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The removal of the tonsils and adenoids—the tissue that sits where the back of the nose meets the throat—called an adenotonsillectomy, is performed approximately 500,000 times a year in the U.S., and is often used as a treatment for children with obstructive sleep apnea. However, the procedure’s ability to improve a child’s attention and functioning skills, behavior, sleep apnea symptoms and quality of life has not been rigorously evaluated until now.
A study led by Susan Redline, MD, MPH, director of the Program in Sleep and Cardiovascular Medicine and associate clinic director of the Division of Sleep Medicine at BWH, found that early adenotonsillectomy in children with mild to moderately severe sleep apnea—a sleep disorder characterized by repetitive pauses in breathing during sleep—can be beneficial in improving a child’s behavior, sleep apnea symptoms and quality of life. Findings did not show improved attention or functioning skills associated with the early procedure.
“Our study provided evidence that surgical treatment can lead to early improvements in many health-related areas of importance to children and their families,” said Redline. “Beneficial effects of surgery were shown among overweight children as well, in whom the effectiveness of surgery has been questioned.”
The study, which was conducted in partnership with eight other institutions, examined 397 children between the ages of 5 and 9 who had obstructive sleep apnea syndrome without prolonged levels of low oxygen—another characteristic of sleep apnea. The children were randomly placed in two groups, with 194 children undergoing adenotonsillectomy within four weeks of entering the study. The remaining 203 children were monitored to see if their sleep apnea symptoms improved without surgery.
Both groups underwent assessments after seven months. Researchers found significant improvements in the quality of life, sleep apnea symptoms and behavior among children who had the early procedure, and no significant difference between the groups in the improvement of attention and functioning skills.
“This new evidence should be carefully considered by physicians and parents who are deciding on the best approach for a child’s sleep apnea problem,” said Redline. “It should be noted that the study showed that many times, sleep apnea resolved without surgery. Thus, watchful waiting is also a reasonable option for some children with sleep apnea without many symptoms.”