Determination Adenoidectomy and Tonsillectomy in Children with Obstructive Sleep Apnea: Are They Effective in Improving Sleep Quality and Cognitive Function

Abstract

Background: Pediatric obstructive sleep apnea (OSA) is commonly managed with adenotonsillectomy (AT), which has shown substantial benefit in symptom reduction and quality-of-life improvement. Despite this, limited evidence exists from low- to middle-income countries incorporating polysomnographic, cognitive, and behavioral assessments. Objective: To compare the effects of AT versus watchful waiting on OSA symptoms, quality of life, and cognitive and behavioral performance in children with moderate OSA. Methods: This randomized trial was conducted at Kaleem Hospital, Lahore, involving 40 children aged 5–10 years with moderate OSA (AHI 10–30 episodes/h) and adenotonsillar hypertrophy. Participants were assigned to AT or watchful waiting. Baseline and 12-month assessments included polysomnography, OSA-18, Child Behavior Checklist (CBCL), full-scale IQ, GIA, attention, verbal fluency, learning measures, executive function, and ADHD symptom scales. Assessors were blinded to group allocation. Analyses followed the intention-to-treat principle using t-tests and ANCOVA. Results: AT produced significantly greater reductions in AHI (-12.0 ± 4.5 vs. -4.0 ± 3.8 episodes/h; P < 0.001) and ODI (-23.9 ± 5.5 vs. -7.7 ± 4.4; P < 0.001). Polysomnographic normalization occurred in 75% of AT patients versus 20% of controls (P = 0.001). Improvements were also larger in OSA-18 (-10.0 ± 5.0 vs. -3.2 ± 4.2; P < 0.001) and CBCL scores (-8.5 ± 4.0 vs. -2.2 ± 3.5; P = 0.001). AT markedly enhanced cognitive outcomes, including IQ (+10.8 ± 4.5 vs. +1.2 ± 3.8; P < 0.001), and reduced inattention and hyperactivity symptoms (both -21%; P < 0.003). Conclusion: AT yields significantly greater improvements than watchful waiting in polysomnographic indices, symptoms, quality of life, cognition, and behavioral functioning in children with moderate OSA.