Evaluation of behavioral change after adenotonsillectomy for obstructive sleep apnea in children with autism spectrum disorder

Emi Murata; Ikuko Mohri; Kumi Kato-Nishimura; Jiro Iimura; Makoto Ogawa; Masaya Tachibana; Yuko Ohno; Masako Taniike

doi:10.1016/j.ridd.2017.04.012

Evaluation of behavioral change after adenotonsillectomy for obstructive sleep apnea in children with autism spectrum disorder

Res Dev Disabil. 2017 Jun:65:127-139. doi: 10.1016/j.ridd.2017.04.012. Epub 2017 May 14.

Authors

Emi Murata¹, Ikuko Mohri², Kumi Kato-Nishimura³, Jiro Iimura⁴, Makoto Ogawa⁵, Masaya Tachibana⁶, Yuko Ohno⁷, Masako Taniike⁶

Affiliations

¹ Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.
² Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan; Department of Pediatrics, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan. Electronic address: ikuko@kokoro.med.osaka-u.ac.jp.
³ Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan; Ota Memorial Sleep Center, 1-50 Nisshincho, Kawasaki, Kawasaki-ku, Kanagawa, 2100024, Japan.
⁴ Department of Otorhinolaryngology, Ota General Hospital, 1-50 Nisshincho, Kawasaki, Kawasaki-ku, Kanagawa, 2100024, Japan.
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.
⁶ Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan; Department of Pediatrics, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.
⁷ Department of Mathematical Health Science, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.

PMID: 28514706
DOI: 10.1016/j.ridd.2017.04.012

Abstract

Background and objective: Obstructive sleep apnea (OSA) may affect daily cognitive functioning in children. The aims of our study were two-fold. The first aim was to detect, using the Child Behavior Checklist (CBCL), whether adenotonsillectomy (AT) for the treatment of OSA improved the behavior of children with autism spectrum disorder (ASD). The second aim was to identify characteristics for behavioral improvement following the treatment of OSA in these children with ASD.

Methods: The behaviors of ASD children aged 5-14 years diagnosed as having OSA (n=30) were evaluated using CBCL before and after AT. CBCL evaluation of ASD children without OSA at two time points with the same interval served as a control (n=24). We statistically examined the two groups. In addition, we conducted a paired t-test to assess changes in CBCL Tscores between the improved group and unchanged/deteriorated group to identify characteristics that may affect behavioral changes following OSA treatment.

Results: After AT, T-scores of the CBCL scales were significantly improved in the OSA group, but no change was observed in the control. A paired t-test revealed that the improved group had significantly higher scores on the CBCL pre-AT than the unchanged/deteriorated group in ASD children with OSA after OSA treatment.

Conclusions: Behavioral problems were significantly improved following AT in ASD children with OSA. Early detection and treatment of children with OSA is essential to prevent behavioral problems and to support mental development.

Keywords: Adenotonsillectomy; Autism spectrum disorder; Behavior; Child Behavior Checklist; Pediatric obstructive sleep apnea.

MeSH terms

Adenoidectomy / methods*
Autism Spectrum Disorder* / complications
Autism Spectrum Disorder* / physiopathology
Autism Spectrum Disorder* / psychology
Behavior Observation Techniques / methods
Case-Control Studies
Child
Child Behavior / physiology
Child Behavior / psychology
Child, Preschool
Cognition / physiology*
Female
Humans
Japan
Male
Polysomnography / methods
Postoperative Period
Problem Behavior*
Sleep Apnea, Obstructive* / complications
Sleep Apnea, Obstructive* / diagnosis
Sleep Apnea, Obstructive* / psychology
Sleep Apnea, Obstructive* / surgery
Tonsillectomy / methods*
Treatment Outcome