Tonsillectomy May Improve Behavioral Problems in School-Aged Children with Apnea

Scottsdale, AZ - May 8, 2001

Experts estimate that between one and three percent of all school-aged children experience sleep-disordered breathing every night. Surgical removal of the tonsils and adenoids (adenotonsillectomy) is usually recommended as treatment for this disorder. Research now indicates the procedure may also improve behavioral, cognitive, and neurocognitive difficulties often seen in children with sleep-disordered breathing, or obstructive sleep apnea (OSA).

Obstructive sleep apnea is often caused by enlarged tonsils and adenoids, compromising the upper airway and making breathing difficult at night. Twenty-five percent of children with OSA have a high prevalence of behavioral or emotional problems, decreasing their quality of life as well as that of family and teachers.

In the study, "Impact of Tonsillectomy and Adenoidectomy on Child Behavior," authors Mahnur Fatima, MD, Nira Goldstein, MD, and Richard M. Rosenfeld, MD, MPH, all of State University of New York Health Sciences Center at Brooklyn, and Thomas F. Campbell, PhD, of the University of Pittsburgh, have found a decrease in behavioral and emotional problems for children with OSA after undergoing adenotonsillectomy. Their findings were presented at the 16th Annual Meeting of the American Society of Pediatric Otolaryngology in Scottsdale, AZ.

Methodology

Parents of 64 children age two through 18 who were scheduled for adenotonsillectomy for treatment of OSA, recurrent tonsillitis, or both from July 1, 1999 through December 31, 2000 were recruited for this study. Parents were asked to complete a standard questionnaire that recorded demographic information, family socioeconomic status and education level. Additionally, a Child Behavior Checklist (CBCL) was completed prior to surgery and three months post-operatively. Teachers of children age five through 18 were asked to complete a Teacher's Report Form (TRF) prior to surgery and three months post-operatively. These responses were evaluated with OSA-18, an 18 item health-related quality of life (QoL) survey of pediatric OSAS, which has been correlated with the respiratory disturbance index (RDI) on NAP polysomnography.

Results

Male to female patient ratio was 1.3:1 with a mean age of 5.8. All children underwent adenotonsillectomy, with 14 having additional procedures done concurrently.

The OSA-18 pre- and post-operative scores indicated a large change in quality of life for physical symptoms, while a moderate quality of life change was noted for emotional symptoms.

Responses to the CBCL survey were difficult to evaluate, as some of the responses were incomplete. However, a trend toward improvement in behavior was noted.

Only 17 teachers completed the TRF, relating no significant difference in post-operative scores. Of those children whose teachers completed surveys, 24 percent underwent adenotonsillectomy for recurrent tonsillitis alone versus the study total of 61 percent for OSA alone and 23 percent for both OSA and recurrent tonsillitis, possibly accounting for results of insignificant behavior change.

Conclusion

This study provides statistically verified evidence that behavioral, emotional, and neurocognitive difficulties are present in children with sleep-disordered breathing and improve following treatment by adenotonsillectomy, demonstrating a significant increase in quality of life.