The LaryngoscopeAug 2, 2007

Behavior changes in children with mild breathing problems during sleep or sleep apnea after tonsil and adenoid removal

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 3, 2026

Abstract

The mean preoperative apnea-hypopnea index (AHI) was 3.1 for children with mild sleep-disordered breathing and 25.3 for those with obstructive sleep apnea.

Children with either mild sleep-disordered breathing or obstructive sleep apnea exhibited behavioral problems prior to surgery.
A significant improvement in overall behavior was observed post-adenotonsillectomy in both groups.
Specific improvements were noted in measures of atypicality, depression, hyperactivity, and somatization after surgery.
Preoperative behavioral assessment scores were not significantly different between children with mild sleep-disordered breathing and those with obstructive sleep apnea.

Simplified

OBJECTIVE: To compare changes in behavior after adenotonsillectomy in children with either mild sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA).

STUDY DESIGN: Prospective cohort study.

METHODS: Children at the University of New Mexico Children's Hospital, Albuquerque with mild SDB or OSA were included in the study. All children underwent preoperative polysomnography before adenotonsillectomy. Mild SDB was defined as an apnea-hypopnea index (AHI) less than 5 or an apnea index (AI) less than 1. OSA was defined as an AHI 5 or greater or an AI 1 or greater. Pre- and postoperative scores from the Behavioral Assessment System for Children (BASC) survey were compared using repeated measures analysis of variance.

RESULTS: The mean preoperative AHI for children with mild SDB (n=17) was 3.1 (range, 1.7-4.7), and for children with OSA (n=23) it was 25.3 (range, 10.0-48.0). The mean preoperative BASC scores for children with mild SDB were not significantly different from the scores for children with OSA. The demographics in the two groups of children were similar. The behavior symptom index, a global measure of behavior, showed significant improvement after surgery for both groups of children (P<.01). Children also showed significant improvement after adenotonsillectomy in the BASC scales of atypicality, depression, hyperactivity, and somatization. Mean changes in BASC scores after adenotonsillectomy were not significantly different in the two groups of children.

CONCLUSIONS: Behavioral problems are prevalent in children with either mild SDB or OSA, and both groups of children show significant improvements in behavior after adenotonsillectomy.

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Behavior changes in children with mild breathing problems during sleep or sleep apnea after tonsil and adenoid removal

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