Benefits of adenotonsillectomy persist in kids

In children with sleep-related breathing disorders, removing the tonsils and adenoids—an operation called adenotonsillectomy—is apt to yield long-lasting improvements in sleep and behavior, doctors from Kansas City report.

More than two years after a group of children with sleep-related breathing disorders had surgery to remove the tonsils and adenoids (glands in the back of the throat) they appear to sleep better than they did before the surgery, but not as well as they did six months after the procedure, they found.

For the most part, initial improvements in behavior after the operation were also maintained, according to Dr. Julie L. Wei and colleagues from the University of Kansas Medical Center. 

In an earlier study, Wei’s team saw improvements in both sleep and behavior six months after adenotonsillectomy in a group of children with sleep-disordered breathing.

They now report longer-term follow up data on 44 of 71 children with sleep-disordered breathing who initially participated in the six-month study. Before surgery, six months afterward, and again at least two years afterward, parents completed a questionnaire assessing their child’s sleep and behavior.

The long-term data, the investigators report, demonstrate that improvements in sleep and behavior may not be exactly maintained over time, but at 2.5 years after the operation, all sleep and behavior parameters analyzed—except for symptoms of attention-deficit/hyperactivity disorder (ADHD)—remained better than before the operation.

“Sleep was still much better at 2.5 years after surgery,” Wei told Reuters Health.

And “three out of four categories of behavior measures had improvements that were statistically significant compared to pre-surgery: hyperactivity, cognition/inattention, oppositional behavior,” Wei noted.

She added that improvements in behavior were greater than improvements in sleep.

It’s worth noting, Wei said, that this study did not take into consideration the children’s weight, which is an important factor in determining long-term benefits. While the benefits of removal of enlarged tonsils and adenoids in children are “increasingly” being recognized, “we are now even more concerned that depending on the patient’s weight, the benefits may not be long-lasting,” Wei explained.

And being overweight or obese, she noted, “are critical factors in how much a child may continue to snore after successful surgical outcome. It is important to look at the relationship between increasing weight and how that may influence the benefits gained from surgery for this group of children,” Wei said.

Some studies have found that after having their tonsils and adenoids out because of obstructed breathing during sleep, some children tend to gain weight. It’s been suggested that this may be due to a decrease in fidgeting and hyperactivity.

SOURCE: Archives of Otolaryngology-Head and Neck Surgery, 2009.

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