2. Agreements and disagreements with other studies and reviews.
| Systematic reviews | ||||||
| No. of studies | Participants | Intervention | Comparison | Outcomes | Results | |
| Baldassari 2008 | 9 | N = 1470 Age: 1 to 18 OSAS |
AT | n/a | QoL 1 to 6 mo (7 studies) | Significant improvement in OSA‐18 scores after AT |
| QoL 6 to 16 mo (2 studies) | Significant improvement in OSA‐18 scores after AT No significant differences between OSA‐18 scores after AT in short and long term |
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| Garetz 2008 | 25 | N = 19 to 297 (range) Age: 0 to 18 oSDB |
AT | Children without SDB symptoms | QoL 6 and 9 to 23 mo (13 studies) | Significant improvements in OSD‐6, OSA‐18 and CHQPF‐28 scores after AT |
| Behaviour (12 studies) | Larger improvement on Conners scale in AT versus control children Significant improvement in CBCL and BASC scores after AT |
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| Neurocognitive functioning (9 studies) | CPT, DAS and K‐ABC scores improved significantly after AT versus matched control children scores. Only NEPSY verbal scores were lower versus controls and these improved after surgery | |||||
| Costa 2009 | 4 | N = 110 Age: 0 to 18 Obese OSAS |
AT | n/a | AHI | Mean AHI decrease after AT: 18.3 events/hour |
| Cure rate using the individual study criteria (AHI < 5 or AHI ≤ 2) | 38.5% | |||||
| Friedman 2009 | 23 | N = 1079 Age: 0 to 20 OSAS |
AT | Different control groups used in individual studies | Treatment success as defined per each individual study (23 studies) | 66.3% |
| Treatment success defined as AHI < 1 (9 studies) | 59.8% | |||||
| Treatment success defined as AHI < 5 (16 studies) | 66.2% | |||||
| PSG cure rate in uncomplicated children (19 studies) | 73.8% | |||||
| PSG cure rate in children with co‐morbidities (e.g. obesity, severe OSAS) or in high‐risk populations (e.g. age < 3) (9 studies) | 38.7% | |||||
| Jeyakumar 2011 | 9 | N = 795 Age: 0 to 18 Normal weight or overweight Surgery for any reason |
T or AT | n/a | Change in BMI (3 studies) | BMI increase after surgery of 7% |
| Change in weight (3 studies) | Increase in standardised weight scores after surgery: 46% to 100% | |||||
| % weight gain (3 studies) | 50% to 75% gained weight, 28% lost weight and 22% to 31% unchanged after surgery | |||||
| Teo 2013 | 14 | N = 418 Age: 2 to 12 oSDB |
AT | n/a | Blood pressure (3 studies) | Improvement after AT |
| Mean pulmonary artery pressure (6 studies) | Improvement after AT | |||||
| Echocardiographic findings (7 studies) | Improvement after AT | |||||
| Pulse rate and pulse rate variability (1 study) | Decrease after AT | |||||
| Sedky 2014 | 12 | N = 529 Age: 0 to 18 oSDB |
AT | n/a | ADHD symptoms | Medium improvement in ADHD symptoms after AT |
| Individual studies not cited in systematic reviews | ||||||
| Study design | Study population | Intervention | Comparison | Outcomes | Results | |
| Arrarte 2007 | Non‐controlled observational study | Brazil N = 27 Age: 2 to 10 Respiratory obstructive symptoms during sleep |
AT | n/a | Nocturnal pulse oximetry (ODI) | Significant decrease in ODI after AT |
| oSDB symptoms | 92.6% of children noticed symptom improvement after AT | |||||
| Apostolidou 2008 | Prospective controlled study | Greece N = 70 Age: 0 to 16 OSAS Habitual snoring Adenoidal and/or tonsillar hypertrophy |
