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Volume 10 No. 08
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Accepted Papers

Scientific Investigations

Do Respiratory Cycle-Related EEG Changes or Arousals from Sleep Predict Neurobehavioral Deficits and Response to Adenotonsillectomy in Children?

Ronald D. Chervin, M.D., M.S., F.A.A.S.M.1; Susan L. Garetz, M.D.2; Deborah L. Ruzicka, R.N., Ph.D.1; Elise K. Hodges, Ph.D.3; Bruno J. Giordani, Ph.D.3; James E. Dillon, M.D.4; Barbara T. Felt, M.D.5; Timothy F. Hoban, M.D., F.A.A.S.M.6; Kenneth E. Guire, M.S.7; Louise M. O'Brien, Ph.D.8; Joseph W. Burns, Ph.D.9
1Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI; ; 2Sleep Disorders Center and Division of Pediatric Otolaryngology, Department of Otolaryngology and Head and Neck Surgery, University of Michigan, Ann Arbor, MI; ; 3Division of Neuropsychology, Department of Psychiatry, University of Michigan, Ann Arbor, MI; ; 4Department of Psychiatry, Central Michigan University, Mount Pleasant, MI; ; 5Division of Behavioral and Developmental Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI; ; 6Sleep Disorders Center and Division of Pediatric Neurology, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI; ; 7Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI; ; 8Sleep Disorders Center, Department of Neurology, and Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI; ; 9Michigan Tech Research Institute, Michigan Technological University, Ann Arbor, MI

Study Objectives:

Pediatric obstructive sleep apnea (OSA) is associated with hyperactive behavior, cognitive deficits, psychiatric morbidity, and sleepiness, but objective polysomnographic measures of OSA presence or severity among children scheduled for adenotonsillectomy have not explained why. To assess whether sleep fragmentation might explain neurobehavioral outcomes, we prospectively assessed the predictive value of standard arousals and also respiratory cycle-related EEG changes (RCREC), thought to reflect inspiratory microarousals.


Washtenaw County Adenotonsillectomy Cohort II participants included children (ages 3-12 years) scheduled for adenotonsillectomy, for any clinical indication. At enrollment and again 7.2 ± 0.9 (SD) months later, children had polysomnography, a multiple sleep latency test, parent-completed behavioral rating scales, cognitive testing, and psychiatric evaluation. The RCREC were computed as previously described for delta, theta, alpha, sigma, and beta EEG frequency bands.


Participants included 133 children, 109 with OSA (apnea-hypopnea index [AHI] ≥ 1.5, mean 8.3 ± 10.6) and 24 without OSA (AHI 0.9 ± 0.3). At baseline, the arousal index and RCREC showed no consistent, significant associations with neurobehavioral morbidities, among all subjects or the 109 with OSA. At follow-up, the arousal index, RCREC, and neurobehavioral measures all tended to improve, but neither baseline measure of sleep fragmentation effectively predicted outcomes (all p > 0.05, with only scattered exceptions, among all subjects or those with OSA).


Sleep fragmentation, as reflected by standard arousals or by RCREC, appears unlikely to explain neurobehavioral morbidity among children who undergo adenotonsillectomy.

Clinical Trial Registration:, ID: NCT00233194


Chervin RD, Garetz SL, Ruzicka DL, Hodges EK, Giordani BJ, Dillon JE, Felt BT, Hoban TF, Guire KE, O'Brien LM, Burns JW. Do respiratory cycle-related EEG changes or arousals from sleep predict neurobehavioral deficits and response to adenotonsillectomy in children?. J Clin Sleep Med 2014;10(8):903-911.

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