Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea
syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior,
quality of life, and polysomnographic findings has not been rigorously evaluated.
We hypothesized that, in children with the obstructive sleep apnea syndrome without
prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful
waiting with supportive care, would result in improved outcomes.
We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep
apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic,
cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months.
The average baseline value for the primary outcome, the attention and executive-function
score on the Developmental Neuropsychological Assessment (with scores ranging from
50 to 150 and higher scores indicating better functioning), was close to the population
mean of 100, and the change from baseline to follow-up did not differ significantly
according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy
group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were
significantly greater improvements in behavioral, quality-of-life, and polysomnographic
findings and significantly greater reduction in symptoms in the early-adenotonsillectomy
group than in the watchful-waiting group. Normalization of polysomnographic findings
was observed in a larger proportion of children in the early-adenotonsillectomy group
than in the watchful-waiting group (79% vs. 46%).
As compared with a strategy of watchful waiting, surgical treatment for the obstructive
sleep apnea syndrome in school-age children did not significantly improve attention
or executive function as measured by neuropsychological testing but did reduce symptoms
and improve secondary outcomes of behavior, quality of life, and polysomnographic
findings, thus providing evidence of beneficial effects of early adenotonsillectomy.
(Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.).