Effects of an Adenotonsillectomy on the Cognitive and Behavioural Function of Children Who Snore: A naturalistic observational study

Abstract

Objectives: This study aimed to evaluate cognitive and behavioural changes among 9–14-year-old Omani children with obstructive sleep apnoea (OSA) after an adenotonsillectomy (AT). Methods: This naturalistic observational study was conducted at the Sultan Qaboos University Hospital, Muscat, Oman, between January 2012 and December 2014. Omani children with adenotonsillar hypertrophy (ATH) underwent overnight polysomnography and those with confirmed OSA were scheduled for an AT. Cognitive and behavioural evaluations were performed using standardised instruments at baseline prior to the procedure and three months afterwards. Results: A total of 37 children were included in the study, of which 24 (65%) were male and 13 (35%) were female. The mean age of the males was 11.4 ± 1.9 years, while that of the females was 11.1 ± 1.5 years. Following the AT, there was a significant reduction of 56% in mean apnoea-hypopnoea index (AHI) score (2.36 ± 4.88 versus 5.37 ± 7.17; P <0.01). There was also a significant positive reduction in OSA indices, including oxygen desaturation index (78%), number of desaturations (68%) and number of obstructive apnoea incidents (74%; P <0.01 each). Significant improvements were noted in neurocognitive function, including attention/concentration (42%), verbal fluency (92%), learning/recall (38%), executive function (52%) and general intellectual ability (33%; P <0.01 each). There was a significant decrease of 21% in both mean inattention and hyperactivity scores (P <0.01 each). Conclusion: These results demonstrate the effectiveness of an AT in improving cognitive function and attention deficit hyperactivity disorder-like symptoms among children with ATH-caused OSA. Such changes can be observed as early as three months after the procedure.Keywords: Adenoidectomy; Obstructive Sleep Apnea; Cognitive Function; Behavior; Attention Deficit Hyperactivity Disorders; Children; Oman.

The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD)

“…A study done by Al-Zaabi et al (2018) aimed to evaluate cognitive and behavioral changes among children aged nine to 14 with OSA after adenotonsillectomy. The results of the study showed a 33% improvement in neurocognitive function and general intellectual ability, as well as a 21% reduction in inattention and hyperactivity scores, thus showing evidence of the effectiveness of adenotonsillectomy in improving ADHD-like symptoms among children [ 29 ].…”

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].…”

“…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.…”

“…Four articles, three RCTs [3,56,59] and one prospective cohort studio [58] evaluated the effect of AT on the results of the neurocognitive performance (Table 4).…”