Adenotonsillectomy Improves Both Sleep and Behavior

By Splete, Heidi | Clinical Psychiatry News, August 2006 | Go to article overview
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Adenotonsillectomy Improves Both Sleep and Behavior


Splete, Heidi, Clinical Psychiatry News


CHICAGO -- Adenotonsillectomy improved both sleep and behavior in a pair of studies presented at the Combined Otolaryngology Spring Meetings.

Children with either obstructive sleep apnea syndrome (OSAS) or mild sleep disordered breathing (SDB) demonstrated significantly improved scores on behavior measurements after adenotonsillectomy, compared with presurgery scores, which suggests that symptom severity does not affect improvement, said Dr. Ron B. Mitchell, a pediatric laryngologist at Virginia Commonwealth University in Richmond.

Of 40 children aged 3-18 years, 23 had OSAS and 17 had SDB; demographics were similar between the two groups. The mean apnea-hypopnea index prior to surgery was 25 among the children with OSAS and 3 among those with SDB.

At a follow-up evaluation an average of 3 months after an adenotonsillectomy, children in both the OSAS and SDB groups showed significant improvements, compared with presurgery scores on the Behavior Symptom Index, a global measure of behavior. Differences in postsurgery scores between the two groups were not significant, however.

In addition, scores on the Behavior Assessment System for Children subscales of depression, hyperactivity, atypicality, and somatization were significantly improved after surgery, compared with presurgery scores for children in both groups, and the scores did not differ significantly between the groups.

All children had been measured with polysomnography and had undergone comprehensive behavior assessments prior to surgery. Children with comorbidities were excluded. The study was limited by the absence of a control group, the short follow-up period, and the selection bias inherent in the use of a population at a specialized clinic for sleep problems.

"Without a control group, all we can say is that adenotonsillectomy and improved behavior were associated, not necessarily correlated," said Dr. Mitchell.

However, the study suggests that SDB is associated with a significant amount of behavioral morbidity regardless of the severity of the condition, and that these problems improve after adenotonsillectomy regardless of whether the child has only mild SDB or OSAS, he said.

In a second study of children with SDB, the 71 for whom follow-up data were available showed significant improvement in both sleep and behavior based on the pediatric sleep questionnaire (PSQ) and the Conners' Parent Rating Scale-Revised (CPRS-RS).

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