Adenotonsillectomy in children with obstructive sleep apnoea. N Engl J Med 2013; 368:2366.
A randomised controlled trial in the USA finds that adenotonsillectomy does not improve cognitive function in children with obstructive sleep apnoea syndrome, although it does have a beneficial effect on symptoms of sleep apnoea.

CONCLUSIONS.

As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.)

A consensus statement on tonsillectomy and adenoidectomy in children with sleep-related breathing disorders endorsed by royal colleges in UK, says that it is not known which children with relatively mild forms of sleep-related breathing disorders benefit from adenotonsillectomy. In the UK, the decision to operate is usually a clinical one, based on the severity of symptoms (both day and night) and presence of complications.

Dr G Mohan.