| Esophageal Pressures, Polysomnography, and Neurobehavioral Outcomes of Adenotonsillectomy in Children. | |
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MedLine Citation:
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PMID: 22302302 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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ABSTRACT BACKGROUND:Esophageal pressure monitoring during polysomnography in children offers a gold-standard, "preferred" assessment for work of breathing, but is not commonly used in part because prospective data on incremental clinical utility are scarce. We compared a standard pediatric apnea/hypopnea index to quantitative esophageal pressures as predictors of apnea-related neurobehavioral morbidity and treatment response. METHODS:Eighty-one children aged 7.8±2.8 [s.d.] years, including 44 boys, had traditional laboratory-based pediatric polysomnography, esophageal pressure monitoring, multiple sleep latency tests, psychiatric evaluations, parental behavior rating scales, and cognitive testing, all just before clinically indicated adenotonsillectomy, and again 7.2±0.8 months later. Esophageal pressures were used, along with nasal pressure monitoring and oro-nasal thermocouples, to identify respiratory events but also more quantitatively to determine the most negative esophageal pressure recorded, and percent of sleep time spent with pressures lower than -10 cm of water. RESULTS:Both sleep-disordered breathing and neurobehavioral measures improved after surgery. At baseline one or both quantitative esophageal pressure measures predicted a disruptive behavior disorder (DSM-IV-defined Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, or Oppositional Defiant Disorder) and more sleepiness, and their future improvement after adenotonsillectomy (each p<.05). The pediatric apnea/hypopnea index did not predict these morbidities or treatment outcomes (each p>.10). Addition of respiratory effort-related arousals to the apnea/hypopnea index did not improve its predictive value. Neither the pre-operative apnea/hypopnea index nor esophageal pressures predicted baseline hyperactive behavior, cognitive performance, or their improvement after surgery. CONCLUSIONS:Quantitative esophageal pressure monitoring may add predictive value for some, if not all neurobehavioral outcomes of sleep-disordered breathing.Study registered with www.clinicaltrials.gov (NCT00233194). |
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Authors:
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Ronald D Chervin; Deborah L Ruzicka; Timothy F Hoban; Judith L Fetterolf; Susan L Garetz; Kenneth E Guire; James E Dillon; Barbara T Felt; Elise K Hodges; Bruno J Giordani |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-2-2 |
Journal Detail:
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Title: Chest Volume: - ISSN: 1931-3543 ISO Abbreviation: - Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-2-3 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1chervin@umich.edu. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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