Effect of surgical intervention for mild childhood obstructive sleep apnoea on attention and behavioural outcomes: A randomized controlled study

Background and objective We evaluated inattention and behavioural outcomes following surgery versus watchful waiting (WW) in school‐aged children with mild obstructive sleep apnoea (OSA). Methods A prospective randomized controlled study was performed in pre‐pubertal children aged 6–11 years with polysomnography (PSG)‐confirmed mild OSA. They were assigned randomly to early surgical intervention (ES) or WW. The surgical intervention consisting of tonsillectomy with or without adenoidectomy and turbinate reduction was carried out within 4–6 weeks after randomization. Both groups underwent PSG, attention and behavioural assessment and review by an otorhinolaryngologist at baseline and 9‐month follow‐up. The primary outcome was omission T score from Conners' continuous performance test (CPT). Secondary outcomes were parent‐reported behaviours, quality of life, symptoms and PSG parameters. Results A total of 114 participants were randomized. Data of 35 subjects from the ES and 36 from the WW group were available for final analysis. No significant treatment effect could be found in all CPT parameters and behavioural outcomes. Nevertheless, significantly greater reductions were seen in PSG parameters (obstructive apnoea–hypopnoea index [−1.4 ± 2.0 cf. +0.3 ± 4.1/h, p = 0.038] and arousal index [−1.3 ± 4.4 cf. +1.4 ± 4.5/h, p = 0.013]) and OSA‐18 total symptom score (−17.3 ± 19.7 cf. −3.6 ± 14.1, p = 0.001) in the ES group. Subjects who underwent surgery also had significantly greater weight gain (+3.3 ± 2.1 cf. +2.2 ± 1.5 kg, p = 0.014) and increase in systolic blood pressure (+5.1 ± 12.4 cf. −1.2 ± 8.7 mm Hg, p = 0.016). Conclusion Despite improvements in PSG parameters and parent‐reported symptoms, surgical treatment did not lead to parallel improvements in objective attention measures in school‐aged children with mild OSA. This randomized trial confirmed improvements in polysomnographic index and parent‐reported symptoms after adenotonsillectomy in pre‐pubertal school‐aged children with mild obstructive sleep apnoea. However, no improvements in objective attention measures were found, and weight gain and elevated blood pressure were observed after surgery. See related Editorial