AT in obese children | AT in non‐obese children | OAHI < 1 | No differences between the 2 groups before and after AT |
| Mitchell 2009 | Prospective controlled study | USA N = 89 Age: 3 to 18 OSAS (AHI >2) |
AT in obese children | AT in non‐obese children | OSA‐18 | Most OSA‐18 scores were higher in obese versus non‐obese children after AT |
| BASC | No significant difference between groups after AT | |||||
| Attia 2010 | Prospective cohort study | Egypt N = 87 Age: 2 to 16 OSAS |
AT | Healthy children | AHI | Significant improvement in AHI after AT with postoperative values matching the control group |
| Ezzat 2010 | Cohort study | Egypt N = 184 Age: 3 to 16 OSAS symptoms with positive OPO |
AT | ‐ Healthy children ‐ AT for other reasons ‐ No ENT surgery |
IQ (S‐BIS) | Significant improvement in IQ after AT with postoperative values matching the control groups |
| Parental symptom questionnaire (not validated) | 99% reported symptom improvements after AT | |||||
| Fung 2010 | Case‐control study | Canada N = 98 Age ≤ 17 oSDB symptoms with positive OPO |
T or AT in obese children | T or AT in non‐obese children | Postoperative respiratory complications | Obese children had more complications than non‐obese children |
| Mean length of stay in hospital | Obese versus non‐obese children: 18 versus 8 hours | |||||
| Randhawa 2011 | Prospective cohort study | UK N = 258 Age: 6 to 16 OSAS (AHI ≥1) |
AT | Healthy children | CHQPF‐28 (4 years) | Significant improvements after AT in 9/13 domains |
| Goldstein 2012 | Non‐controlled observational study | USA N = 100 Age: 2 to 12 Snoring and disruptive sleep for 3 mo OSAS |
AT | n/a | CAS‐15 (not validated) | Significant improvement after AT |
| OSA‐18 | Significant improvement after AT | |||||
| PedsQL | Significant improvement after AT | |||||
| CBCL | Significant improvement after AT | |||||
| AHI | Mean AHI decrease after AT: 15.9 events/hour | |||||
| Tagaya 2012 | Non‐controlled observational study | Japan N = 49 Age: 1 to 10 OSAS (AHI ≥ 5) Normal weight |
AT | n/a | AHI (1.5 years) | Pre‐ and postoperative AHI were significantly higher in symptomatic versus asymptomatic children |
| Abreu 2013 | Prospective controlled study | Brazil N = 60 Age: 6 to 17 Symptoms of airway obstruction |
AT | Other paediatric surgery | TAVIS‐3 visual attention test | Significantly greater improvements in AT group versus other surgery group |
| Modified Epworth Sleepiness scale | Marked reduction in daytime sleepiness in AT group versus other surgery group | |||||
| Burstein 2013 | Matched, historical cohort study | USA N = 33 Age: 1 to 12 OSAS |
AT | No treatment | CAS‐15 (not validated) | Mean CAS‐15 was significantly lower in AT group |
| CBCL | Mean CBCL scores were significantly lower in AT group | |||||
| AHI | Significantly greater decrease in AHI among the AT group versus control group | |||||
| Huang 2014 | Non‐controlled observational study | Taiwan N = 88 Age: 8.9 (SD 2.7) OSAS |
AT | n/a | AHI (0 mo) | Mean AHI 13.5 (SD 7.2) |
| AHI (6 mo) | Mean AHI 3.5 (SD 8.1) | |||||
| AHI >1 (6 mo) | 53% | |||||
| AHI (36 mo) | Mean AHI 6.5 (SD 5.6) Residual OSAS after AT was associated with BMI, AHI, enuresis and allergic rhinitis before surgery |
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| AHI >1 (36 mo) | 68% | |||||
| Kang 2014 | Non‐controlled observational study | Taiwan N = 119 Age: 6.9 (SD 3.3) OSAS |
