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| |  Adenotonsillectomy Associated With Ongoing Benefits for Children Sleep-Disordered Breathing CHICAGO -- July 20, 2009 -- Two and a half years after children with sleep-related breathing disorders had surgery to remove their tonsils and adenoids, they appear to sleep better than they did before the procedure but not as well as they did 6 months after, according to a report in the July issue of Archives of Otolaryngology - Head & Neck Surgery, one of the JAMA/Archives journals. Initial improvements in their behaviour were maintained except when measured by an index of attention-deficit/hyperactivity disorder (ADHD) symptoms. “Since the publication of our previous report demonstrating improvements in both sleep and behaviour at 6 months after adenotonsillectomy for children with sleep-disordered breathing, there have been several articles that continue to support the impact of sleep-disordered breathing on neurocognitive development, behaviour, and quality of life,” the authors wrote as background information in the article. “Specifically, ADHD, hyperactivity, and behaviour have been shown to improve at 6 or 12 months after adenotonsillectomy in correlation with improved postoperative polysomnography parameters regardless of which instruments were used to evaluate behaviour.” Julie L. Wei, MD, University of Kansas School of Medicine, Kansas City, Missouri, and colleagues analysed long-term (2.4 to 3.6 years) follow-up data from 44 of 71 children with sleep-disordered breathing who initially participated in the 6-month study. Before surgery, 6 months afterward, and again at least 2 years afterward, parents completed a questionnaire assessing their child’s sleep and a multipart parent rating scale with sections about ADHD symptoms, cognitive problems or inattention, hyperactivity, and oppositional behaviour. “Our longitudinal study demonstrates that improvements in sleep and behaviour may not be exactly maintained over time, but at 2.5 years after the surgical intervention, all parameters reported in this study except the ADHD index remained below baseline values,” the authors wrote. “Although speculative and based on extrapolation, this longitudinal model shows that even if the sleep-related breathing disorder subscale scores increase by 7% per year for many consecutive years, which is a statistically significant increase compared with baseline values, it would take 9 or 10 years before the values could climb back to baseline values, if indeed a return to baseline values were likely.” Because it is not a randomised controlled trial, the results do not prove the relationship between adenotonsillectomy and changes in sleep and behaviour. However, the findings do support an association between the intervention and improvements in theses outcomes, the authors noted. SOURCE: Archives of Otolaryngology - Head & Neck Surgery
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