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Lung India. 2019 Jul-Aug;36(4):304-312. doi: 10.4103/lungindia.lungindia_398_18.

Neurocognitive and behavioral abnormalities in Indian children with sleep-disordered breathing before and after adenotonsillectomy.

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Department of Chest Medicine, SKIMS Medical College, Srinagar, Jammu and Kashmir, India.
Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Department of Pulmonary, Critical Care and Sleep Medicine, AlIMS, New Delhi, India.
Department of Otorhinolaryngology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.



Children with untreated sleep-disordered breathing (SDB) have impaired intellectual ability and behavioral effects. Timely treatment of SDB by adenotonsillectomy (AT) may prevent this morbidity. This study was designed to assess the prevalence of neurocognitive and behavioral dysfunction in Indian children with SDB and to evaluate the impact of AT.


Children recruited underwent diagnostic polysomnography (PSG), a detailed neurocognitive and behavioral assessment using a battery of validated instruments - the Malin's Intelligence Scale (MIS) for Indian children, Modified Wisconsin's Card Sorting Test, Parent Conners' Scale, and the Childhood Behavior Checklist (6-18). These children then underwent AT and subsequent reassessment at 3 and 6 months.


Neurocognitive impairment was common among the 33 enrolled children (mean age 9 [±2.97] years; 78.8% males). There was a significant correlation between the lowest O2saturation and the "categories completed" (r = -0.379; P = 0.029); and the lowest O2saturation and the "failure to maintain sets" (r = 0.386; P = 0.026) of the Modified Wisconsin's Card Sorting Test. Postsurgery, although apnea-hypopnea index (AHI) significantly decreased after surgery, 15 children still had SDB. Mean scores of most of the tested neurocognitive and behavioral domains showed improvement, although residual deficits were prevalent even after 6 months. Patients with a baseline AHI >5/h and those who had complete resolution of SDB (postoperative AHI <1/h) showed improvement in more subscales than patients with baseline AHI < 5/h and patients with incomplete resolution of SDB.


The decreased neurocognitive performance related to SDB may be a result of hypoxemia, rather than the frequency of SDB events. Despite AT, residual disease is common and such patients may require further treatment.


Adenotonsillectomy; behavioral assessment; neurocognitive assessment; oxygen desaturation; pediatric sleep-disordered breathing; polysomnography

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