STUDY OBJECTIVES To determine in children with obstructive sleep apnea (OSA) the effect of adenotonsillectomy 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 adenotonsillectomy (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 BRIEF GCE: 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 quality-of-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 adenotonsillectomy in children with mild-to-moderate OSA does not alter the microstructure of NREM sleep compared to 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).

中文翻译：

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阻塞性睡眠呼吸暂停患儿的循环交替模式 (CAP) 及其与扁桃体切除术、行为、认知和生活质量的关系

研究目的 确定阻塞性睡眠呼吸暂停 (OSA) 儿童腺样体扁桃体切除术对循环交替模式 (CAP) 的影响以及 CAP 与行为、认知和生活质量指标之间的关系。方法 对参加儿童腺样体扁桃体切除术试验 (CHAT) 的轻中度 OSA 儿童的 365 次夜间多导睡眠图记录分析了 CAP 参数，这些儿童被随机分为早期腺样体扁桃体切除术 (eAT) 或支持性护理观察等待 (WWSC)。我们还分析了 72 名中度 OSA（呼吸暂停低通气指数>10）儿童的 CAP，这些儿童是 CHAT 样本的一部分。进行因果中介分析以确定 CAP 变化对选定结果测量的独立影响。结果 在基线时，每小时睡眠 A1 期次数越多，行为功能越差（看护人 BRIEF GCE：ρ=0.24，P=0.042；看护人康纳斯评定量表全球指数：ρ=0.25，P=0.036）和质量越低中度 OSA 儿童亚组的生命周期（OSA-18：ρ=0.27，P=0.022；PedsQL：ρ=-0.29，P=0.015），但并非在整个样本中。在 7 个月的随访中，eAT 和 WWSC 组之间 CAP 参数的变化具有可比性。CAP 的变化并没有解释随访时行为、认知和生活质量表现指标的显着变化比例。结论 我们发现慢、高振幅波的频率与行为功能以及中度 OSA 儿童的生活质量之间存在显着关联。与大约 7 个月的随访期后的观察等待相比，轻度至中度 OSA 儿童的早期腺样体扁桃体切除术不会改变 NREM 睡眠的微观结构。临床试验 “阻塞性睡眠呼吸暂停综合征儿童腺样体切除术的随机对照研究”已在 Clinicaltrials.gov (#NCT00560859) 上注册。