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Published on: December 6, 2016
Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea
H Gerry Taylor1, Susan R Bowen1, Dean W Beebe2
1Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;
Insights
Adenotonsillectomy (AT) showed small, selective cognitive benefits in children with obstructive sleep apnea syndrome (OSAS). These improvements in nonverbal reasoning and attention suggest limited but positive effects of AT on cognitive function.
Area of Science:
- Pediatric Sleep Medicine
- Neuropsychology
- Otolaryngology
Background:
- Obstructive sleep apnea syndrome (OSAS) in children can impact cognitive function.
- Evidence regarding the effects of adenotonsillectomy (AT) on cognitive test performance in children with OSAS is mixed.
- The Childhood Adenotonsillectomy Trial (ChAT) provides a robust dataset to investigate these effects.
Purpose of the Study:
- To evaluate the impact of adenotonsillectomy (AT) on cognitive test scores in children diagnosed with obstructive sleep apnea syndrome (OSAS).
- To compare cognitive changes between children undergoing early AT versus watchful waiting within the ChAT study.
- To explore the relationship between cognitive improvements and sleep measure changes following AT.
Main Methods:
- Randomized controlled trial comparing early AT (eAT) with watchful waiting in children aged 5-9 with OSAS.
- Neuropsychological tests administered at baseline and 7 months post-intervention.
- Mixed-effects models and regression analyses used to compare group changes and assess associations with sleep measures.
Main Results:
- Cognitive scores improved significantly more in the eAT group than the watchful waiting group (P < .05).
- Improvements were observed in nonverbal reasoning, fine motor skills, and selective attention, with small effect sizes (Cohen's d, 0.20-0.24).
- Gains in cognitive test scores for the eAT group correlated with improvements in sleep measures.
Conclusions:
- Adenotonsillectomy (AT) demonstrates small, selective positive effects on specific cognitive domains in children with OSAS.
- These cognitive benefits may be limited or require longer follow-up to become fully apparent compared to broader effects of AT on sleep, behavior, and quality of life.
- Further research with extended follow-up is warranted to fully elucidate the long-term cognitive impact of AT in pediatric OSAS.
Objective:
Research reveals mixed evidence for the effects of adenotonsillectomy (AT) on cognitive tests in children with obstructive sleep apnea syndrome (OSAS). The primary aim of the study was to investigate effects of AT on cognitive test scores in the randomized Childhood Adenotonsillectomy Trial.
Methods:
Children ages 5 to 9 years with OSAS without prolonged oxyhemoglobin desaturation were randomly assigned to watchful waiting with supportive care (n = 227) or early AT (eAT, n = 226). Neuropsychological tests were administered before the intervention and 7 months after the intervention. Mixed model analysis compared the groups on changes in test scores across follow-up, and regression analysis examined associations of these changes in the eAT group with changes in sleep measures.
Results:
Mean test scores were within the average range for both groups. Scores improved significantly (P < .05) more across follow-up for the eAT group than for the watchful waiting group. These differences were found only on measures of nonverbal reasoning, fine motor skills, and selective attention and had small effects sizes (Cohen's d, 0.20-0.24). As additional evidence for AT-related effects on scores, gains in test scores for the eAT group were associated with improvements in sleep measures.
Conclusions:
Small and selective effects of AT were observed on cognitive tests in children with OSAS without prolonged desaturation. Relative to evidence from Childhood Adenotonsillectomy Trial for larger effects of surgery on sleep, behavior, and quality of life, AT may have limited benefits in reversing any cognitive effects of OSAS, or these benefits may require more extended follow-up to become manifest.
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