Neurocognitive outcomes after pediatric adenotonsillectomy for obstructive sleep apnea: A systematic review and meta-analysis

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 IQafter 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. Published by Elsevier Ireland Ltd.