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Effects of adenotonsillectomy on neurocognitive and behavioural function in pediatric obstructive sleep apnea syndrome.
Objectives: Aim of this study is to verify the presence of neurocognitive, neurobehavioral or sleep disturbances in children affected by adenotonsillar hypertrophy (ATH) and Obstructive Sleep Apnea Syndrome (OSAS) and verify their improvement after Adeno-Tonsillectomy (AT).
Methods: Eighty children suffering from adenotonsillar hypertrophy and OSAS were recruited for AT in the ENT Department of the University of Palermo. All the children underwent clinical evaluation, including rhinofibroscopy for grading the obstruction due to the adenotonsillar hypertrophy (before and 6 months after surgery), and polysomnography and 6 months after surgery. Two different rating scales were administered to the parents, the Sleep Disturbance Scale for Children (SDSC) for the evaluation of sleep disturbance and the subscales B and C of the Conners’ Parent Rating Scale Revisited (CPRS-R) for the evaluation of behavioral disturbances (before and 6 months after surgery).
Results: Children’s mean age was 5.3 + 1.6 years with a percentage of 59.2% for male and 40.8% for female. All patients showed adenotonsillar hypertrophy grade III-IV. Polisomnography showed the presence of moderate OSAS in 72.6% of the children and severe in 27.2%. In the preoperative evaluation all the children had pathological values in the CPRS-R, regarding the cognitive and inattention subscale (B) and the hyperactivity subscale (C). In the SDSC results were also pathological, with variables depending on the subscales. After AT, CPRS-R evidenced a statistically significant improvement in scores for all children. Even SDSC scale postoperatively showed a statistically significant improvement in the scores of each subscale.
Conclusion: Adenotonsillar hypertrophy is the most frequent cause of snoring and OSAS in children. OSAS in children is a frequent cause of sleep disorders and daytime behavioral changes. AT in children improve significantly both OSAS and behavioral disturbances.