From the Journals

Adenotonsillectomy doesn’t improve cognitive function in preschoolers with OSA



Adenotonsillectomy does not improve cognitive function in preschoolers with mild obstructive sleep apnea, according to a prospective study.

The study showed no significant difference in global IQ at 12 months between children who underwent adenotonsillectomy and those who did not. However, as expected, the adenotonsillectomy group did experience improvements in sleep.

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Karen A. Waters, MBBS, PhD, of the Children’s Hospital at Westmead and the University of Sydney, and her colleagues reported these results in Pediatrics. There also was a related commentary.

The study enrolled 190 children (ages 3-5 years) with mild obstructive sleep apnea. Roughly half of patients (n = 99) were randomized to early adenotonsillectomy (within 2 months), and the other half (n = 91) were randomized to no adenotonsillectomy (12-month routine wait). There were 121 patients who had global IQ assessments at 12 months, as measured by the Woodcock Johnson III Brief Intellectual Ability (BIA) test. Of these patients, 61 were in the adenotonsillectomy group, and 60 were in the control group.

Both groups had improvements in BIA scores from baseline to 12 months, and the 12-month BIA score was not significantly different between the groups.

At baseline, the mean W score (task proficiency) for BIA was 448.36 in the adenotonsillectomy group and 451.3 in the control group. At 12 months, the scores were 465.46 and 463.12, respectively (P = .29).

“Intellectual ability scores improved in both groups over time with no effect attributable to the intervention [adenotonsillectomy],” Dr. Waters and her colleagues wrote.

However, patients in the adenotonsillectomy group did have greater improvements in sleep than patients in the control group, as assessed by polysomnogram and parent reports.

In the adenotonsillectomy group, the mean total sleep time was 469.2 minutes at baseline and 481.8 minutes at 12 months. In the control group, the mean total sleep time was 463.8 minutes at baseline and 475.3 minutes at 12 months. The adjusted mean difference was –2.12 (P less than .001).

According to parent reports, children in the adenotonsillectomy group were significantly less likely than those in the control group to have trouble sleeping at night at 12 months: 8% and 74%, respectively (P less than .001).

“Children randomly assigned to adenotonsillectomy did show greater improvement in polysomnography obstructive indices and parent-reported behavior but did not demonstrate a treatment-attributable improvement in cognitive function,” David O. Francis, MD, of University of Wisconsin–Madison, and Derek J. Lam, MD, of Oregon Health & Science University in Portland, wrote in a related commentary.

The commentators noted that these results are similar to those of the CHAT study, which showed no significant differences in Developmental Neuropsychological Assessment results between children (ages 5-9 years) who underwent adenotonsillectomy and those who did not (N Engl J Med. 2013 Jun 20;368[25]:2366-76).

The current study was funded by the National Health and Medical Research Council, Sydney University, The Garnett Passe and Rodney Williams Memorial Foundation, and The Golden Casket, Brisbane. Dr. Waters, her coauthors, and the commentary authors said they have no relevant conflicts of interest. The commentators received no external funding.

SOURCE: Waters KA et al. Pediatrics. 2020;145(2):e20191450; Francis DO and Lam DJ. Pediatrics. 2020;145(2):e20192479.

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