TOPLINE:
Children with mild sleep disordered breathing (SDB) showed no improvement in executive function or attention after adenotonsillectomy compared with those who did not have the surgery, but several secondary outcomes improved over 12 months.
METHODOLOGY:
- The value of adenotonsillectomy for children with mild SDB remains unknown; the researchers randomized 458 children with mild SDB to adenotonsillectomy within 4 weeks of randomization or watchful waiting.
- All patients received supportive care including education about healthy sleep and lifestyle and referrals for asthma or untreated allergies; approximately, one third (30.3%) were younger than 5 years, and approximately, one third came from households with annual incomes below $30,000.
- The primary outcomes were changes from baseline to 12 months in scores on the caregiver-reported Behavior Rating Inventory of Executive Function (BRIEF) and the Go/No-go (GNG), an objective test of attention; secondary outcomes included 22 measures of changes in neurodevelopmental, behavioral, sleep, health, and quality of life outcomes.
TAKEAWAY:
- From baseline to 12 months, the mean BRIEF Global Executive Composite score improved by 1.9 points in the watchful waiting group and 3.1 points in the surgery group; the between-group difference of −0.96 was not statistically significant.
- The GNG value for sustained attention increased slightly in both groups over the study period, with no sign of differences.
- However, secondary outcomes of behavior, symptom burden, quality of life, blood pressure, and apnea hypopnea index showed more improvement over 12 months after surgery in the surgery group; the findings suggest the potential predictive role of symptoms in terms of outcomes and treatment response.
- A total of six adverse events occurred that were related to perioperative complications in the surgery group, but no long-term consequences from the surgery were noted; adverse events overall were not significantly different between the surgery and watchful waiting groups.
IN PRACTICE:
"These findings do not provide support for adenotonsillectomy in children with mild SDB with the goal of improving cognition, although it is possible that differences may have been observed with additional follow-up," the researchers wrote.
SOURCE:
The lead author on the study was Susan Redline, MD, of Brigham and Women's Hospital, Boston, Massachusetts. The study was published online in JAMA on December 5, 2023.
LIMITATIONS:
Outcome assessments may have been affected by the lack of blinding of caregivers to the intervention and by the lack of assessment of learning and memory.
DISCLOSURES:
The study was supported by the National Heart, Lung, and Blood Institute. Redline reported receiving personal fees from Jazz Pharma, Eli Lilly, and ApniMed, as well as grants to her institution from the National Institutes of Health.
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