Depressive symptomatology in school-aged children with obstructive sleep apnea syndrome: incidence, demographic factors, and changes following a randomized controlled trial of adenotonsillectomy. Issue 12 (13th September 2018)

• Record Type: Journal Article
• Authors: Hodges, Elise; Marcus, Carole L; Kim, Ji Young; Xanthopoulos, Melissa; Shults, Justine; Giordani, Bruno; Beebe, Dean W; Rosen, Carol L; Chervin, Ronald D; Mitchell, Ron B; Katz, Eliot S; Gozal, David; Redline, Susan; Elden, Lisa; Arens, Raanan; Moore, Renee; Taylor, H Gerry; Radcliffe, Jerilynn; Thomas, Nina H
• Is Part Of: Sleep. Volume 41:Issue 12(2018)
• Publication Date: 2018-09-13
• Subjects: obstructive sleep apnea -- pediatrics – sleep apnea -- depression -- mental health -- neuropsychology -- sleep and psychiatric conditions; Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy180
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Study Objectives: Depressive symptoms following adenotonsillectomy (AT) relative to controls were examined in children with obstructive sleep apnea syndrome (OSAS). Methods: The Childhood Adenotonsillectomy Trial (CHAT) multisite study examined the impact of AT in 453 children aged 5 to 9.9 years with polysomnographic evidence of OSAS without prolonged desaturation, randomized to early adenotonsillectomy (eAT) or watchful waiting with supportive care (WWSC). One hundred seventy-six children (eAT n = 83; WWSC n = 93) with complete evaluations for depressive symptomatology between baseline and after a 7-month intervention period were included in this secondary analysis. Results: Exact binomial test assessed proportion of depressive symptomatology relative to norms, while effects of AT and OSAS resolution were assessed through linear quantile mixed-models. Treatment group assignment did not significantly impact depression symptoms, although self-reported depression symptoms improved over time ( p < 0.001). Resolution of OSAS symptoms demonstrated a small interaction effect in an unexpected direction, with more improvement in parent ratings of anxious/depressed symptoms for children without resolution ( p = 0.030). Black children reported more severe depressive symptoms ( p = 0.026) and parents of overweight/obese children reported more withdrawn/depressed symptoms ( p = 0.004). Desaturation nadir during sleep was associated with self-report depressed ( r = −0.17, p = 0.028), parent-reported anxious/depressed ( r = −0.15, p = 0.049), and withdrawn/depressed ( r = −0.24, p = 0.002) symptoms. Conclusions: Increased risk for depressed and withdrawn/depressed symptoms was detected among children with OSAS, and different demographic variables contributed to risk in self-reported and parent-reported depression symptoms. Arterial oxygen desaturation nadir during sleep was strongly associated with depressed symptoms. However, despite improvements in child-reported depressed symptoms over time, changes were unrelated to either treatment group or OSAS resolution status. Trials Registration: Childhood Adenotonsillectomy Study for Children with OSAS (CHAT), https://clinicaltrials.gov/show/NCT00560859, NCT00560859.