Cyclic alternating pattern (CAP) in children with obstructive sleep apnea and its relationship with adenotonsillectomy, behavior, cognition, and quality-of-life

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dc.contributor.authorHartmann, S.
dc.contributor.authorBruni, O.
dc.contributor.authorFerri, R.
dc.contributor.authorRedline, S.
dc.contributor.authorBaumert, M.
dc.date.issued2021
dc.description.abstractStudy Objectives: To determine in children with obstructive sleep apnea (OSA) the effect of adenotonsillectomy (AT) on the cyclic alternating pattern (CAP) and the relationship between CAP and behavioral, cognitive, and quality-of-life measures. Methods: CAP parameters were analyzed in 365 overnight polysomnographic recordings of children with mild-to-moderate OSA enrolled in the Childhood Adenotonsillectomy Trial (CHAT), randomized to either early AT (eAT) or watchful waiting with supportive care (WWSC). We also analyzed CAP in a subgroup of 72 children with moderate OSA (apnea–hypopnea index > 10) that were part of the CHAT sample. Causal mediation analysis was performed to determine the independent effect of changes in CAP on selected outcome measures. Results: At baseline, a higher number of A1 phases per hour of sleep was significantly associated with worse behavioral functioning (caregiver Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC): ρ = 0.24, p = 0.042; caregiver Conners’ Rating Scale Global Index: ρ = 0.25, p = 0.036) and lower quality of life (OSA-18: ρ = 0.27, p = 0.022; PedsQL: ρ = −0.29, p = 0.015) in the subgroup of children with moderate OSA, but not across the entire sample. At 7-months follow-up, changes in CAP parameters were comparable between the eAT and WWSC arms. CAP changes did not account for significant proportions of variations in behavioral, cognitive, and qualityof- life performance measures at follow-up. Conclusions: We show a significant association between the frequency of slow, high-amplitude waves with behavioral functioning, as well as the quality of life in children with moderate OSA. Early AT in children with mild-to-moderate OSA does not alter the microstructure of nonrapid eye movement sleep compared with watchful waiting after an approximately 7-month period of follow-up. Clinical Trial: The study “A Randomized Controlled Study of Adenotonsillectomy for Children With Obstructive Sleep Apnea Syndrome” was registered at Clinicaltrials.gov (#NCT00560859).
dc.description.statementofresponsibilitySimon Hartmann, Oliviero Bruni, Raffaele Ferri, Susan Redline, and Mathias Baumert
dc.identifier.citationSleep, 2021; 44(1):zsaa145-1-zsaa145-8
dc.identifier.doi10.1093/sleep/zsaa145
dc.identifier.issn0161-8105
dc.identifier.issn0161-8105
dc.identifier.orcidHartmann, S. [0000-0001-9689-0594]
dc.identifier.orcidBruni, O. [0000-0003-2207-1398]
dc.identifier.orcidFerri, R. [0000-0001-6937-3065]
dc.identifier.orcidBaumert, M. [0000-0003-2984-2167]
dc.identifier.urihttps://hdl.handle.net/2440/145310
dc.language.isoen
dc.publisherOxford University Press
dc.rights© Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.
dc.source.urihttps://doi.org/10.1093/sleep/zsaa145
dc.subjectchildren; sleep; cyclic alternating pattern; sleep-disordered breathing; adenotonsillectomy; cognitive performance; child behavior; quality of life; deep learning
dc.subject.meshHumans
dc.subject.meshSleep Apnea, Obstructive
dc.subject.meshPolysomnography
dc.subject.meshAdenoidectomy
dc.subject.meshTonsillectomy
dc.subject.meshCognition
dc.subject.meshQuality of Life
dc.subject.meshChild
dc.titleCyclic alternating pattern (CAP) in children with obstructive sleep apnea and its relationship with adenotonsillectomy, behavior, cognition, and quality-of-life
dc.typeJournal article
pubs.publication-statusPublished

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