title: Effects of Adenotonsillectomy on Parent-Reported Behavior in Children With Obstructive Sleep Apnea.
abstract: The childhood obstructive sleep apnea syndrome (OSAS) is associated with behavioral abnormalities. Studies on the effects of OSAS treatment on behavior are conflicting, with few studies using a randomized design. Further, studies may be confounded by the inclusion of behavioral outcome measures directly related to sleep. The objective of this study was to determine the effect of adenotonsillectomy on behavior in children with OSAS. We hypothesized that surgery would improve behavioral ratings, even when sleep symptom items were excluded from the analysis.
  
  
  
  This was a secondary analysis of Child Behavior Checklist (CBCL) data, with and without exclusion of sleep-specific items, from the Childhood Adenotonsillectomy Trial (CHAT). CBCL was completed by caregivers of 380 children (7.0+1.4 [range 5-9] years) with OSAS randomized to early adenotonsillectomy (eAT) versus 7 months of watchful waiting with supportive care (WWSC).
  
  
  
  There was a high prevalence of behavioral problems at baseline; 16.6% of children had a Total Problems score in the clinically abnormal range. At follow-up, there were significant improvements in Total Problems (p < .001), Internalizing Behaviors (p = .04), Somatic Complaints (p = .01), and Thought Problems (p = .01) in eAT vs. WWSC participants. When specific sleep-related question items were removed from the analysis, eAT showed an overall improvement in Total (p = .02) and Other (p = .01) problems. Black children had less improvement in behavior following eAT than white children, but this difference attenuated when sleep-related items were excluded.
  
  
  
  This large, randomized trial showed that adenotonsillectomy for OSAS improved parent-rated behavioral problems, even when sleep-specific behavioral issues were excluded from the analysis.
authors.affiliation: Department of Child and Adolescent Psychiatry and Behavioral Sciences.|Neurobehavioral and.
authors.forename: Nina Hattiangadi
authors.initials: NH
authors.lastname: Thomas
authors.affiliation: Department of Child and Adolescent Psychiatry and Behavioral Sciences.|Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Xanthopoulos
authors.affiliation: Biostatistical and Informatics Cores of the Clinical and Translational Research Center and.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Biostatistical and Informatics Cores of the Clinical and Translational Research Center and.
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.affiliation: Biostatistical and Informatics Cores of the Clinical and Translational Research Center and.
authors.forename: Emma
authors.initials: E
authors.lastname: Escobar
authors.affiliation: Department of Psychiatry and Psychology, University of Michigan.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giordani
authors.affiliation: Department of Psychiatry and Psychology, University of Michigan.
authors.forename: Elise
authors.initials: E
authors.lastname: Hodges
authors.affiliation: Department of Neurology and Sleep Disorders Center, University of Michigan.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.affiliation: Department of Pediatrics, Saint Louis University.
authors.forename: Shalini
authors.initials: S
authors.lastname: Paruthi
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine.
authors.forename: Gerry H
authors.initials: GH
authors.lastname: Taylor
authors.affiliation: Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine.
authors.forename: Raanan
authors.initials: R
authors.lastname: Arens
authors.affiliation: Division of Respiratory Diseases, Boston Children's Hospital.
authors.forename: Eliot S
authors.initials: ES
authors.lastname: Katz
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center.
authors.forename: Dean W
authors.initials: DW
authors.lastname: Beebe
authors.affiliation: Departments of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Neurobehavioral and.|Children's Hospital of Philadelphia, University of Pennsylvania.
authors.forename: Jerilynn
authors.initials: J
authors.lastname: Radcliffe
authors.affiliation: Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA.|Children's Hospital of Philadelphia, University of Pennsylvania.
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
mesh_terms: D000233:Adenoidectomy; D001741:Black or African American; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D015995:Prevalence; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D014068:Tonsillectomy; D044465:White People
keywords: CBCL; CHAT.; behavior; obstructive sleep apnea