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Review
. 2017 Feb;139(2):e20163491.
doi: 10.1542/peds.2016-3491. Epub 2017 Jan 17.

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Sivakumar Chinnadurai  1 , Atia K Jordan  2 , Nila A Sathe  3 , Christopher Fonnesbeck  4 , Melissa L McPheeters  3 , David O Francis  5
Affiliations
Review

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Sivakumar Chinnadurai et al. Pediatrics. 2017 Feb.

Abstract

Context: The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood.

Objective: To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB.

Data sources: Medline, Embase, and the Cochrane Library.

Study selection: Two investigators independently screened studies against predetermined criteria.

Data extraction: Two investigators independently extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. Investigators synthesized data qualitatively and meta-analyzed apnea-hypopnea index (AHI) scores.

Results: We included 11 studies. Relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy. In 5 studies including children with polysomnography-confirmed OSDB, AHI scores improved more in children receiving tonsillectomy versus surgery. A meta-analysis of 3 studies showed a 4.8-point improvement in the AHI in children who underwent tonsillectomy compared with no surgery. Sleep-related quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy. Changes in executive function were not significantly different. The length of follow-up in studies was generally <12 months.

Limitations: Few studies fully categorized populations in terms of severity of OSDB; outcome measures were heterogeneous; and the durability of outcomes beyond 12 months is not known.

Conclusions: Tonsillectomy can produce short-term improvement in sleep outcomes compared with no surgery in children with OSDB. Understanding of longer-term outcomes or effects in subpopulations is lacking.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Disposition of studies identified for this review. Numbers do not tally as studies could be excluded for multiple reasons.
See this image and copyright information in PMC

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