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Dean W Beebe

Publications and source records attributed to Dean W Beebe.

11 recordsLinked to original sources
PubMed2006

The contribution of intermittent hypoxia, sleep debt and sleep disruption to daytime performance deficits in children: consideration of respiratory and non-respiratory sleep disorders.

In children, the most abundant available information regarding the effects of paediatric sleep disturbance on daytime function has been obtained by studying children with sleep disordered breathing (SDB). The purported underlying pathophysiological mechanisms responsible for these deficits include hypoxia secondary to obstructive apneas/hypopneas and/or disrupted sleep architecture from frequent arousals during sleep. This review will present evidence that, while hypoxia is likely to play a role for many children with SDB, sleep disruption is an important and often overlooked factor that can contribute to daytime deficits in children with SDB. Indeed, sleep deprivation and disruption appear to have a potent impact on the daytime functioning of the much larger number of children with non-respiratory sleep disorders. It is concluded that sleep deprivation, sleep disruption, and intermittent hypoxia independently may be sufficient to cause daytime effects in vulnerable children, and the combination of two or more of these factors can result in particularly impaired daytime functioning. These conclusions have significant implications for research and clinical practice.

Brain↗
PubMed2006

Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing.

OBJECTIVE: To document the sleep of overweight adolescents and to explore the degree to which weight-related sleep pathology might account for diminished psychosocial outcome. METHODS: Sixty children aged 10-16.9 from a weight-management clinic were compared to 22 healthy controls using comprehensive actigraphic, polysomnographic, and parent- and self-report questionnaire assessments. RESULTS: Overweight participants averaged more symptoms of sleep-disordered breathing, later sleep onset, shorter sleep time, and more disrupted sleep than controls. Although the groups did not differ in self-reported sleep habits, multiple concerns were reported by parents of overweight participants, including daytime sleepiness, parasomnias, and inadequate sleep. Group differences in academic grades and depressive symptoms were at least partially accounted for by short sleep and daytime sleepiness. CONCLUSIONS: Excessive weight is associated with an increased risk of sleep problems. There is a need for further research in this area and for clinicians who work with overweight children to evaluate their sleep.

Adolescent↗
PubMed2006

Neurobehavioral morbidity associated with disordered breathing during sleep in children: a comprehensive review.

STUDY OBJECTIVES: To comprehensively review research on the association between childhood sleep-disordered breathing (SDB) and neurobehavioral functioning. DESIGN: Qualitative and quantitative literature review. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The findings of 61 studies of the relationship between childhood SDB and neurobehavioral functioning were critically evaluated and synthesized. There is strong evidence that childhood SDB is associated with deficits in behavior and emotion regulation, scholastic performance, sustained attention, selective attention, and alertness. There is also evidence that SDB has minimal association with a child's typical mood, expressive language skills, visual perception, and working memory. Findings have been insufficient to draw conclusions about intelligence, memory, and some aspects of executive functioning. Mechanisms by which SDB might result in neurobehavioral morbidity are being explored, but clinical symptoms such as chronic snoring remain the best predictors of morbidity. Short-term SDB treatment outcome studies are encouraging, but the long-term outcomes are not known. Failing to treat SDB appears to leave children at risk for long-term neurobehavioral deficits. CONCLUSIONS: Childhood SDB is associated with neurobehavioral morbidity. Applying commonly used guidelines for causal inference, even in the absence of a much-needed randomized clinical trial, there is strong evidence of association, consistent findings, and specificity of effect. There is suggestive evidence that this association fits the expected temporal pattern and that SDB is a biologically plausible cause of neurobehavioral deficits. Clinicians should be alert to the coexistence of SDB symptoms and concerns about a child's academic progress, attention, arousal, or behavior or emotion regulation.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Cognitive and adaptive outcome in low-grade pediatric cerebellar astrocytomas: evidence of diminished cognitive and adaptive functioning in National Collaborative Research Studies (CCG 9891/POG 9130).

