Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-23T16:41:08.172Z Has data issue: false hasContentIssue false
  • English
  • Français

Physical and emotional disturbances in children with adenotonsillar hypertrophy

Published online by Cambridge University Press:  30 November 2007

P Kurnatowski ,
L Putyński ,
M Łapienis  and
B Kowalska
P Kurnatowski*
Affiliation:
Department of Biology and Medical Genetics, Medical University, Łódź, Poland
L Putyński
Affiliation:
Department of Psychology, University of Łódź, Poland
M Łapienis
Affiliation:
Department of Otorhinolaryngology, Medical University, Łódź, Poland
B Kowalska
Affiliation:
Department of Psychology, University of Łódź, Poland
*
Address for correspondence: Prof Piotr Kurnatowski, Department of Biology and Medical Genetics, Medical University, Pl Hallera 1, 90-647 Łódź, Poland. Fax: +48 42 63 93 371 E-mail: pkurnatowski@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Enlarged tonsils and adenoids (part of Waldeyer's ring) are responsible for obstructive sleep disordered breathing. Obstructive sleep disordered breathing episodes lead to hypoxaemia, hypercapnia and a state of arousal, all of which affect normal development of the nervous system. In this study, two hypotheses were tested: (1) obstructive sleep disordered breathing is caused by adenotonsillar hypertrophy and is associated with hypoxia and brain dysfunction; and (2) children with obstructive sleep disordered breathing more commonly display emotional lability, depressive behaviour and anxiety.

Material and methods:

A total of 225 children were examined. The study group consisted of 121 children with adenotonsillar hypertrophy (87 aged six to nine years and 34 aged 10 to 13 years) and with obstructive sleep apnoeas and hypopnoeas confirmed by polysomnography. Patients were compared with 104 children with no obstructive sleep disordered breathing and no adenotonsillar hypertrophy (74 aged six to nine years and 30 aged 10 to 13 years). The following tests were used to measure the children's emotional disorders: the children's depression inventory; the state-trait anxiety inventory for children; and the emotional instability scale. The average values and standard deviations were calculated for all results. Student's t-test was used to compare differences in all groups of children. The minimum level of p < 0.05 was set as statistically significant.

Results:

Children with adenotonsillar hypertrophy are more likely to experience poor brain development and sleep problems. They also have emotional disturbances. In the sick and healthy children aged six to nine years, mean results for the emotional instability scale were statistically significantly different in the two groups, being higher in children with adenotonsillar hypertrophy than in healthy children. Mean values for the children's depression inventory test were higher in children with adenotonsillar hypertrophy, but the differences were not statistically significant. In the state-trait anxiety inventory for children test, the mean T score was T = 1.760 and the level of significance was p = 0.08 for both groups. Since the standard level of significance was p < 0.05, the differences in mean values for the state-trait anxiety inventory for children test bordered on statistical significance. There were no differences between tests results in the older children (10 to 13 years).

Conclusions:

Recent studies have confirmed the negative emotional effect of adenotonsillar hypertrophy induced obstructive sleep disordered breathing in children aged six to nine years. The main problems are emotional lability, and anxiety and depressive disturbances. Such emotional problems subside in older children (aged 10 to 13 years).

Keywords

Sleep Apnoea SyndromesAirway ObstructionTonsilAdenoidsEmotional DisturbancesChild
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 9 , September 2008 , pp. 931 - 935
Copyright
Copyright © JLO (1984) Limited 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Marcus, CL. Pathophysiology of childhood obstructive sleep apnea: current concepts. Respiration Physiology 2000;119:143–54CrossRefGoogle ScholarPubMed
2 Rosen, CL, Storfer-Isser, A, Taylor, HG, Kirchner, LH, Emancipator, JL, Redline, S. Increased behavioral morbidity in school-aged children with sleep-disordered breathing. Pediatrics 2004;114:1640–8CrossRefGoogle ScholarPubMed
3 Kurnatowski, P, Putynski, L, Lapienis, M, Kowalska, B. Neurocognitive abilities in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 2006;70:419–24CrossRefGoogle ScholarPubMed
4 Mitchell, RB, Kelly, J. Child behavior after adenotonsillectomy for obstructive sleep apnea syndrome. Laryngoscope 2005;115:2051–5CrossRefGoogle ScholarPubMed
5 Bower, CHM, Gungor, A. Pediatric obstructive sleep apnea syndrome. Otolaryngol Clin North Am 2000;33:49–73CrossRefGoogle ScholarPubMed
6 Ray, RM, Bower, CHM. Pediatric obstructive sleep apnea: the year in review. Curr Opin Otolaryngol Head Neck Surg 2005;13:360–5CrossRefGoogle ScholarPubMed
7 Rola, J. Mental Impairment as a Risk Factor for Child Depression. Warszawa: WSPS, 1996Google Scholar
8 Spielberger, CD, Vagg, PR. Psychometric properties of the STAI: a reply to Ramanaiah, Frenzen and Schill. J Pers Assess 1984;48:95–7CrossRefGoogle Scholar
9 Siek, St. Chosen Methods of Personality Examination. Warsaw: Academy of Theology, 1993Google Scholar
10 Chervin, R, Archbold, H. Hyperactivity and polysomnographic findings in children evaluated for sleep-disordered breathing. Sleep 2001;24:313–20CrossRefGoogle ScholarPubMed
11 O'Brien, LM, Mervis, CB, Brunner, JL, Klaus, CJ, Rutheford, J, Raffield, TJ et al. Neurobehavioral implications of habitual snoring in children. Pediatrics 2004;114:44–9CrossRefGoogle ScholarPubMed
12 Blunden, S, Lushington, K, Kennedy, D, Martin, J, Dawson, D. Behavior and neurocognitive performance in children aged 5–10 years who snore compared to controls. J Clin Exper Neuropsychol 2000;22:554–68CrossRefGoogle ScholarPubMed
13 Mulvaney, SA, Goodwin, JL, Morgan, WJ, Rosen, GR, Quan, SF, Kaemingk, KL. Behavior problems associated with sleep disordered breathing in school-aged children – the Tucson children's assessment of sleep apnea study. J Pediatr Psychol 2006;31:322–30CrossRefGoogle ScholarPubMed
14 O'Brien, LM, Holbrook, CR, Mervis, CJ, Klaus, CJ, Bruner, JL, Raffield, TJ et al. Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 2003;111:554–63CrossRefGoogle ScholarPubMed
15 Brown, WD. The psychological aspects of obstructive sleep apnea. Semin Respir Crit Care Med 2005;26:33–43CrossRefGoogle Scholar
16 Gozal, D, Pope, DW Jr. Snoring during early childchood and academic performance at ages 13–14 years. Pediatrics 2001;107:1394–9CrossRefGoogle Scholar
17 Friedman, BC, Hendeles-Amitai, A, Kozminsky, E, Leiberman, A, Friger, M, Tarasiuk, A et al. Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome. Sleep 2003;26:999–1005CrossRefGoogle ScholarPubMed
18 Goldstein, NA, Fatima, M, Campbell, TF, Rosenfeld, RM. Child behavior and quality of life before and after tonsillectomy and adenoidectomy. Arch Otolaryngol Head Neck Surg 2002;128:770–6CrossRefGoogle ScholarPubMed