Sleep and behavior 24 months after early tonsillectomy for mild OSA: An RCT

Abstract

Background and objectives: The Preschool Obstructive Sleep Apnea Tonsillectomy and Adenoidectomy study is a prospective randomized controlled study of children aged 3 to 5 years. This follow-up evaluated postoperative outcomes 24 months after randomization. Methods: Baseline, 12-month, and 24-month assessments included intellectual ability, polysomnography, audiology, a pediatric sleep questionnaire, the parent rating scale of the Behavior Assessment System for Children, and the Behavior Rating Inventory of Executive Functioning. Results: In total, 117 (55% male) of 190 children, 61.6% of those initially randomly assigned, attended 24-month follow-up; 62 of 99 were assigned T/A within 2 months (eT/A); and 55 of 91 were assigned to T/A after the 12-month follow-up (T/A₁₂). Intellectual ability, our primary outcome, did not differ according to the timing of T/A. Exploratory analyses revealed changes in both groups after T/A, including fewer children having day sleeps (eT/A from baseline 97% to 11%, T/A₁₂ from 36% at 12 months to 9%), improved symptom scores (eT/A 0.62 to 0.25, T/A₁₂ 0.61 to 0.26; P < .001), improved behavior T-scores (eT/A 71.0 to 59.9, T/A₁₂ 63.6 to 50.5; P < .001), and improved polysomnography (obstructive apnea-hypopnea index eT/A 1.9 to 0.3 per hour, T/A₁₂ 1.3 to 0.3; P < .001). The eT/A group revealed temporary postoperative improvement of Woodcock-Johnson III subscales (sound blending and incomplete word scores) and behavioral withdrawal. Conclusions: T/A for mild obstructive sleep apnea led to large improvements in sleep and behavior in preschool-aged children, regardless of the timing of surgery. (PsycInfo Database Record (c) 2022 APA, all rights reserved)Sleep Medicine Service, Children’s Hospital at Westmead, Westmead, NSW, Australia. Release Date: 20220414. Publication Type: Journal (0100), Peer Reviewed Journal (0110). Format Covered: Electronic. Document Type: Journal Article. Language: EnglishMajor Descriptor: Cognitive Ability; Pediatrics; Sleep; Sleep Apnea; Surgery. Minor Descriptor: Behavior Problems. Classification: Medical Treatment of Physical Illness (3363). Population: Human (10); Male (30); Female (40). Location: Australia. Age Group: Childhood (birth-12 yrs) (100); Preschool Age (2-5 yrs) (160). Tests & Measures: Brief Intellectual Ability; Woodcock-Johnson III Tests of Cognitive Abilities; Behavior Rating Inventory of Executive Function; Pediatric Sleep Questionnaire DOI: 10.1037/t24052-000. Methodology: Clinical Trial; Empirical Study; Quantitative Study. Supplemental Data: Experimental Materials Internet. References Available: Y. ArtID: e2020038588. Issue Publication Date: Aug, 2021. Publication History: Accepted Date: Mar 9, 2021. Copyright Statement: The American Academy of Pediatrics. 2021.Sponsor: National Health and Medical Research Council, Australia. Grant: APP1049788. Recipients: No recipient indicated <br />Sponsor: Sydney University, Australia. Recipients: No recipient indicated <br />Sponsor: Garnett Passe and Rodney Williams Memorial Foundation. Recipients: No recipient indicated <br />Sponsor: Golden Casket, Australia. Recipients: No recipient indicated <br />