{"doi":"10.1093/sleep/zsaa145","title":"Cyclic alternating pattern in children with obstructive sleep apnea and its relationship with adenotonsillectomy, behavior, cognition, and quality of life","abstract":"STUDY OBJECTIVES: To determine in children with obstructive sleep apnea (OSA) the effect of adenotonsillectomy (AT) on the cyclic alternating pattern (CAP) and the relationship between CAP and behavioral, cognitive, and quality-of-life measures. METHODS: CAP parameters were analyzed in 365 overnight polysomnographic recordings of children with mild-to-moderate OSA enrolled in the Childhood Adenotonsillectomy Trial (CHAT), randomized to either early AT (eAT) or watchful waiting with supportive care (WWSC). We also analyzed CAP in a subgroup of 72 children with moderate OSA (apnea-hypopnea index > 10) that were part of the CHAT sample. Causal mediation analysis was performed to determine the independent effect of changes in CAP on selected outcome measures. RESULTS: At baseline, a higher number of A1 phases per hour of sleep was significantly associated with worse behavioral functioning (caregiver Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC): ρ = 0.24, p = 0.042; caregiver Conners' Rating Scale Global Index: ρ = 0.25, p = 0.036) and lower quality of life (OSA-18: ρ = 0.27, p = 0.022; PedsQL: ρ = -0.29, p = 0.015) in the subgroup of children with moderate OSA, but not across the entire sample. At 7-months follow-up, changes in CAP parameters were comparable between the eAT and WWSC arms. CAP changes did not account for significant proportions of variations in behavioral, cognitive, and quality-of-life performance measures at follow-up. CONCLUSIONS: We show a significant association between the frequency of slow, high-amplitude waves with behavioral functioning, as well as the quality of life in children with moderate OSA. Early AT in children with mild-to-moderate OSA does not alter the microstructure of nonrapid eye movement sleep compared with watchful waiting after an approximately 7-month period of follow-up. CLINICAL TRIAL: The study \"A Randomized Controlled Study of Adenotonsillectomy for Children With Obstructive Sleep Apnea Syndrome\" was registered at Clinicaltrials.gov (#NCT00560859).","journal":"SLEEP","year":2020,"id":102523,"datarank":0.7393455187236782,"base_score":3.295836866004329,"endowment":3.295836866004329,"self_citation_contribution":0.4943755299006494,"citation_network_contribution":0.24496998882302878,"self_endowment_contribution":0.4943755299006494,"citer_contribution":0.24496998882302878,"corpus_percentile":null,"corpus_rank":null,"citation_count":26,"citer_count":15,"citers_with_citation_signal":8,"citers_with_endowment":8,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9557,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT00560859"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":477490,"name":"Oliviero Bruni","orcid":"0000-0003-2207-1398","position":1,"is_corresponding":false},{"id":477491,"name":"Raffaele Ferri","orcid":"0000-0001-6937-3065","position":2,"is_corresponding":false},{"id":17008,"name":"Susan Redline","orcid":"0000-0002-6585-1610","position":3,"is_corresponding":false},{"id":477492,"name":"Mathias Baumert","orcid":"0000-0003-2984-2167","position":4,"is_corresponding":false},{"id":477489,"name":"Simon Hartmann","orcid":"0000-0001-9689-0594","position":0,"is_corresponding":true}],"reference_count":39,"raw_metadata":null,"created_at":"2026-07-18T22:41:53.173268Z","pmid":"32777055","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}