Dados do Trabalho

Título

Adenotonsillectomy Versus Watchful Waiting on Sleep Quality in Children with Obstructive Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis

Introdução

Adenotonsillectomy (AT) is a widely performed pediatric surgery for obstructive sleep-disordered breathing (OSDB), including snoring and obstructive sleep apnea. While these conditions are suggested to potentially impact children's sleep quality and overall health, definitive evidence is lacking. This systematic review and meta-analysis aims to assess this gap by evaluating the effects of AT versus watchful waiting (WW) on sleep outcomes in children, addressing recent trials for an updated perspective on the current literature.

Objetivo

To assess the impact of adenotonsillectomy compared to watchful waiting on sleep quality in children with OSDB.

Métodos

This research was performed according to the PRISMA guideline. PubMed, Embase and Cochrane Central databases were comprehensively searched for randomized controlled trials and cohort studies that compared AT to WW in children with obstructive sleep-disordered breathing. Data were examined using the Mantel-Haenszel method to calculate the mean differences (MD) with 95% confidence intervals (CI). Heterogeneity was evaluated with I² statistics and p value < 0.05 were considered statistically significant. Statistical analysis was performed using R statistical software 4.4.0 version.

Resultados

A total of 6 studies were included. Among the 1320 patients comprehended, 657 underwent AT, while 663 were assigned to a WW protocol. Mean age ranged from 3.8 to 8.4 years, with 48.1% female participants. Regarding OSDB, AT showed a statistically significant improvement in Pediatric Sleep Questionnaire Sleep-Related Breathing Disorder Scale (MD -0.25; 95% CI -0.35, -0.15; P < 0.001; I2 = 96%) and Obstructive Sleep Apnea-18 tool (MD -14.34; 95% CI -21.68, -7.00; P < 0.001; I2 = 69%) compared to WW. The intervention group also had a significantly greater reduction in sleepiness than in the control group, measured by the Epworth Sleepiness Scale modified for children (MD -1.54; 95% CI -2.95, -0.12; P = 0.033748; I2 = 78%). Behavior, assessed with the Behavior Rating Inventory of Executive Function, also improved significantly in the AT group compared to WW (MD -2.19; 95% CI -4.18, -0.20; P = 0.030981; I² = 56%).

Conclusões

This systematic review and meta-analysis demonstrate significant improvements in sleep quality, symptomatology, and behavioral outcomes following adenotonsillectomy compared to watchful waiting, as indicated by enhanced scores on all evaluated scales.

Palavras -chave

Adenotonsillectomy; Obstructive Sleep-Disordered Breathing; Meta-analysis