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In his response Dr Kotagal cites a study by Gozal (1) published 7
years ago,
and this is possibly the best study he could find to support his belief
that
obstructive sleep apnoea (OSA) is often causing academic or behavioural
problems in children.
The study by Gozal is interesting: in a sample of first grade pupils
in urban
New Orleans the 358 children in the lowest 10th percentile in their class
ranking were contacted; 297 (82%) participated in the study. 54 of these
297
children seemed to have OSA and 24 of them underwent adenotonsillectomy.
One year later these 24 had increased their school grades while the other
30
untreated children had not. The problem with this study is that treatment
was
not randomized, and therefore no firm conclusions can be made. The parents
of all 54 children with suspected OAS were advised to contact their
pediatrician for evaluation and surgery, but 30 families did not seek
treatment. It seems very likely that the families who did not seek
treatment
also were less active in helping their underperforming children in other
ways.
Gozal unfortunately give no information if treated and untreated children
differed in other ways (sex, race, obesity, comorbid conditions, single
parent,
education level or income of parents).
Searching PubMed I could not find a single randomized controlled
trial
looking at neuropsychiological or academic outcomes after treatment of OSA
in children. I did find a study from Finland by Lojander et al (2). Here
male
adults/adolescents with OSA were randomized to active treatment or
conservative management. Success in treatment of OSA did not affect
neuropsychiological outcome.
Nocturnal hypoxemia is obviously not good for you, and pulse oximeter
saturation below 91% is clearly associated with impaired performance in
mathematics (3). But before we can draw conclusions about when OSA is the
cause of academic underperformance, and which treatment should be tried,
we must have proper randomized controlled trials.
1. Gozal D. Sleep-disordered breathing and school performance in
children.
Pediatrics 1998;102: 616-20.
2. Lojander J et al. Cognitive function and treatment of obstructive
sleep
apnea syndrome. J Sleep Res. 1999 Mar;8(1):71-6.
3. Urschitz MS et al. Nocturnal arterial oxygen saturation and
academic
performance in a community sample of children. Pediatrics. 2005
Feb;115(2):
e204-9. Epub 2005 Jan 14.
Randomized controlled trials are still lacking
In his response Dr Kotagal cites a study by Gozal (1) published 7
years ago,
and this is possibly the best study he could find to support his belief
that
obstructive sleep apnoea (OSA) is often causing academic or behavioural
problems in children.
The study by Gozal is interesting: in a sample of first grade pupils
in urban
New Orleans the 358 children in the lowest 10th percentile in their class
ranking were contacted; 297 (82%) participated in the study. 54 of these
297
children seemed to have OSA and 24 of them underwent adenotonsillectomy.
One year later these 24 had increased their school grades while the other
30
untreated children had not. The problem with this study is that treatment
was
not randomized, and therefore no firm conclusions can be made. The parents
of all 54 children with suspected OAS were advised to contact their
pediatrician for evaluation and surgery, but 30 families did not seek
treatment. It seems very likely that the families who did not seek
treatment
also were less active in helping their underperforming children in other
ways.
Gozal unfortunately give no information if treated and untreated children
differed in other ways (sex, race, obesity, comorbid conditions, single
parent,
education level or income of parents).
Searching PubMed I could not find a single randomized controlled
trial
looking at neuropsychiological or academic outcomes after treatment of OSA
in children. I did find a study from Finland by Lojander et al (2). Here
male
adults/adolescents with OSA were randomized to active treatment or
conservative management. Success in treatment of OSA did not affect
neuropsychiological outcome.
Nocturnal hypoxemia is obviously not good for you, and pulse oximeter
saturation below 91% is clearly associated with impaired performance in
mathematics (3). But before we can draw conclusions about when OSA is the
cause of academic underperformance, and which treatment should be tried,
we must have proper randomized controlled trials.
1. Gozal D. Sleep-disordered breathing and school performance in
children.
Pediatrics 1998;102: 616-20.
2. Lojander J et al. Cognitive function and treatment of obstructive
sleep
apnea syndrome. J Sleep Res. 1999 Mar;8(1):71-6.
3. Urschitz MS et al. Nocturnal arterial oxygen saturation and
academic
performance in a community sample of children. Pediatrics. 2005
Feb;115(2):
e204-9. Epub 2005 Jan 14.
Competing interests:
None declared
Competing interests: No competing interests