Adenotonsillectomy for Obstructive Sleep Apnea

ADENOTONSILLECTOMY FOR OBSTRUCTIVE SLEEP APNEA IMPROVES A CHILD'S BREATHING AND A WIDE RANGE OF BEHAVIORAL PROBLEMS

Obstructive sleep apnea syndrome (OSAS) is a serious medical disorder that is normally associated with adults but can also strike children, often with more serious consequences. A new study reveals that removing a child's tonsils and adenoids can alleviate OSAS symptoms plus improve overall behavior.

Children are often diagnosed with obstructive sleep apnea syndrome because of nighttime breathing difficulties. Reported symptoms include snoring, choking, gasping, struggling to breathe, restless sleep, unusual sleeping positions, and frequent awakenings. Daytime sleepiness is not as prevalent a symptom as it is in adults with OSAS.

Children with OSAS also display a wide range of behavioral disturbances, including learning difficulties, attention disorders, hyperactivity, aggression, and antisocial behavior. When OSAS is diagnosed, the typical treatment is a tonsillectomy and adenoidectomy (when performed concurrently, called an adenotonsillectomy). Most assessments of the procedure's effectiveness have focused on the surgery's impact on the physical symptoms. Now, a new study evaluates the surgery's impact on the behavioral and emotional problems of children with OSAS or upper airway obstruction by using a standardized assessment, the Child Behavior Checklist (CBCL).

Participating in the study, "Impact on Tonsillectomy and Adenoidectomy on Child Behavior," are Nira A. Goldstein MD and Richard M. Rosenfeld MD (SUNY Health Science Center, Brooklyn, NY); J. Christopher Post MD (Allegheny General Hospital, Pittsburgh, PA); and Thomas F. Campbell, PhD (University of Pittsburgh and Children's Hospital of Pittsburgh). The study findings were presented April 29 at the annual meeting of the American Society of Pediatric Otolaryngology, being held April 28-30 at the Marriott's Desert Springs, Palm Desert, CA.

Methodology: Parents of children scheduled for a tonsillectomy and adenoidectomy were recruited at the otolaryngology clinic at the Children's Hospital of Pittsburgh. To be included, the children had to display typical symptoms associated with OSAS; no sleep studies were performed on any of the children.

Prior to the tonsillectomy and adenoidectomy and three months postoperatively, parents of the children completed two forms: (1) a standard questionnaire that recorded demographic information regarding the frequency of OSAS symptoms and (2) The Child Behavior Checklist for ages 2-3 or 4-18, a reliable survey instrument that has been in use since 1991.

Results: Parents of 36 children, ages 2 through 18, participated in the study. Prior to the surgical procedure, 10 children (or 28 percent) displayed abnormal behavior. After the surgery, only two of the children displayed qualities indicative of abnormal behavior.

The study suggests that parents who suspect their child has obstructive sleep apnea syndrome should investigate a surgical option to alleviate physical symptoms and behavioral abnormalities.

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Contact Ken Satterfield at 703-519-1563 (until 4/22) or 760-776-8503 (4/22-4/29) for an interview with Dr. Goldstein or additional information.