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Cognition After Early Tonsillectomy for Mild OSA
Karen A Waters1,2, Jasneek Chawla3,4, Margaret-Anne Harris3
1Department of Sleep Medicine, The Children's Hospital at Westmead, Westmead, Australia; karen.waters@health.nsw.gov.au.
Insights
Adenotonsillectomy for obstructive sleep apnea in children did not improve cognitive function. However, surgery did lead to improvements in sleep and behavior, according to parent reports and polysomnogram monitoring.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Developmental Psychology
Background:
- Obstructive sleep apnea (OSA) is common in preschool children.
- The impact of adenotonsillectomy on cognitive function in pediatric OSA remains unclear.
- The Preschool Obstructive Sleep Apnea Tonsillectomy and Adenoidectomy (PATS) study aimed to clarify this uncertainty.
Purpose of the Study:
- To evaluate the effect of adenotonsillectomy on cognitive function in preschool children with OSA.
- To compare outcomes 12 months after surgery versus a non-surgical waitlist approach.
- To assess changes in sleep, behavior, and other health indicators post-surgery.
Main Methods:
- A prospective randomized controlled trial involving 190 children aged 3-5 years with symptomatic OSA.
- Participants were randomized to early adenotonsillectomy or a 12-month non-surgical waitlist (NoAT).
- Cognitive (global IQ via Woodcock Johnson III BIA), behavioral, sleep (polysomnography), and medical assessments were conducted at baseline and 12 months.
Main Results:
- No significant difference in global IQ (BIA scores) was observed between the adenotonsillectomy and NoAT groups at 12 months.
- Adenotonsillectomy significantly improved polysomnogram measures of sleep, including arousal and apnea indices.
- Parents reported improvements in behavioral symptoms, overall health, and daytime napping after surgery.
Conclusions:
- Adenotonsillectomy does not appear to enhance cognitive function in preschool children with OSA within 12 months.
- The surgery effectively improves objective sleep parameters and subjective behavioral and health outcomes.
- Further research may explore longer-term cognitive effects or specific subgroups benefiting from intervention.
Objectives:
It remains uncertain whether treatment with adenotonsillectomy for obstructive sleep apnea in children improves cognitive function. The Preschool Obstructive Sleep Apnea Tonsillectomy and Adenoidectomy study was a prospective randomized controlled study in which researchers evaluated outcomes 12 months after adenotonsillectomy compared with no surgery in preschool children symptomatic for obstructive sleep apnea.
Methods:
A total of 190 children (age 3-5 years) were randomly assigned to early adenotonsillectomy (within 2 months) or to routine wait lists (12-month wait, no adenotonsillectomy [NoAT]). Baseline and 12-month assessments included cognitive and behavioral testing, medical assessment, polysomnography, and audiology. The primary outcome was global IQ at 12-month follow-up, measured by the Woodcock Johnson III Brief Intellectual Ability (BIA). Questionnaires included the Pediatric Sleep Questionnaire, Parent Rating Scale of the Behavioral Assessment System for Children-II, and Behavior Rating Inventory of Executive Function, Preschool Version.
Results:
A total of 141 children (75.8%) attended baseline and 12-month assessments, and BIA was obtained at baseline and 12-month follow-up for 61 and 60 participants in the adenotonsillectomy versus NoAT groups, respectively. No cognitive gain was found after adenotonsillectomy compared with NoAT, adjusted for baseline; BIA scores at 12-month follow-up were as follows: adenotonsillectomy, 465.46 (17.9) versus NoAT, 463.12 (16.6) (mean [SD]). Improvements were seen for polysomnogram arousals and apnea indices and for parent reports of symptoms (Pediatric Sleep Questionnaire), behavior (Behavior Assessment System for Children behavioral symptoms, P = .04), overall health, and daytime napping.
Conclusions:
Structured testing showed no treatment-attributable improvement in cognitive functioning of preschool children 12 months after adenotonsillectomy compared with NoAT. Improvements were seen after adenotonsillectomy in sleep and behavior by using polysomnogram monitoring and parental questionnaires.
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