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Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and
Sungjin A Song1, Anthony M Tolisano1, Benjamin B Cable1
1Department of Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
Insights
Pediatric adenotonsillectomy significantly improves neurocognitive function and IQ scores in children. This benefit is most pronounced in younger children, suggesting a potential age-related threshold for irreversible deficits.
Area of Science:
- Pediatric Otolaryngology
- Neurodevelopmental Pediatrics
- Evidence-Based Medicine
Background:
- Obstructive sleep-related breathing disorders are common in children.
- Adenotonsillectomy is a primary treatment for these conditions.
- The impact of adenotonsillectomy on neurocognitive function requires systematic evaluation.
Purpose of the Study:
- To systematically review and critically appraise prospective studies on neurocognitive outcomes in children following adenotonsillectomy.
- To synthesize evidence on the effects of adenotonsillectomy on cognitive development.
Main Methods:
- Systematic literature search of PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library.
- Inclusion of nineteen prospective studies involving 898 pediatric adenotonsillectomy patients.
- Analysis of pre- and post-operative neurocognitive assessment scores and apnea-hypopnea index (AHI).
Main Results:
- Significant improvements observed in Neuropsychological Developmental Assessment scores (p<0.0001) and IQ scores (p<0.0001) post-adenotonsillectomy.
- Average AHI decreased from 8.0 to 1.8, indicating effective treatment of sleep-disordered breathing.
- Improvements were particularly noted in younger children, though based on limited studies.
Conclusions:
- Pediatric adenotonsillectomy is associated with enhanced neurocognitive function and IQ.
- The positive effects appear more significant in pre-school aged children.
- Further research is needed to understand age-related efficacy and potential irreversible neurocognitive deficits in older children.
Objective:
To provide an up-to-date systematic review and critical appraisal of prospectively performed studies evaluating neurocognitive function in children treated with adenotonsillectomy.
Data Sources:
PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library.
Review Methods:
Searches were performed from inception through September 2, 2015.
Results:
Nineteen prospective studies (898 adenotonsillectomy patients) met criteria and reported neurocognitive outcomes. The average age of children was 6.6±2.3 years (range 2.5-14 years) and 51.1% were male. Pre- and post-operative data utilizing the Neuropsychological Developmental Assessment score demonstrated an increase from a means±standard deviations of 101.5±14.7 [95% CI 100.0, 103.0] to 108.8±13.4 [95% CI 107.4, 110.2], p-value <0.0001 (375 children, three studies). Pre- and post-operative data utilizing the Stanford-Binet Intelligence Scales (IQ) demonstrated an increase in IQ scores from a means±standard deviations of 97.1±13.8 [95% CI 91.6, 95.4] to 100.7±11.1 [95% CI 100.4, 103.4], p-value <0.0001 (254 children, three studies). The mean pre- and post-adenotonsillectomy apnea-hypopnea index (AHI) decreased from 8.0 to 1.8 (274 children, six studies).
Conclusions:
This meta-analysis found an improvement in neurocognitive function and IQ after pediatric adenotonsillectomy, especially in pre-school aged children. However, this must be interpreted with caution as only three studies were performed in pre-school aged children. The decreased effectiveness in older children suggests possibly a threshold age when neurocognitive deficits become irreversible.
