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Adenotonsillectomy Improves Sleep Apnea in Children

As symptoms lessen, so do related behavioral issues.

Published: May 23, 2013

Children with moderate obstructive sleep apnea who undergo adenotonsillectomy showed greater reductions in symptoms and behavioral issues compared to non-surgical patients, according to a landmark study published in the New England Journal of Medicine.

The Childhood Adenotonsillectomy Trial, the first randomized study of sleep apnea surgery in children, involved 464 pediatric patients, nearly half of whom were overweight or obese, assigned to surgical treatment or watchful waiting with supportive care groups.

Children who underwent adenotonsillectomy, the surgical removal of adenoid and tonsils, were less sleepy during the day, had less trouble sleeping at night, got along better with other kids, kept up with daily tasks, exhibited less mood swings or angry outbursts, and worried less.

However, children in both the surgical and non-surgical groups showed no significant difference in the Developmental Neuropsychological Assessment, a test administered by licensed psychometricians to measure performances in attention and executive functioning — planning, strategizing, organizing, setting goals and paying attention to important details.

Adenotonsillectomy is the primary treatment for obstructive sleep apnea, the researchers note, with more than 500,000 kids undergoing the procedure annually. But watchful waiting is also a safe treatment option, says Carole Marcus, MD, the study's lead author and a sleep specialist and director of the sleep center at Children's Hospital of Philadelphia. She believes it's a reasonable treatment option for children with less severe sleep apnea, as long as physicians monitor the condition to ensure it doesn't worsen.

Daniel Cook


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