The Effect of Adenotonsillectomy on Children's Behavior and Cognitive Performance with Obstructive Sleep Apnea Syndrome: State of the Art.

Salvatore Ferlito,Roberta Anzivino,Deborak Rasà,Ignazio La Mantia,Claudio Vicini,Paola Di Mauro,Antonino Maniaci,Giannicola Iannella,Salvatore Cocuzza

doi:10.3390/children8100921

Abstract

(1) Background: This systematic review was designed to analyze adenotonsillectomy’s role in treating behavioural disorders and sleep-related quality of life in pediatric OSAS. (2) Methods: Papers that report pre-operative and post-operative outcomes by using the Epworth sleepiness scale, OSA-18, NEPSY, Conners’ rating scale, BRIEF, PSQ-SRBD, PedsQL and CBCL. We performed a comprehensive review of English papers published during the last 20 years regarding behavioural disorders in OSAS patients and adenotonsillectomy. (3) Results: We included 11 studies reporting behavioral outcomes and sleep related quality of life after surgery. We investigated changes in behavior and cognitive outcomes after AT, and we found significant improvements of the scores post-AT in almost all studies. After comparing the AT group and control group, only one study had no difference that reached significance at one year post-AT. In another study, it did not show any significant improvement in terms of all behavioural and cognitive outcomes. The questionnaires on sleep-related quality of life after AT (PSQ-SRBD or ESS or OSA-18 or KOSA) may improve with positive changes in sleep parameters (AHI, ODI and SpO2). Furthermore, there is a significantly higher decrease in OSAS symptoms than the pre-AT baseline score. (4) Conclusion: Future studies should pay more attention to characterizing patient populations as well as rapid surgical treatments through existing criteria.

Highlights

Obstructive Sleep Apnea Syndrome (OSAS) is a condition characterized by repeated episodes of complete or partial cessation of airflow through the upper airways during sleep [1,2]
In order to analyze sleep quality, we analyzed data from Apnea/Hypopnea Index (AHI) (Apnea Hypopnea index), ODI (Oxygen Desaturation Index), OSA- 18 items, PSQ-SRBD (Sleep-Related Breathing Disorder scale of the Pediatric Sleep Questionnaire), mESS (Epworth Sleepiness Scale modified for children), SpO2, KOSA-18 (Korean version of the obstructive sleep apnea-18), pediatric daytime sleepiness scale and mean sleep latency
This review highlights the importance of future screening for behavioral symptoms and quality of life in children who present OSAS and compares behavioral symptoms and quality of life before and after AT as a predictive criterion

Summary

Introduction

Obstructive Sleep Apnea Syndrome (OSAS) is a condition characterized by repeated episodes of complete (apnea) or partial (hypopnea) cessation of airflow through the upper airways during sleep [1,2]. The prevalence of respiratory sleep disorders in preschool and school-age varies widely, with an estimated rate of primary snoring in children ranging from 8% to 27% and of OSAS from 1% to 5% [3,4,5,6,7,8]. Children with OSAS present behavioral disorders such as irritability, attention deficit, sleepiness or hyperactivity in contrast, emotional lability and aggressiveness [13,25,26,27,28,29,30,31,32,33,34]. There have been numerous mostly cross-sectional studies reporting the association between OSAS and neurocognitive and behavioral morbidity [41,42,43,44,45,46]

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Conclusion