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Pediatrics. 2016 Aug;138(2). pii: e20154458. doi: 10.1542/peds.2015-4458.

Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea.

Author information

1
Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;
2
Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
3
Departments of Psychiatry and Psychology, and.
4
Department of Pediatrics, Children's Hospital at Montefiore and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;
5
Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan;
6
Department of Otolaryngology-Head and Neck Surgery and Sleep Disorders Center, University of Michigan Health Center, Ann Arbor, Michigan;
7
Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
8
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia;
9
Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
10
Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania;
11
Department of Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University, St Louis, Missouri;
12
Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts;
13
Department of Child and Adolescent Psychiatry and Behavioral Sciences, Neuropsychology and Assessment Group, and.
14
Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
15
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

Abstract

OBJECTIVE:

Research reveals mixed evidence for the effects of adenotonsillectomy (AT) on cognitive tests in children with obstructive sleep apnea syndrome (OSAS). The primary aim of the study was to investigate effects of AT on cognitive test scores in the randomized Childhood Adenotonsillectomy Trial.

METHODS:

Children ages 5 to 9 years with OSAS without prolonged oxyhemoglobin desaturation were randomly assigned to watchful waiting with supportive care (n = 227) or early AT (eAT, n = 226). Neuropsychological tests were administered before the intervention and 7 months after the intervention. Mixed model analysis compared the groups on changes in test scores across follow-up, and regression analysis examined associations of these changes in the eAT group with changes in sleep measures.

RESULTS:

Mean test scores were within the average range for both groups. Scores improved significantly (P < .05) more across follow-up for the eAT group than for the watchful waiting group. These differences were found only on measures of nonverbal reasoning, fine motor skills, and selective attention and had small effects sizes (Cohen's d, 0.20-0.24). As additional evidence for AT-related effects on scores, gains in test scores for the eAT group were associated with improvements in sleep measures.

CONCLUSIONS:

Small and selective effects of AT were observed on cognitive tests in children with OSAS without prolonged desaturation. Relative to evidence from Childhood Adenotonsillectomy Trial for larger effects of surgery on sleep, behavior, and quality of life, AT may have limited benefits in reversing any cognitive effects of OSAS, or these benefits may require more extended follow-up to become manifest.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00560859.

PMID:
27464674
PMCID:
PMC4960728
DOI:
10.1542/peds.2015-4458
[Indexed for MEDLINE]
Free PMC Article

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