Impact of adenotonsillectomy on sleep and behavioral outcomes in children: a longitudinal study.

Abstract

Background: Adenotonsillar hypertrophy is a prevalent pediatric condition that may affect children's health due to its association with obstructive sleep-disordered breathing (OSDB). This can negatively affect sleep quality, daytime behavior, neurocognitive development, and growth. This study aimed to evaluate the impact of adenotonsillectomy on children's sleep habits and behavior. A secondary objective was to explore differences in outcomes between children undergoing surgery for recurrent upper respiratory tract infections (URTIs) versus those with OSDB.

Methods: A prospective longitudinal observational study was conducted from December 2023 to December 2024, enrolling 28 children aged 2-10 years undergoing adenotonsillectomy. Sleep and behavioral changes were assessed preoperatively and postoperatively (3-6 months) using the validated Children's Sleep Habits Questionnaire-adapted Portuguese version and the Strengths and Difficulties Questionnaire-Portuguese version. Paired samples t-tests and general linear models were used for statistical analysis.

Results: Significant improvements were observed in several sleep parameters: sleep duration, parasomnias, sleep-related breathing disorders, daytime sleepiness, and the total sleep disturbance index (P < 0.001 for all). In the behavioral domain, hyperactivity was the only subscale to show statistically significant improvement (P = 0.028). Surgical indication (OSDB vs. recurrent URTIs) did not significantly influence most outcomes, except for sleep-related breathing disorders, where greater improvement was noted in the OSDB group, as expected.

Conclusion: Adenotonsillectomy positively affects multiple dimensions of sleep, particularly reducing parasomnia episodes and hyperactivity symptoms, regardless of surgical indication. These findings underscore the importance of early recognition and management of pediatric adenotonsillar disorders to promote healthy sleep, improved daytime functioning, and long-term psychosocial development.