Effect of surgical intervention for mild childhood obstructive sleep apnoea on attention and behavioural outcomes: A randomized controlled study

Abstract

Background and objective: We evaluated inattention and behavioural outcomes following surgery versus watchful waiting (WW) in school-aged children with mild obstructive sleep apnoea (OSA). Methods: A prospective randomized controlled study was performed in pre-pubertal children aged 6-11 years with polysomnography (PSG)-confirmed mild OSA. They were assigned randomly to early surgical intervention (ES) or WW. The surgical intervention consisting of tonsillectomy with or without adenoidectomy and turbinate reduction was carried out within 4-6 weeks after randomization. Both groups underwent PSG, attention and behavioural assessment and review by an otorhinolaryngologist at baseline and 9-month follow-up. The primary outcome was omission T score from Conners' continuous performance test (CPT). Secondary outcomes were parentreported behaviours, quality of life, symptoms and PSG parameters. Results: A total of 114 participants were randomized. Data of 35 subjects from the ES and 36 from the WW group were available for final analysis. No significant treatment effect could be found in all CPT parameters and behavioural outcomes. Nevertheless, significantly greater reductions were seen in PSG parameters (obstructive apnoeahypopnoea index [−1.4 AE 2.0 cf. +0.3 AE 4.1/h, p = 0.038] and arousal index [−1.3 AE 4.4 cf. +1.4 AE 4.5/h, p = 0.013]) and OSA-18 total symptom score (−17.3 AE 19.7 cf. −3.6 AE 14.1, p = 0.001) in the ES group. Subjects who underwent surgery also had significantly greater weight gain (+3.3 AE 2.1 cf. +2.2 AE 1.5 kg, p = 0.014) and increase in systolic blood pressure (+5.1 AE 12.4 cf. −1.2 AE 8.7 mm Hg, p = 0.016). Conclusion: Despite improvements in PSG parameters and parent-reported symptoms, surgical treatment did not lead to parallel improvements in objective attention measures in school-aged children with mild OSA.

The Effect of Adenotonsillectomy on Children’s Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art

“…At least eleven papers (2776 patients) were considered eligible for our analysis [3,[56][57][58][59][60][61][62][63][64][65], of which four were prospective cohort studies [58,61,62,64] and seven were randomized controlled trials [3,56,57,59,60,63,65] (see Table 1). The main features of the data of the included articles and the studies measured with time of follow-up are summarized in Table 2.…”

“…Most of patients performed polysomnography, reporting Apnea/Hypopnea Index (AHI) [3,[56][57][58][59][60][61][63][64][65], Oxygen Desaturation Index (ODI) [52,54,56,60] or Obstructive Apnea Index (OAI) [61]. Some studies further measured percentage sleep time with end-tidal CO2 values > 50 mmHG [55,56], OSA-18 items [56,60,64] or the Korean version of it (KOSA-18) [63]. Quality of life was measured by using the Pediatric Quality of Life (Ped-sQL) [3,60].…”

“…In particular, we provided 11 articles with a total of 2712 patients [3,[56][57][58][59][60][61][62][63][64][65]. In particular, 1455/2712 (53.65%) patients received AT, while 1061/2712 (39.12%) patients were assigned to watchful waiting with supportive care (WWSC) group.…”

Surgical treatment of obstructive sleep apnoea in childhood: Lessons for the way forward

“…8 In a recent publication in Respirology, Au et al present the results of a randomized controlled trial of early surgery compared to watchful waiting in a group of non-obese children aged 6-11 years with mild OSA defined by polysomnography. 9 A significant but modest treatment effect was seen at follow-up at least 6 months later in the obstructive apnoea-hypopnoea index (À1.4 AE 2.0/h in the surgery group compared to 0.3 AE 4.1 in the watchful waiting group, p = 0.038). However, consistent with previous studies, 44% of the watchful waiting group experienced polysomnographic resolution of OSA.…”

“…14 The current finding of greater weight gain in the surgical group highlights the potential for this unwanted side effect to affect normal weight children. 9 Aside from the risks of the surgery itself, these findings remind us that long-term unforeseen adverse consequences of surgery are possible and need to be balanced with the likely benefits of the procedure.…”