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

Khalid Al-Zaabi¹, Samir Al-Adawi², Sanjay Jaju³

¹Department of Surgery, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman.

Sultan Qaboos University Medical Journal

|April 17, 2019

Insights

Adenotonsillectomy (AT) significantly improved cognitive function and reduced attention deficit hyperactivity disorder-like symptoms in Omani children with obstructive sleep apnoea (OSA). These positive changes in children with adenotonsillar hypertrophy (ATH) were evident within three months post-surgery.

Area of Science:

Pediatric Sleep Medicine
Otorhinolaryngology
Pediatric Neurology

Background:

Obstructive sleep apnoea (OSA) in children, often caused by adenotonsillar hypertrophy (ATH), can lead to significant cognitive and behavioral impairments.
Early diagnosis and intervention are crucial for mitigating long-term effects on child development.

Purpose of the Study:

To evaluate the impact of adenotonsillectomy (AT) on cognitive function and behavioral changes in Omani children diagnosed with OSA.
To assess the effectiveness of AT in improving neurocognitive deficits and attention-related symptoms in pediatric patients.

Main Methods:

A naturalistic observational study involving 37 Omani children (ages 9-14) with ATH-confirmed OSA.
Baseline and three-month post-adenotonsillectomy (AT) assessments using polysomnography and standardized cognitive/behavioral instruments.
Analysis of changes in apnoea-hypopnoea index (AHI) and neurocognitive/behavioral scores.

Main Results:

Adenotonsillectomy (AT) led to a significant reduction in OSA severity, with a 56% decrease in mean apnoea-hypopnoea index (AHI) and substantial improvements in oxygen desaturation and obstructive events.
Significant improvements were observed in various cognitive domains, including attention/concentration (42%), verbal fluency (92%), learning/recall (38%), executive function (52%), and general intellectual ability (33%).
A notable decrease of 21% in both inattention and hyperactivity scores indicated improvement in attention deficit hyperactivity disorder-like symptoms.

Conclusions:

Adenotonsillectomy (AT) is an effective treatment for improving cognitive function and reducing ADHD-like symptoms in children with OSA secondary to ATH.
The positive effects of AT on neurocognitive and behavioral outcomes can be observed as early as three months after the surgical intervention.

Read full analysis

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 Attention Deficit Hyperactivity Disorders Behavior Children Cognitive Function Obstructive Sleep Apnea Oman

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