Dados do Trabalho

Título

CHANGES IN BEHAVIORAL AND COGNITIVE ABILITIES IN CHILDREN AFFECTED BY PERSISTENT SNORING AFTER RAPID MAXILLARY EXPANSION

Introdução

Children with Sleep-disordered breathing may have behavioral, emotional, and neurocognitive difficulties such as depression, attention deficit, hyperactivity, aggressiveness, and impulsivity, often leading to poor school performance.

Objetivo

To verify the changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy (AT).

Métodos

A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children aged from 5 to 12 years, who had adenotonsillectomy, but whose parents/guardians reported that they still snore ≥4 nights per week. The 24 patients with transverse maxillary deficiency (TMD) in the sample were divided into two groups based on Pre-RME Obstructive Apnea-Hypopnea Index (OAHI) values, considering the following criteria: Primary Snoring (PS) Group - OAHI < 1 (n = 13), and OSA Group OAHI > 1 (n = 11). Analyzes were performed on the total sample (N = 24) and separately in the PS group and in the OSA group. The patients underwent fiberoptic nasopharyngolaryngoscopy, type 1 polysomnography, Pediatric Sleep Questionnaire (PSQ), Quality of Life Questionnaire (OSA-18), and behavioral and neurocognitive tests.

Resultados

The PSQ and OSA-18 scores showed statistically significant decrease in both groups (p < 0.001) after RME. In the OSA group, the mean scores of "Somatic" and "Aggressiveness" domains decreased significantly (p < 0.001). The cognitive functions did not register significant differences Pre- and Post-RME in any of the cognitive functions, except for visuospatial function in the OSA group.

Conclusões

The symptoms and behavioral disturbances should be considered in addition to obstructive apnea-hypopnea index (OAHI) when determining the need for treatment in pediatric SDB. RME can be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects, but these improvements to cannot be assigned to only one cause.

Palavras -chave

palatal expansion technique, obstructive sleep apnea syndrome; pediatric behavior disorders; pediatric sleep apnea; sleep disordered breathing.