The way to improve the sleep quality of children with sleep apnea – as well as helping to solve their behavior and academic problems – may be a tonsillectomy, according to a new research at Israel’s Soroka Medical Center.
Removal of the tonsils and the adenoids improves the quality of sleep and as a result, better academic performance and overall cognitive ability in children who are suffering from what is known as obstructive sleep apnea syndrome.
“The most important aspect of what we found is that the effects of the sleep apnea were totally reversible with tonsillectomy,” said Prof. Asher Tal, who led the research along with Dr. Haim Reuveni of the Department of Health Policy Management and Department of Pediatrics, and Dr. Ariel Tarasiuk, Head of the Sleep Laboratory.
The findings were published in two separate studies published in the December 2003 issue of the medical journal Chest and in the December 2003 issue of the medical journal Sleep.
Tal, of the Department of Pediatrics at Soroka Medical Center, Ben-Gurion University of the Negev, notes that 3 percent of all children suffer from breathing problems in their sleep, resulting from blockage of upper respiratory passages.
The syndrome known as “obstructive sleep apnea” is mainly associated with overweight men in adulthood, but is far more common in children according to Tal. And the most overlooked factor in the cases of child sleep apnea is enlarged tonsils and adenoids.
The syndrome has implications for children in their daytime lives as well as at night. Many research studies have found that OSA can cause children to develop cognitive and behavioral problems, accompanied by problems with listening and concentration that lead to learning disorders. They also suffer from growth and other health problems.
“We knew from previous studies in the states that sleep apnea is probably related to ADHD and there was some preliminary evidence that it may impair cognitive function. An Israeli physician in Louisville Kentucky, has proven that among first graders in the lower percentile of grades, 20 percent of them presented with sleep disorders,” Tal told ISRAEL21c. “But ours is the first research that addresses the issue directly.”
Earlier studies led by Tal found that children who suffer from sleep apnea are heavy users of the health system, are treated, hospitalized and medicated more than their peers. In order to better understand the sleep patterns of children with OSA before and after after removal of tonsils and adenoids, Tal’s latest research was initiated at the Sleep-Wake Disorders Unit at Soroka.
Thirty-six children were examined in the sleep laboratory before tonsil and adenoid removal and then several months after their operations. General assessments of the children at the clinic, with questionnaires detailed about their sleep habits filled out by their parents, and devices in the sleep labs.
The results showed clearly that the removal of tonsils and adenoids greatly improves the quality of their sleep, most notably during the important REM phase.
An accompanying Soroka-Ben-Gurion University study, published in the December issue of the medical journal Sleep, looked at the behavioral problems, attention disorders and learning disorders that can accompany OSA, due to the reduction of the provision of oxygen to the brain during sleep. In this study, 39 children suffering from OSA, ages 5 to 9, were examined before and after their tonsil and adenoid removals, and compared to a control group of 20 healthy children.
Before their operations, it was clear that among the children when had the sleep apnea greater level of behavior and lowered cognitive ability was found as compared to the control group. But just a few months after their operation, their cognitive function improved significantly and reached that of their peers.
The research indicated for the first time to the fact that removal of tonsils and adenoids in children with sleep apnea can significantly improve their academic performance and achievement in school.
Currently, the level of awareness among doctors of the influence of OSA on academic performance is relatively low, and the BGU researchers believe that the results of this study will be an important contribution to doctors’ decisions as to whether to remove tonsils and adenoids in children.
The trend in pediatrics currently leans towards only performing tonsillectomies in cases when it is considered absolutely necessary, such as when a child snores loudly. This research, says Tal, is likely in time, to alter the balance in decision-making as awareness grows among doctors, parents, and teachers.
“It will take time for people to understand that sleep apnea is not benign,” said Tal, “and that when children have decreased oxygen supplement to the brain during sleep, and their sleep is fragmented, there are cognitive and behavioral implications. We are now having neurologists refer us to children for suspected ADHD, and finding that 20-30 percent of them suffer from sleep apnea. It may turn out that for some children, correcting their sleep may correct their ADHD and they won’t need drugs like Ritalin. That’s important information.”
Tal’s research is ongoing, currently focusing on sleep issues in young children aged 2 to 5 years old.
‘The most important aspect of what we found is that the effects of the sleep apnea were totally reversible with tonsillectomy,’ said Prof. Asher Tal, who led the research.