PURPOSE: Clinicians often assume that children with posterior fossa tumors are at minimal risk for cognitive or adaptive deficits if they do not undergo cranial irradiation. However, small case series have called that assumption into question, and have also suggested that nonirradiated cerebellar tumors can cause location-specific cognitive and adaptive impairment. This study (1) assessed whether resected but not irradiated pediatric cerebellar tumors are associated with cognitive and adaptive functioning deficits, and (2) examined the effect of tumor location and medical complications on cognitive and adaptive functioning. PATIENTS AND METHODS: The sample was composed of 103 children aged 3 to 18 years with low-grade cerebellar astrocytomas, who underwent only surgical treatment as part of Children's Cancer Group protocol 9891 or Pediatric Oncology Group protocol 9130. The sample was divided into three groups based on primary tumor location: vermis, left hemisphere, or right hemisphere. Data were collected prospectively on intelligence, academic achievement, adaptive skills, behavioral functioning, and pre-, peri-, and postsurgical medical complications. RESULTS: The sample as a whole displayed an elevated risk for cognitive and adaptive impairment that was not associated consistently with medical complications. Within this group of children with cerebellar tumors, tumor location had little effect on cognitive, adaptive, or medical outcome. CONCLUSION: We did not replicate previous findings of location-specific effects on cognitive or adaptive outcome. However, the elevated risk of deficits in this population runs contrary to clinical lore, and suggests that clinicians should attend to the functional outcomes of children who undergo only surgical treatment for cerebellar tumors.

Adaptation, Psychological↗
PubMed2005

Neurobehavioral effects of obstructive sleep apnea: an overview and heuristic model.

PURPOSE OF REVIEW: Obstructive sleep apnea can cause significant daytime behavioral and adaptive deficits, conventionally called 'neurobehavioral' because they are presumed to be mediated by the brain. The past few years have witnessed a marked increase in research into the neurobehavioral effects of obstructive sleep apnea, making it difficult for researchers and clinicians to stay abreast of the field. This article summarizes recent findings on the neurobehavioral effects of adult and pediatric obstructive sleep apnea, and presents a heuristic model to guide future research and clinical conceptualizations. RECENT FINDINGS: Recent publications have suggested overlapping but distinct neurobehavioral deficits that tend to accompany obstructive sleep apnea in the adult versus childhood years. There have been exciting new developments into the mechanisms by which obstructive sleep apnea may result in these deficits, including findings based upon advanced neuroimaging tools and carefully controlled animal research. There has also been accumulating evidence for potential moderators of morbidity; that is, factors that alter the nature or severity of neurobehavioral deficit resulting from obstructive sleep apnea. Task- and context-related factors that may affect outcome have been identified, as have potential markers for individual risk and resiliency. SUMMARY: The relation between obstructive sleep apnea and neurobehavioral deficit is probably not dependent on a single mediating mechanism, nor is it invariant across individuals. In outlining several potential moderating factors, the model presented here was designed to provide a guide for future research and a way of thinking about obstructive sleep apnea that better captures the wide variation in neurobehavioral outcome seen by practicing clinicians.

Adult↗
PubMed2004

Neuropsychological effects of pediatric obstructive sleep apnea.

Obstructive sleep apnea (OSA) is a fairly common nocturnal breathing disorder, affecting 2-4% of individuals. Although OSA is associated with medical morbidity, its most functionally disruptive effects in adults appear to be neuropsychological in nature. Research on the neuropsychological effects of pediatric OSA has been limited. This study compared the neuropsychological functioning of school-aged children with OSA to that of healthy children. The primary goal was to clarify the presence and pattern of neuropsychological morbidity associated with pediatric OSA. Sleep was assessed with parent-report questionnaires and laboratory sleep studies. Neuropsychological functioning was assessed by formal tests and parent- and teacher-report questionnaires. Data indicated OSA-related cognitive and behavioral impairment that was particularly marked on measures of behavior regulation and some aspects of attention and executive functioning. Minimal effects were observed on measures of intelligence, verbal memory, or processing speed. Exploratory analyses failed to indicate any clear relationship between neuropsychological functioning and objective indexes of hypoxia or sleep disruption, though the sample was small. These data add to a growing literature which suggests that significant neuropsychological deficits are associated with pediatric OSA. Findings suggest a pattern of neuropsychological morbidity that is similar but not identical to that seen in adult OSA.

Attention↗
PubMed2004

Executive functioning and memory for the Rey-Osterreith complex figure task among community adolescents.

