Sleep apneas are breathing interruptions that occur during sleep. Children who experience sleep apneas do not get a good night’s sleep, and research indicates that this may contribute to behavioral and cognitive problems including daytime sleepiness, hyperactivity and attention-deficits. One treatment option for sleep apnea in children with enlarged tonsils and adenoids is a procedure known as adenotonsillectomy .

In a study published online in the April 2006 Pediatrics , researchers report that children who underwent adenotonsillectomy reported significantly lower rates of attention deficit/hyperactivity disorder (ADHD) and daytime sleepiness one year after surgery. Somewhat surprisingly, however, these outcomes did not correspond to measures of nighttime sleep and breathing taken one year after surgery.

About the Study

The researchers recruited 105 children, aged 5 – 13. Seventy-eight of these children were scheduled to undergo adenotonsillectomy, to treat either sleep apnea or repeated ear and throat infections. The other 27 children (the controls) were scheduled to undergo unrelated surgery (such as hernia repair ). All children participated in an overnight sleep study to monitor several measures of sleep, interruptions in breathing. Before undergoing any surgical procedure, all of the children were evaluated by their parents for inattention and hyperactivity; by standard testing for cognitive attention and daytime sleepiness; and by a psychiatrist for ADHD diagnosis. These tests were repeated one year after surgery.

Before surgery, the children scheduled for adenotonsillectomy were significantly more likely to have sleep apnea, be hyperactive, have lower cognitive attention, experience daytime sleepiness, and have an ADHD diagnosis than the children in the control group. One year after surgery, there were no significant differences between the two groups in any of these areas (in all cases, because of improvement in the adenotonsillectomy group). Interestingly, with the exception of daytime sleepiness, the children’s behavioral, cognitive, and psychiatric scores did not correspond to any measures of sleep or breathing taken during the overnight sleep study, either before or after the surgery.

How Does This Affect You?

In this study, children who underwent adenotonsillectomy had lower rates of cognitive and behavioral problems one year after surgery. This seems to suggest that treating the underlying sleep disturbance alleviated ADHD symptoms. It is important to remember, however, that the study was not designed to establish a cause and effect relationship between adenotonsillectomy and ADHD outcomes. In addition, nearly half of the children who had adenotonsillectomy had no sleep problems to begin with, and the children’s ADHD diagnoses did not closely correspond to their disturbed sleep. Adenotonsillectomy, therefore, should not be viewed as a treatment for conditions such as ADHD.

On the other hand, in those children whose sleep apnea may be contributing to persistent cognitive and behavior problems during the day, the surgeon may be of some help in selected cases where enlarged tonsils and adenoids are clearly to blame. Symptoms of sleep apnea include loud snoring, restless sleep, excessive sleepiness during the daytime, and problems with attention and hyperactivity. If you suspect your child might have sleep apnea, talk to his or her pediatrician.