Case Report Effects of Adenotonsillectomy on Neurocognitive Function in Pediatric Obstructive Sleep Apnea Syndrome

Obstructive sleep apnea syndrome (OSAS) in children does not only present with symptoms of sleep disturbances but also with associated symptoms such as growth failure, enuresis, academic learning difficulties, and behavioral problems, including attention deficit/hyperactivity disorder-(ADHD-) like symptoms. We evaluated neurocognitive functions before and after adenotonsillectomy in a patient with OSAS. An 11-year-old boy suspected of having ADHD with nocturnal enuresis was referred for evaluation. He was found to have adenotonsillar hypertrophy. Presence of snoring was evident only after detailed medical interview. Polysomnography confirmed the diagnosis of OSAS, which was subsequently treated by adenotonsillectomy. The apnea/hypopnea index decreased from 21.9 at baseline to 1.8 after surgery, and the frequency of enuresis fell from almost nightly to 2-3 times per month. Neurocognitive and behavioral assessment after the treatment of OSAS showed significant improvement in cognitive functions, especially attention capacity and considerable amelioration of behavioral problems including ADHD-like symptoms. As the most common cause of pediatric OSAS is adenotonsillar hypertrophy, medical interview and oropharyngeal examination should always be performed in children suspected of having ADHD. The necessity of sleep evaluation for children with ADHD-like symptoms was also emphasized

Extreme prolongation of expiration breathing: Effects on electroencephalogram and autonomic nervous function

To clarify the physiological and psychological effects of deep breathing, the effects of extreme prolongation of expiration breathing (Okinaga) were investigated using electroencephalogram (EEG) and electrocardiogram (ECG). Participants were five male Okinaga practitioners in their 50s and 60s. Participants performed Okinaga for 31 minutes while continuous EEG and ECG measurements were taken. After 16 minutes of Okinaga, and until the end of the session, the percentages of theta and alpha 2 waves were significantly higher than at baseline. After 20 minutes, and until the end of the session, the percentage of beta waves was significantly lower than at baseline. The high frequency component of heart rate variability was significantly lower after 12 minutes of Okinaga and lasted until 23 minutes. The low frequency/high frequency ratio was significantly lower after 18 minutes of Okinaga and until the end of the session. Okinaga produced relaxation, suggesting that deep breathing may relieve anxiety. However, study limitations include potential ambiguity in the interpretation of the low frequency/high frequency ratio, the small sample, and the fact that EEG was measured only on the forehead

The relaxation effect of prolonged expiratory breathing

This study was performed to confirm that autonomic nervous activity is affected by breathing speed. I hypothesized that prolonged expiratory breathing would promote parasympathetic dominance, whereas rapid breathing would promote sympathetic dominance. Ten healthy men, ages 21–28 years old, were instructed to perform prolonged expiratory breathing (6 seconds expiration, 4 seconds inspiration) after spontaneous breathing and rapid breathing (1 second expiration, 1 second inspiration) after spontaneous breathing; changes in high frequency (HF) and low frequency (LF)/HF of heart rate variability (HRV) were measured during each type of breathing. During prolonged expiratory breathing, parasympathetic nervous function was significantly activated. Conversely, during rapid breathing, parasympathetic nervous function was significantly suppressed. The HRV method assessing sympathetic and parasympathetic modulation in this study is an indirect, non-invasive method with clear limitations. The use of additional techniques should be considered to clarify the relationships between the breathing speed and the mind

The effects of phosphatidylserine and omega-3 fatty acid-containing supplement on late life depression

Late life depression is often associated with a poor response to antidepressants; therefore an alternative strategy for therapy is required. Although several studies have reported that phosphatidylserine (PS) may be effective for late life depression and that omega-3 fatty acids DHA and EPA have also proven beneficial for many higher mental functions, including depression, no concrete conclusion has been reached. This study was performed to clarify the effect of PS and omega-3 fatty acid-containing supplement for late life depression by not only clinical evaluation but also salivary cortisol levels. Eighteen elderly subjects with major depression were selected for the study. In all, insufficient improvement had been obtained by antidepressant therapy for at least 6 months. The exclusion criteria from prior brain magnetic resonance images (MRI) included the presence of structural MRI findings compatible with stroke or other gross brain lesions or malformations, but not white matter hypersensitivities. They took a supplement containing PS 100 mg, DHA 119 mg and EPA 70 mg three times a day for 12 weeks. The effects of the supplement were assessed using the 17-item Hamilton depression scale (HAM-D17) and the basal levels and circadian rhythm of salivary cortisol. The study adopted them as indices because: salivary cortisol levels are high in patients with depression, their circadian rhythm related to salivary cortisol is often irregular, and these symptoms are alleviated as depression improves. The mean HAM-D17 in all subjects taking the supplement was significantly improved after 12 weeks of taking the supplement. These subjects were divided into 10 non-responders and 8 responders. The basal levels and circadian rhythm of salivary cortisol were normalized in the responders while not in non-responders. PS and omega-3 fatty acids, or other elements of the supplement, may be effective for late life depression, associated with the correction of basal levels and circadian rhythm of salivary cortisol

Anti-stress effects of simplified aroma hand massage

In order to be able to use the aroma hand massage as a skill that can be done by a nurse who does not have a special aromatherapy technique, we examine antistress effects of simplified aroma hand massage for healthy subjects. We evaluated the anti-stress action of aroma hand massage and the different components of the procedure in 20 healthy women in their twenties. We used autonomic nervous function measured via electrocardiogram as an index of stress. After conducting a baseline electrocardiogram, we induced stress in the participants by asking them to spend 30 minutes completing Kraepelin’s arithmetic test. We then administered various treatments and examined the anti-stress effects. Kraepelin’s test significantly increased sympathetic nervous function and significantly reduced parasympathetic nervous function. Compared with massage without essential oil or aroma inhalation, aroma hand massage significantly increased parasympathetic nervous function and significantly decreased sympathetic nervous function. The effect of the aroma hand massage persisted when the procedure was simplified. The anti-stress action of the aroma hand massage indicates that it might have beneficial application as a nursing technique. There are several limitations in this study; ambiguities of low component/high component ratio of heart rate variability and bias by small subjects groups of the same women