Pediatric OSA: no cognitive benefit seen from adenotonsillectomy

  • Pediatrics
  • 09/01/2020

  • Susan London
  • Clinical Essentials
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Takeaway

  • Adenotonsillectomy was tied to improved measures of sleep and behavior but not cognition among preschoolers with symptomatic, predominantly mild obstructive sleep apnea (OSA).

Why this matters

  • Commentary authors: the effect of the surgery on other, specific cognitive measures in this age group and potential long-term outcomes remain unclear.

Key results

  • Improvement in global scores on the Woodcock Johnson III Brief Intellectual Ability scale was similar with and without adenotonsillectomy.
  • Mean adjusted 12-month global scores did not differ between groups (465.46 vs 463.12; P=.29).
  • However, other outcomes were better with vs without adenotonsillectomy (adjusted mean difference between groups):
    • Polysomnogram arousals: –4.15/hour (P=.001);
    • Apnea hypopnea index: –1.11 events/hour (P=.0001);
    • Obstructive apnea hypopnea index: –0.98 events/hour (P<.0001>
    • Proportion Pediatric Sleep Questionnaire “yes” responses: 2.89 (P=.07); and
    • Behavior Assessment System for Children behavioral symptoms: –3.56 (P=.03).

Study design

  • Australian multicenter randomized controlled trial among 190 children ages 3-5 years with symptomatic OSA (POSTA study).
  • Randomization: early adenotonsillectomy (within 2 months) vs no adenotonsillectomy (12-month waitlist).
  • Main outcome: global intelligence quotient scores at 12 months.
  • Funding: National Health and Medical Research Council; Sydney University; others.

Limitations

  • Losses to follow-up.
  • OSA was generally mild.