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Adenotonsillectomy May Benefit Children With Sleep-Related Breathing Disorders

According to a prospective, nonrandomized interventional study results, kids who underwent adenotonsillectomy appeared to sleep better than they did before surgery, but not as well as they did 6 months after surgery.

In our previous study, we found a statistically significant improvement in sleep after adenotonsillectomy as measured by a reduction in the [Pediatric Sleep Questionnaire (PSQ)] scores, write Julie L. Wei, MD, from the University of Kansas School of Medicine in Kansas City, and colleagues. The present study prospectively analyzed the same group of patients to see whether the improvements in sleep and behavior were maintained over time and to evaluate changes in sleep and behavior 2.5 years after surgery.

This follow-up study was conducted at an ambulatory surgery center affiliated with an academic medical center involving 71 patients. Of all, for 44 patients who completed the initial study comparing PSQ and Conners Parent Rating Scale-Revised: Short Form data before and 6 months after surgery, long-term follow-up data were available. Parents completed the PSQ and Conners Parent Rating Scale-Revised: Short Form at least 2 years after surgery.

The 4 Conners behavior categories tested included oppositional behavior, cognitive problems or inattention, hyperactivity, and attention-deficit/hyperactivity disorder index. The patients had follow-up ranged from 2.4 to 3.6 years after adenotonsillectomy. For each patient assessment of follow-up PSQ data and long-term changes in age- and sex-adjusted T scores was done for all 4 Conners behavior categories, and linear mixed models were used for analysis.

Across time, although most measures stayed below baseline levels (P <.05), there was a significant increase in PSQ scores during follow-up. But even during follow-up PSQ scores did not reach baseline levels. The Conners scores in all behavioral categories did not increase significantly from short-term to long-term follow-up (attention-deficit/hyperactivity disorder index, P = .61; cognitive problems or inattention, P = .02; hyperactivity, P < .001; and oppositional behavior, P < .001). The attention-deficit/hyperactivity disorder index at long-term follow-up did not differ significantly from that at baseline, which might be attributable to the high degree of variability in this measure.

Improvements in sleep experienced by children after adenotonsillectomy for sleep-disordered breathing were not as great 2.5 years after surgery as they were 6 months after surgery but were still significant compared with baseline levels, the study authors write. Improvements in behavior were maintained in all categories of the Conners scores except for the [attention-deficit/hyperactivity disorder] index.

The study limitations included that fewer of the older patients were involved in long-term follow-up, that it had an observational design precluding determination of causality, and a lack of polysomnography data.

Several studies have demonstrated improvement in behavior, cognition, and quality of life after adenotonsillectomy for [sleep-disordered breathing] using validated instruments, but because of the absence of randomized trial data, the definitive evidence for the efficacy of adenotonsillectomy for [sleep-disordered breathing] has not yet been fully demonstrated, the study authors conclude.