title: A randomized trial of adenotonsillectomy for childhood sleep apnea.
abstract: BACKGROUND
  Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.
  
  
  METHODS
  We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months.
  
  
  RESULTS
  The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%).
  
  
  CONCLUSIONS
  As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.).
authors.affiliation: Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA.
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
authors.forename: Reneé H
authors.initials: RH
authors.lastname: Moore
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.forename: Bruno
authors.initials: B
authors.lastname: Giordani
authors.forename: Susan L
authors.initials: SL
authors.lastname: Garetz
authors.forename: H Gerry
authors.initials: HG
authors.lastname: Taylor
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
authors.forename: Raouf
authors.initials: R
authors.lastname: Amin
authors.forename: Eliot S
authors.initials: ES
authors.lastname: Katz
authors.forename: Raanan
authors.initials: R
authors.lastname: Arens
authors.forename: Shalini
authors.initials: S
authors.lastname: Paruthi
authors.forename: Hiren
authors.initials: H
authors.lastname: Muzumdar
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.forename: Nina Hattiangadi
authors.initials: NH
authors.lastname: Thomas
authors.forename: Janice
authors.initials: J
authors.lastname: Ware
authors.forename: Dean
authors.initials: D
authors.lastname: Beebe
authors.forename: Karen
authors.initials: K
authors.lastname: Snyder
authors.forename: Lisa
authors.initials: L
authors.lastname: Elden
authors.forename: Robert C
authors.initials: RC
authors.lastname: Sprecher
authors.forename: Paul
authors.initials: P
authors.lastname: Willging
authors.forename: Dwight
authors.initials: D
authors.lastname: Jones
authors.forename: John P
authors.initials: JP
authors.lastname: Bent
authors.forename: Timothy
authors.initials: T
authors.lastname: Hoban
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.forename: Susan S
authors.initials: SS
authors.lastname: Ellenberg
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D010100:Oxygen / Q000097:blood; D017286:Polysomnography; D011788:Quality of Life; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000523:psychology / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D010100:Oxygen