Adenotonsillectomy for obstructive sleep apnea in young children has no effect on cognition

1. Adenotonsillectomy done for obstructive sleep apnea (OSA) in children ages 3-5 years had no effect on cognition over time when compared to controls.

2. Those children who received an adenotonsillectomy did demonstrate improvements in sleep patterns on polysomnogram, improvement in parent-reported symptoms, as well as improvements in behavior, daytime napping, and overall health.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Much investigation has been done on the effect of adenotonsillectomy for OSA on cognitive function in school-aged children, with many studies demonstrating a significant improvement in attention and executive function in children who underwent the procedure. In this study, researchers focus on cognitive outcomes after adenotonsillectomy for OSA in younger children, specifically those ages 3-5 years, with participants randomized to either adenotonsillectomy or no adenotonsillectomy (NoAT). The study demonstrated no difference in intellectual ability at the 12-month follow up between the 2 groups, though there was significant improvement in behavioral survey results and objective improvement in polysomnogram results in patients who underwent adenotonsillectomy. There was also signficiant improvement in parents’ report of symptoms, including difficulty sleeping, daytime sleeping, and snoring while sleeping, in the intervention group. Results also revealed significant parental report of overall health improvement in the post-surgical group as compared to controls. While much of the results are based on subjective parent reporting, specifically regarding behavior, rather on objective scales, an accompanying commentary does identify this study as one of the few randomized controlled trials assessing the effect of adenotonsillectomy on neurocognitive function, adding a important contribution to existing literature on the subject.

In-Depth [randomized controlled trial]: Participants included 190 children in 3 tertiary care centers across Australia; 99 children were randomized to undergo adenotonsillectomy, while 91 were randomized to NoAT. All children underwent standardized polysomnography, medical review, audiology, and cognitive and behavioral assessments at the start of the study as well as at the 12-month follow-up. Of those children initially randomized, 67 and 69 children in the adenotonsillectomy and NoAT groups, respectively, presented for follow up. Intellectual ability scores improved in both groups over time with no significant different in improvement between the adenotonsillectomy and NoAT groups (baseline scores = 448.36 vs 465.46 and 12 months = 451.3 vs 463.12, adenotonsillectomy versus NoAT, respectively; P = .29). Behavioral questionnaires showed improvements in adaptability (P = .003) and decreased rates of somatization (P = .05) in the post-surgical group as compared to the NoAT group. On polysomnogram, post-adenotonsillectomy patients demonstrated fewer periods of arousal per hour (P = .001) and lower obstructive apnea hypopnea index events per hour (P < .0001). Parents reported less snoring, less trouble sleeping at night or less trouble breathing while sleeping, less day time sleeping, and improved eating and overall health (scored out of 10) (all P < .001) in the post-surgical group.