Early Surgery Reduces Psychiatric and Learning Disorder Risk in Pediatric Sleep-Disordered Breathing

To determine whether the type and timing of intervention for pediatric sleep-disordered breathing (SDB) affect the risk of developing neuropsychiatric and learning disorders.

A retrospective cohort study using TriNetX, from January 2016 to March 2025, was conducted. Patients < 18 years with a diagnosis of SDB were included. Propensity score matching (1:1) based on demographics and concomitant diagnoses was performed for three comparisons: untreated versus surgical management (n = 152,653), untreated versus non-surgical management (n = 8,634), and surgical versus non-surgical management (n = 8,873). The incidence of anxiety, depressive, eating, behavioral, and learning disorders at 1 year, 5 years, and anytime post-intervention was recorded. In surgical patients, outcomes were also stratified by timing of surgery: within versus beyond 3, 6, and 12 months of diagnosis.

Compared to surgery, no treatment was associated with significantly elevated risk of anxiety (risk ratio [RR] 1.44), depressive (RR 1.71), eating (RR 1.27), behavioral (RR 1.31), and learning disorders (RR 1.39) at 1 year. Compared to surgery, non-surgical management significantly increased the risk of anxiety (RR 2.27), depressive (RR 1.69), behavioral (RR 1.24), and learning disorders (RR 2.72) at 1 year. Similar trends were observed at 5 years. Surgery within 6 months significantly reduced the risk of anxiety (RR 1.06), eating (RR 1.38), behavioral (RR 1.12), and learning disorders (RR 1.14) (p < 0.05 for all comparisons).

Early surgical intervention for pediatric SDB is associated with significantly lower risks of neuropsychiatric and learning disorders compared to delayed surgery, non-surgical management, or no treatment, necessitating validation through future prospective trials.