Improved Sleep and Behavior after Adenotonsillectomy in Children with Sleep Disordered Breathing

Abstract

Background and objective: Sleep disordered breathing (SDB) is a common problem in preschool and school going children and is generally perceived as a neurodevelopmental condition leading to maltreatment resulting in abnormal behavioural complications and reduced cognition. The present study was undertaken to evaluate whether adenotonsillectomy done in children with SDB improves their behavior, cognition and quality of life. Methods: This prospective interventional study of pre-test post-test design was conducted in Rajshahi Medical College Hospital, Rajshahi over a period of 3-years from July 2012 to June 2015 on 50 children (selected based on predefined eligibility criteria) aged 3-8 years who underwent adenotonsillectomy for sleep disordered breathing (SDB) with or without behavioural problem. The outcome variables were sleep disordered breathing, attention-deficit hyperactivity disorder (ADHD), cognitive function and quality of life. Result: About three-quarters (74%) of the study children were 6 or > 6 years old with mean age being 6.6 years. Female-to-male ratio was 3:2. Half of the children was rural residents (50%) and 40% belonged to lower middle class. Snoring (86%), upper airway resistance syndrome (90%), obstructive hypoventilation (86%) and obstructive sleep-apnoea syndrome (OSAS) (80%) all demonstrated their dominance before adenotonsillectomy. After intervention major proportions of these symptoms reduced indicating that adenotonsilitis was the main reason of these symptoms. The major behavioral problems in children before intervention were ADHD (82%), problemetic behaviours on awakening (86%), night-to-night sleep duration variability (78%) and headache (80%). All the major problems responded well following adenotosillectomy (p < 0.001). Of the minor problems incidence of enuresis reduced to less than half (p = 0.027). Cognitive function like learning disabilities and poor academic performance showed commendable improvement following adenotonsillectomy (p < 0.001). Conclusion: The study concluded that children diagnosed with SDB experience significant improvement in both sleep and behavior after adenotonsillectomy.