|
 Some previous research suggests that apnea, a sleep-related
breathing disorder, may lead to deficits in things like attention,
language skills, reasoning, and executive function in school-age
children, the study team notes in Pediatrics. While some prior
studies also suggest that tonsillectomies may counter these
deficits, results have been mixed and less is known about what
happens among younger children.
For the current study, researchers randomly assigned 190 children 3
to 5 years old with mild apnea to either undergo to
adenotonsillectomy - surgery to remove both the tonsils and adenoids
– or to join a waiting list for these operations and continue with
routine nonsurgical care.
One year later, kids had similar improvements on tests of
intellectual ability, executive function and memory whether or not
they had surgery.
"For young, preschool-aged children with only mild obstructive sleep
apnea (OSA), there is a limited benefit from adenotonsillectomy with
respect to improving cognitive function," said Dr. Neil
Bhattacharyya, a professor of otolaryngology at Harvard Medical
School in Boston.
"Parents do not need to think of doing a tonsillectomy early to
protect cognitive development in this age group as long as the sleep
apnea is mild," Bhattacharyya, who wasn't involved in the study,
said by email. "However, there are other potential indications for
tonsillectomy depending on the child's emotional and physical
behavior or impact of the OSA, and those factors should also be
taken into account."
Sleep studies did show bigger improvements in several sleep measures
for kids who had surgery compared to children who didn't.
Tonsillectomies were associated with bigger gains in total sleep
time, and more reductions in nighttime awakenings and apnea events.
Parents reported bigger reductions in snoring and breathing
difficulties with surgery, too.
[to top of second column] |
Behavior also improved more with surgery than without it. Operations
were associated with larger gains in attention, too, but the
difference was too small to rule out the possibility it was due to
chance.
It's not clear how much behavior may have improved because of the
surgery versus because kids slept better.
One limitation of the study is that many children dropped out before
the end, leaving only 141 kids with complete data for analysis. With
so few kids remaining, it's possible researchers lacked enough data
to detect small but meaningful differences in outcomes with and
without surgery.
Lead study author Karen Waters of The Children's Hospital at
Westmead, in Australia, didn't respond to requests for comment.
"I am not sure if there is much benefit is getting tonsils removed
at an early age unless it is severe," said Dr. Paul Hong, a
researcher at Dalhousie University in Halifax, Canada, who wasn't
involved in the study.
"We know from previous studies that many children with primary
snoring and mild OSA can improve over time without any surgery -
they grow out of it," Hong said by email. "And we know this happens
as tonsils and adenoids can shrink over time while the child is
growing so there is more room in the nose and throat."
Unless kids have serious problems related to apnea that aren't
getting better over time, there isn't much advantage to doing
surgery in preschoolers, Hong added. Younger patients can have more
surgical complications, and more breathing problems after
tonsillectomy, and waiting to see if they still need operations when
they're older can often be the best course of action.
SOURCE: https://bit.ly/2sT4wZR Pediatrics, online January 9, 2019.
[© 2020 Thomson Reuters. All rights
reserved.] Copyright 2020 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content. |