Although there is empirical support for the link between executive functioning (EF) and visual memory among adults, there has been less exploration of this link among children, especially adolescents. We examined the relation between several EF measures and performance on the Rey-Osterrieth Complex Figure (RCF) in a sample of 160 community adolescents. Each was administered the Wisconsin Card Sorting Test (WCST), Conners Continuous Performance Test (CPT), and the RCF, scored using Bernstein and Waber's (1996) Developmental Scoring System (DSS). Ability to organize the RCF related to memory encoding/retrieval, but not to long-term storage. Indexes derived from the WCST and CPT failed to correlate with any RCF index, raising questions about the relation between DSS scores and EF. Even so, data supported the convergent validity of the DSS system as a reflection of visual-constructional ability and provided evidence of the importance of organizational strategies to visual memory among adolescents.

Adolescent↗
PubMed2003

The neuropsychological effects of obstructive sleep apnea: a meta-analysis of norm-referenced and case-controlled data.

STUDY OBJECTIVES: The research literature on the neuropsychological effects of obstructive sleep apnea (OSA) has yielded seemingly contradictory findings, and narrative reviews of this literature are prone to interpretive errors. We used sophisticated meta-analytic models to minimize such errors, with the goal of clarifying the effect of OSA on neuropsychological functioning. DESIGN: Meta-analytic review of research through 2001. PARTICIPANTS: We reviewed studies of neuropsychological functioning among adults with untreated OSA. Twenty-five studies met review criteria, representing 1092 patients with OSA and 899 healthy controls. MEASUREMENTS AND RESULTS: Two sets of effect sizes were generated. One compared OSA group means against those of healthy controls in case-controlled studies. The other compared all OSA group means against published normative data. Within each data set, 10 neuropsychological outcome domains were coded. In both data sets, untreated OSA was found to have a negligible impact on intellectual and verbal functioning but a substantial impact upon vigilance and executive functioning. Data were mixed with regard to visual and motor functioning; posthoc inspection of the data suggested that tests of fine-motor coordination or drawing were more sensitive to OSA than were tests of fine-motor speed or visual perception. Data were also mixed with regard to memory functioning, probably related to methodologic differences across studies. CONCLUSIONS: Etiologic models should emphasize mechanisms known to affect vigilance, executive functioning, and motor coordination but not intelligence, verbal functioning, or visual perception. Clinicians should be alert to OSA symptoms in patients with declines in vigilance, executive functioning, or coordination.

Arousal↗
PubMed2002

Obstructive sleep apnea and the prefrontal cortex: towards a comprehensive model linking nocturnal upper airway obstruction to daytime cognitive and behavioral deficits.

Obstructive sleep apnea (OSA) is accompanied by significant daytime cognitive and behavioral deficits that extend beyond the effects of sleepiness. This article outlines a causal model by which to understand these psychological effects among OSA patients. The model proposes that sleep disruption and blood gas abnormalities prevent sleep-related restorative processes, and further induce chemical and structural central nervous system cellular injury. This, in turn, leads to dysfunction of prefrontal regions of the brain cortex (PFC), manifested behaviorally in what neuropsychologists have termed 'executive dysfunction'. Executive dysfunction is proposed to markedly affect the functional application of cognitive abilities, resulting in maladaptive daytime behaviors. The proposed model (1) accounts for the specific psychological phenotype associated with OSA, (2) accommodates developmental components in this phenotype, (3) bridges between physical and psychological phenomena, (4) suggests mechanisms by which the nocturnal disorder might have effects on daytime functioning, (5) is empirically testable, (6) generates unique research hypotheses, and (7) has practical implications. The model is intended to act as a catalyst for future research and as a preliminary guide for clinicians.

Adaptation, Psychological↗
PubMed2000

Evaluation of the validity of the Wechsler Intelligence Scale for Children--Third Edition comprehension and picture arrangement subtests as measures of social intelligence.

Clinical lore suggests that the Wechsler Intelligence Scale for Children--Third Edition (D. M. Wechsler, 1991) Comprehension and Picture Arrangement scores may be used as indices of social intelligence. This study evaluated this supposition by comparing these subtest scores with mother- and teacher-reported social functioning in 142 children with ADHD and 30 control children. After general intelligence was partialled out, the Comprehension subtest related to some aspects of social functioning, but the clinical significance of this was limited. The Picture Arrangement subtest was unrelated to social functioning, once general intelligence was controlled. These findings were consistent across study groups.

Attention Deficit Disorder with Hyperactivity↗