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Adenotonsillectomy decreased some symptoms of childhood sleep apnea
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Adenotonsillectomy in children with obstructive sleep apnea improved behavior, quality of life and other symptoms compared with those treated with watchful waiting, according to study results published in The New England Journal of Medicine.
“This was the first randomized clinical trial of surgery for obstructive sleep apnea in children,” Carole L. Marcus, MD, sleep specialist and director of the Sleep Center at The Children’s Hospital of Philadelphia, said in a press release. “Some previous, smaller studies had found this condition associated with cognitive and behavioral problems, including [attention-deficit/hyperactivity disorder], so it was important to do a controlled trial to evaluate the benefits of surgery, which is a common treatment.”
The multicenter, single blind, randomized controlled Childhood Adenotonsillectomy Trial (CHAT) included 464 children aged 5 to 9 years randomly assigned to early adenotonsillectomy or watchful waiting. Researchers measured polysomnographic, cognitive, behavioral and health outcomes at baseline and 7 months.
Researchers found that the average baseline value for the primary outcome — the attention and executive-function score on the Developmental Neuropsychological Assessment — was close to the population mean. Change from baseline to follow-up was not significantly different between the study groups (mean improvement, 7.1 in the adenotonsillectomy group and 5.1 in the watchful waiting group; P=.16).
However, significantly improvements were seen in behavioral, quality-of-life and polysomnographic findings. There also was a reduction in symptoms in the adenotonsillectomy group.
In an editorial about the study, Robert T. Brouillette, MD, of the department of pediatrics at McGill University in Montreal, said it is possible that the months to years of untreated obstructive sleep apnea can impair attention and executive function in children.
“The primary outcome may not have captured the disordered function, the 7-month follow-up period may have been too short, or such outcomes may be seen only in younger children, or in those with more severe disease,” he said. “Interestingly, a secondary outcome measure did show between-group differences favoring early surgery.”
Disclosure: See the study for a full list of disclosures.
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