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Neurobehavioral outcomes after adenotonsillectomy for pediatric sleep-disordered breathing: A systematic review and

Yi-Chieh Lee1, Chun-Ting Lu1, Yun-Ting Wang2

  • 1Department of Otolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.

American Journal of Otolaryngology
|July 15, 2026
PubMed

Insights

Adenotonsillectomy surgery moderately improves behavior and executive function in children with sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA). Effects on objective neurocognitive and ADHD measures require further study.

Area of Science:

  • Pediatric Sleep Medicine
  • Otolaryngology
  • Neuroscience

Background:

  • Pediatric sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) are prevalent conditions.
  • These conditions are linked to significant neurocognitive and behavioral deficits in children.
  • Adenotonsillectomy is a common treatment, but its impact on neurocognition and behavior is debated.

Purpose of the Study:

  • To conduct a meta-analysis evaluating the effects of adenotonsillectomy on neurocognition and behavior in pediatric patients with SDB/OSA.
  • To synthesize existing evidence on surgical outcomes for these specific patient populations.

Main Methods:

  • Systematic literature search up to August 15, 2025.
  • Inclusion of eight original studies for meta-analysis.
  • Application of random-effects models for pooled estimates, with subgroup analyses and meta-regression.

Main Results:

  • Moderate improvement observed in parent-reported behavioral measures (SMD = -0.58).
  • Significant, though smaller, improvement in executive function (SMD = -0.25).
  • Objective neurocognitive and ADHD-related measures did not reach statistical significance, but favored surgical intervention.

Conclusions:

  • Adenotonsillectomy offers a reliable benefit for parent-reported behavioral symptoms and executive function in children with SDB/OSA.
  • Further research is needed to clarify the impact of surgery on objective neurocognitive and ADHD-related outcomes.

Keywords:
AdenotonsillectomyBehaviorNeurocognitionPediatric OSASleep-disorder breathing

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