Taking Care of Kids' Tonsils for Better Sleep

Adenotonsillectomy for sleep apnea in children improved symptoms and behavior

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) The long-term health risks of sleep apnea can affect almost every system in the body. Sleep apnea that is diagnosed and treated early means better health, especially for children.

A recent study found that one type of treatment for obstructive sleep apnea for children was effective in reducing symptoms and improving sleep and behavior.

Sleep apnea is a condition in which a person stops breathing multiple times during the night.

Obstructive sleep apnea occurs because the air passages are blocked, often by a child's tonsils.

"Discuss sleep apnea treatments with your doctor."

The study, led by Carole L. Marcus, MB, BCh, of the Department of Pediatrics at the Children's Hospital of Philadelphia, aimed to find out whether adenotonsillectomies in children with obstructive sleep apnea resulted in better outcomes than no treatment.

An adenotonsillectomy is a surgery to remove a person's tonsils and adenoids, the tissues which, when enlarged, are usually what cause the breathing obstructions when a child is sleeping.  

The researchers randomly divided 464 children, aged 5 to 9, into two groups. One group received an adenotonsillectomy and the other underwent "watchful waiting."

During watchful waiting, a patient is regularly observed for symptoms and worsening before any medical intervention is done.

The children had sleep studies and had their overall health, their behavior and their cognitive skills assessed at the start of the study and seven months later.

On the test measuring their psychological development, the children had an average score of 100. The test has a scale of 50 to 150 with higher scores showing better functioning.

At the 7-month follow-up, there was no significant difference between the two groups on this test.

However, the children who had adenotonsillectomies had better scores in the behavioral assessment, improved quality of life and better outcomes in their sleep studies at the follow-up than the children experiencing watchful waiting.

At the follow-up, 79 percent of the children who had adenotonsillectomies had normal range scores on the sleep study, compared to only 46 percent of the children who had watchful waiting.

The children who had adenotonsillectomies also had fewer symptoms of obstructive sleep apnea at the follow-up than the children who did not have the surgery.

The authors concluded that the surgery did not help children's attention or the brain functions related to planning. However, the surgery did appear to improve the children's quality of life, sleep apnea symptoms, behavior and sleep.

"Beneficial effects of early adenotonsillectomy were observed in non-obese children as well as in obese children," the authors wrote.

"This article is additional important information on the need to intervene early if a child has obstructive sleep apnea," said William Kohler, MD, the the director of Pediatric Sleep Services at Florida Hospital Tampa and a dailyRx expert.

"The cognitive improvement was not statistically significant, but was a slight improvement," Dr. Kohler said. "The important part was that quality of life as well as behavior were significant improved compared to the control group."

The timing may be especially important, Dr. Kohler said.

"There may be a potential time that's crucial where if intervention hasn't occurred, it will be more difficult to intervene later," he said. "So, early intervention is important in children with obstructive sleep apnea."

Adenotonsillectomies, also usually covered by insurance, costs about $2,000 to $4,000. The most common complication is bleeding, which occur in 2 to 5 percent of children.

The study was published May 21 in the New England Journal of Medicine. The research was funded by the National Institutes of Health.

One author has received research equipment on loan from Philips Respironics and Ventus Medical, and another has consulted for Galleon Pharmaceuticals.

Another authors has received consulting fees from several pharmaceutical companies and has served as a board member for Sweet Dreamzzz and Pavad Medical, where he also has stock options.

Reviewed by: 
Review Date: 
May 21, 2013
Last Updated:
August 5, 2013