AT | n/a | AHI (3 mo) | Mean AHI decrease after AT: 13.8 events/hour |
| OSA‐18 (3 mo) | Significant improvement after AT | |||||
| Kobayashi 2014 | Non‐controlled observational study | Japan N = 45 Age < 13 OSAS |
AT | n/a | AHI (3 to 6 mo) | Significant improvement after AT |
| OSA‐18 (3 to 6 mo) | Significant improvement after AT | |||||
| Lee 2014 | Non‐controlled observational study | Taiwan N = 144 Age: 2 to 18 Primary snoring (AHI < 1) and OSAS (AHI > 1) |
AT | n/a | OSA‐18 (3 mo) | Improvement in mean OSA‐18 scores after AT increased as disease severity increased and was not affected by gender, age or adiposity |
| Volsky 2014 | Prospective non‐randomised controlled study | USA N = 64 Age: 3 to 16 OSAS (AHI 1 to 5) and tonsillar hypertrophy |
AT | Observation | OSA‐18 (3 mo) | Mean OSA‐18 significantly improved in AT group versus no significant change in observation group |
| OSA‐18 (8 mo) | No statistically significant difference between the 2 groups | |||||
| CHQPF‐28 (3 mo) | No statistical difference between the 2 groups | |||||
| CHQPF‐28 (8 mo) | No statistically significant difference between the 2 groups | |||||
| Feng 2015 | Prospective cohort study | China N = 35 Age: 4 to 8 OSAS |
A and AT | Healthy children | OSA‐18 | Significant improvement after AT with postoperative values matching the control groups |
| C‐WISC | Significant improvement after AT with postoperative values matching the control groups | |||||
| Hamada 2015 | Non‐controlled observational study | Japan N = 147 Age: 11 mo to 6 years OSAS |
AT | n/a | AHI in infants and toddlers (N = 50) | Mean AHI before AT: 13.5 (SD 7.1); Mean AHI after AT: 4.7 (SD 3.4). |
| AHI in preschool children (N = 97) | Mean AHI before AT: 16.0 (SD 10.2); Mean AHI after AT: 4.4 (SD 2.2) |
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| Lee 2015 | Non‐controlled observational study | Taiwan N = 144 Age: 2 to 18 Primary snoring (AHI < 1) and OSAS (AHI > 1) |
AT | n/a | OSA‐18 (3 mo) | Significant improvement after AT |
| OSA‐18 (6 mo) | Significant improvement after AT. No differences between 3 and 6 mo mean total OSA‐18 scores |
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A: adenoidectomy; ADHD: attention deficit hyperactivity disorder; AHI: Apnoea/Hypopnoea Index; AT: adenotonsillectomy; BASC: Behavioural Assessment System for Children test; BMI: body mass index; CAS‐15: Clinical Assessment Score‐15; CBCL: Child Behavior Checklist; CHQPF‐28: Child Health Questionnaire Parent Form‐28; Conners: Conners rating scale; CPT: continuous performance test; C‐WISC: Chinese Wechsler Intelligence Scale For Children; DAS: Differential Abilities Scale; ENT: ear, nose and throat; K‐ABC: Kaufman Assessment Battery For Children; mo: months; n/a: not applicable; N: number; NEPSY: Developmental Neuropsychological Assessment; OAHI: Obstructive Apnoea/Hypopnoea Index; ODI: Oxygen Desaturation Index; OPO: overnight pulse oximetry; OSA‐18: Obstructive Sleep Apnoea‐18; OSAS: obstructive sleep apnoea syndrome; OSD‐6: Obstructive Sleep Disorders 6‐Survey; oSDB: obstructive sleep‐disordered breathing; PedsQL: Pediatric Quality of Life Inventory; PSG: polysomnography; QoL: quality of life; S‐BIS: Stanford‐Binet Intelligence Scales; SD: standard deviation; T: tonsillectomy; TAVIS‐3: 3rd version of a computerised test of visual attention