone + Montelukast (WMD-4.74[95%CrIs -7.50 to -2.11], Budesonide (-3.45[-6.86 to -0.15], and Montelukast(-3.41[-5.45 to -1.39] exhibited significantly superior therapeutic effects compared to the placebo concerning apnea hypopnea index (AHI) value with 95%CrIs excluding no effect. Moreover, Mometasone + Montelukast achieved exceptionally high SUCRA values for both AHI (85.0 %) and SaO2 (91.0 %).

CONCLUSIONS AND RELEVANCE

The combination of mometasone furoate nasal spray and oral montelukast sodium exhibits the highest probability of being the most effective intervention. Further research is needed to investigate the long-term efficacy and safety profiles of these interventions in pediatric patients with OSA.

Associations Between Sleep-Disordered Breathing and Behavioral and Cognitive Functions in Children With and Without Attention-Deficit/Hyperactivity Disorder

BACKGROUND

Sleep-related problems are highly prevalent comorbidities in Attention-Deficit/Hyperactivity Disorder (ADHD).

OBJECTIVE

This study aimed to investigate the associations between sleep-disordered breathing (SDB) and behavioral and cognitive functions in children with and without ADHD.

METHODS

A total of 341 children were included (ADHD group: 155, control group: 186; age: 6-10 years). The participants' sleep-related symptoms were assessed using a parent-rated questionnaire, and they were categorized into low- and high-risk SDB groups based on their scores. Behavioral symptoms were assessed using the Behavioral Assessment System for Children, Second Edition (BASC-2), and cognitive sustained attention and inhibitory control were assessed using a computer-based continuous performance test.

RESULTS

In the ADHD group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in externalizing problems (F = 4.22; P = 0.042), including hyperactivity (F = 4.65; P = 0.033) and attention problems (F = 8.19; P = 0.005), but not internalizing problems. Meanwhile, in the control group, the high-risk SDB children showed significantly higher scores than the low-risk SDB group in internalizing problems (F = 9.89; P = 0.002), depression (F = 9.45; P = 0.002), and somatization (F = 7.83; P = 0.006), as well as in externalizing problems (F = 7.72; P = 0.006), including hyperactivity (F = 6.23; P = 0.013), aggression (F = 5.00; P = 0.027), and conduct problems (F = 6.79; P = 0.010). Contrary to the behavioral outcomes, none of the attention performance subscale scores showed significant differences between the high- and low-risk SDB groups in either the ADHD or control group.

CONCLUSIONS

The present findings suggest that SDB is associated with behavioral problems in children with ADHD and controls, with stronger associations in control children. On the contrary, SDB has no association with cognitive attention performance. This study extends our understanding of the associations of SDB with behavioral symptoms and cognitive functions in children.

Pediatric obstructive sleep apnea: Preoperative and neurocognitive considerations for perioperative management

Obstructive sleep apnea (OSA) affects up to 7.5% of the pediatric population and is associated with a variety of behavioral and neurocognitive sequelae. Prompt diagnosis and treatment is critical to halting and potentially reversing these changes. Depending on the severity of the OSA and comorbid conditions, different treatment paradigms can be pursued, each of which has its own unique risk:benefit ratio. Adenotonsillectomy is first-line recommended surgical treatment for pediatric OSA. However, it carries its own perioperative risks and the decision regarding surgical timing is therefore made in the context of procedural risk versus patient benefit. This article presents the seminal perioperative and neurocognitive risks from pediatric OSA to aid with perioperative management.

[Validation and reliability study of the parent concerns about surgery questionnaire: What worries parents?]

INTRODUCTION

The study of mediating variables and psychological responses to child surgery involves the evaluation of both the patient and the parents as regards different stressors.

OBJECTIVE

To have a reliable and reproducible valid evaluation tool that assesses the level of paternal involvement in relation to different stressors in the setting of surgery.

MATERIAL AND METHOD

A self-report questionnaire study was completed by 123 subjects of both sexes, subdivided into 2populations, due to their relationship with the hospital setting. The items were determined by a group of experts and analysed using the Lawshe validity index to determine a first validity of content. Subsequently, the reliability of the tool was determined by an item-re-item analysis of the 2sub-populations. A factorial analysis was performed to analyse the construct validity with the maximum likelihood and rotation of varimax type factors.

RESULTS

A questionnaire of paternal concern was offered, consisting of 21 items with a Cronbach coefficient of 0.97, giving good precision and stability. The posterior factor analysis gives an adequate validity to the questionnaire, with the determination of 10 common stressors that cover 74.08% of the common and non-common variance of the questionnaire.

CONCLUSION

The proposed questionnaire is reliable, valid and easy-to-apply and is developed to assess the level of paternal concern about the surgery of a child and to be able to apply measures and programs through the prior assessment of these elements.

Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis

OBJECTIVE

To provide an up-to-date systematic review and critical appraisal of prospectively performed studies evaluating neurocognitive function in children treated with adenotonsillectomy.

DATA SOURCES

PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library.

REVIEW METHODS

Searches were performed from inception through September 2, 2015.

RESULTS

Nineteen prospective studies (898 adenotonsillectomy patients) met criteria and reported neurocognitive outcomes. The average age of children was 6.6±2.3 years (range 2.5-14 years) and 51.1% were male. Pre- and post-operative data utilizing the Neuropsychological Developmental Assessment score demonstrated an increase from a means±standard deviations of 101.5±14.7 [95% CI 100.0, 103.0] to 108.8±13.4 [95% CI 107.4, 110.2], p-value <0.0001 (375 children, three studies). Pre- and post-operative data utilizing the Stanford-Binet Intelligence Scales (IQ) demonstrated an increase in IQ scores from a means±standard deviations of 97.1±13.8 [95% CI 91.6, 95.4] to 100.7±11.1 [95% CI 100.4, 103.4], p-value <0.0001 (254 children, three studies). The mean pre- and post-adenotonsillectomy apnea-hypopnea index (AHI) decreased from 8.0 to 1.8 (274 children, six studies).

CONCLUSIONS

This meta-analysis found an improvement in neurocognitive function and IQ after pediatric adenotonsillectomy, especially in pre-school aged children. However, this must be interpreted with caution as only three studies were performed in pre-school aged children. The decreased effectiveness in older children suggests possibly a threshold age when neurocognitive deficits become irreversible.

Cognitive deficits in adults with obstructive sleep apnea compared to children and adolescents

Obstructive sleep apnea (OSA) can negatively affect the patient's physical and psychological functioning, as well as their quality of life. A major consequence of OSA is impaired cognitive functioning. Indeed, several studies have shown that OSA mainly leads to deficits in executive functions, attention, and memory. As OSA can present in all age groups, these associated cognitive deficits have been observed in adults, as well as in children and adolescents. However, these cognitive deficits may have a different clinical picture in young patients compared to adults. In this review, we analyze the most affected cognitive domains in adults and children/adolescents with OSA, as evaluated by neuropsychological and neuroimaging studies. We found that deficits in working memory, attention, or executive functions cognitive domains are found in both adults and children with OSA. However, children with OSA also show changes in behavior and phonological processing necessary for proper development. Moreover, we examine the possible OSA treatments in children and adults that can have a positive influence on cognition, and therefore, improve patients' general functioning and quality of life.