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Surgery offers mixed benefits for kids' sleep apnea

By Gene Emery

NEW YORK (Reuters Health) - A new study has confirmed that removing the tonsils and adenoids of children with obstructive sleep apnea can reduce sleepiness and improve the quality of life, but putting off the surgery might not hurt either.

The study is the first controlled test to compare the operation with so-called watchful waiting as a strategy for stopping childhood obstructive sleep apnea syndrome, where the structures in the back of the mouth can temporarily block breathing during sleep.

The findings, released May 21 at an American Thoracic Society International Conference in Philadelphia, and appearing online in the New England Journal of Medicine, found that after seven months, surgery improved many gauges of everyday living.

"Improvements in emotional regulation, attention, organizational skills, reduced sleepiness, improved quality of life including socialization and physical and emotional wellbeing were quite large, larger than we anticipated," coauthor Dr. Susan Redline of Brigham and Women's Hospital in Boston told Reuters Health.

Yet when the children were formally tested, youngsters in both groups performed equally well, an indication that the sleep disturbance wasn't causing any measurable cognitive problems.

"Where you objectively measure these cognitive tasks, children can do fairly well in that motivated and structured environment" whether or not they have surgery, she said. "It shows that over a 7-month period of watchful waiting, cognition does not decline."

Nearly half the children who did not have the operation improved on their own, Redline said.

About 500,000 such operations are done in the U.S. each year, mostly to help children with apnea. It's the second most common pediatric surgical procedure after tubes in the ears, and costs about $2,850, according to the Healthcare Blue Book.

Redline and her colleagues took 464 children age 5 to 9 and randomly assigned them to surgery or observation at seven academic sleep centers. Nearly half were overweight or obese. The children with the most severe apnea were excluded.

Children with the surgery showed a large improvement on ratings of things such as impulsiveness, emotional control and quality of sleep that were assessed by parents and teachers.

"It really was across-the-board improvement in everyday life" for surgery patients, Redline said.

On the other hand, "almost half the children improved spontaneously over the 7-month period without surgery," she said.

Growth of the airway, a regression of the tissue blocking the airway at night, or routine medical care may have been some of the reasons, the researchers said.

Nonetheless, six of the 203 children in the watchful waiting group had an exacerbation of their symptoms. There was no worsening among the children who got surgery.

Three percent of the children who had surgery had some type of complication related to the surgery, but none was associated with death or disability.

The results also varied by weight, and the surgery was less effective among black children. The reason is unclear, the authors write.

SOURCE: http://bit.ly/165LeNT New England Journal of Medicine, online May 21, 2013.

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