Obstructive sleep disordered breathing has been associated with behavioral issues in children. These concerns can lead to adenotonsillectomy (AT) for those with obstructive sleep apnea (OSA). Waters et al (10.1542/peds.2019-1450) studied whether AT can improve cognitive function among children with mild OSA. 190 children entered the study and had assessments including cognitive and behavioral tests along with polysomnography and other measures of baseline function before being randomized to immediate AT or waiting 12 months before having the surgery. A year later, 121 of these children were able to be retested for their cognitive, behavioral, and sleep outcomes. The results showed improvements related to AT in sleep outcomes and in parent-reported behavior. In contrast, no differences were seen in cognitive improvement.
Should the lack of differences in cognitive improvement decrease AT for OSA? Not necessarily, according to an accompanying commentary by otolaryngologists Drs. David Francis and Derek Lam (10.1542/peds.2019-2479). They note that this is the first randomized controlled trial of cognitive outcomes following AT in this young age group. While the study is well done, Drs. Francis and Lam also note that the small sample size and follow-up time limits the inferences that can be made about the lack of cognitive improvements. In addition, young children with severe OSA were excluded from Waters et al. Perhaps young children with more severe OSA would show cognitive improvement. Have you found cognitive improvements in your young patients who have undergone AT for OSA? Share your experience with us by responding to this blog, posting a comment on our website with the posted article, or sharing your thoughts on our Facebook, Twitter, or Instagram sites.
