title: Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis.
abstract: OBJECTIVE
  To provide an up-to-date systematic review and critical appraisal of prospectively performed studies evaluating neurocognitive function in children treated with adenotonsillectomy.
  
  
  METHODS
  PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library.
  
  
  METHODS
  Searches were performed from inception through September 2, 2015.
  
  
  RESULTS
  Nineteen prospective studies (898 adenotonsillectomy patients) met criteria and reported neurocognitive outcomes. The average age of children was 6.6±2.3 years (range 2.5-14 years) and 51.1% were male. Pre- and post-operative data utilizing the Neuropsychological Developmental Assessment score demonstrated an increase from a means±standard deviations of 101.5±14.7 [95% CI 100.0, 103.0] to 108.8±13.4 [95% CI 107.4, 110.2], p-value <0.0001 (375 children, three studies). Pre- and post-operative data utilizing the Stanford-Binet Intelligence Scales (IQ) demonstrated an increase in IQ scores from a means±standard deviations of 97.1±13.8 [95% CI 91.6, 95.4] to 100.7±11.1 [95% CI 100.4, 103.4], p-value <0.0001 (254 children, three studies). The mean pre- and post-adenotonsillectomy apnea-hypopnea index (AHI) decreased from 8.0 to 1.8 (274 children, six studies).
  
  
  CONCLUSIONS
  This meta-analysis found an improvement in neurocognitive function and IQ after pediatric adenotonsillectomy, especially in pre-school aged children. However, this must be interpreted with caution as only three studies were performed in pre-school aged children. The decreased effectiveness in older children suggests possibly a threshold age when neurocognitive deficits become irreversible.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA. Electronic address: Sungjin.a.song.mil@mail.mil.
authors.forename: Sungjin A
authors.initials: SA
authors.lastname: Song
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Tolisano
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA.
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Cable
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Tripler Army Medical Center, Honolulu, HI, USA; Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford, CA, USA.
authors.forename: Macario
authors.initials: M
authors.lastname: Camacho
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000293:Adolescent; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003071:Cognition; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D009483:Neuropsychological Tests; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: Adenotonsillectomy; Meta-analysis; Neurocognitive; Systematic review; Tonsillectomy