Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis. (April 2016)

• Record Type: Journal Article
• Authors: Song, Sungjin A.; Tolisano, Anthony M.; Cable, Benjamin B.; Camacho, Macario
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 83(2016:Apr.)
• Page Start: 205
• Page End: 210
• Publication Date: 2016-04
• Subjects: Tonsillectomy -- Adenotonsillectomy -- Neurocognitive -- Systematic review -- Meta-analysis; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2016.02.011
• Languages: English
• ISSNs: 0165-5876

Abstract

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. Data sources: PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library. Review 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.