Researchers from Kansas City, Missouri, conducted a non-randomized prospective study to examine changes in behavior and sleep among children with sleep-disordered breathing (SDB) who underwent removal of their tonsils and adenoids.
They enrolled 117 consecutive children (61 boys) with SDB who had undergone adenotonsillectomy (mean patient age 6.5±3.1 years). Children were excluded if the primary reason for adenotonsillectomy was recurrent infections or if significant comorbidities were present. Behavior and sleep changes were measured using the validated Pediatric Sleep Questionnaire (PSQ)1 and the Conners’ Parent Rating Scale-Revised Short Form (CPRS-R5). Parents completed the PSQ and CPRS-R5 before surgery and six months after the adenotonsillectomy.
Complete follow-up data were available for 71 (61%) patients. As compared to before surgery, scores on the CPRS-R5 for four domains – oppositional behavior, inattention or cognitive problems, hyperactivity, and ADHD index – improved significantly (P<.001) six months after surgery. Higher baseline scores were associated with larger changes in scores after surgery in all four domains.
The PSQ provides scores on a scale of 0 to 1 with scores higher than 0.33 suggesting obstructive sleep apnea. PSQ scores decreased from a mean of 0.6±0.1 preoperatively to 0.1±0.1 postoperatively. Correlations between sleep and behavior scores were found to be statistically significant after adenotonsillectomy for cognitive problems or inattention (P=.049; correlation coefficient, 0.24) and oppositional behavior (P=.03; correlation coefficient, 0.25), but not for the ADHD index or hyperactivity.
Owing to the subjective nature of the caregiver-based, questionnaire-type study, the postoperative scores may have improved partly owing to expectations of improvement. The authors conclude that children diagnosed with SDB experience improvement in both sleep and behavior after adenotonsillectomy. They also suggest that the PSQ and the CPRS-R5 might be helpful for screening children prior to and following adenotonsillectomy for SDB.
Dr. Dubik has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Although cause and effect cannot be determined in an observational study like the one reported here, these results should not be surprising. SDB, especially obstructive sleep apnea, has been found to be associated with enuresis, learning disabilities, behavioral difficulties, daytime sleepiness, and somatic complaints.2,3 Studies have also shown SDB to be associated with ADHD in children.4,5
In the same issue of the Archives of Otolaryngology, Head and Neck Surgery there is an article describing how adenotonsillectomy reduces the oropharyngeal carriage of potential respiratory pathogens.6 Is the otolaryngological pendulum swinging toward a more aggressive approach to removing tonsils and adenoids? (See
Alas, our knowledge of physics has faded, but we recall a pendulum’s swing has something to do with its weight. With regard to the...