Supervisors info:
Παναγιώτα Περβανίδου, Επίκουρη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Αθανάσιος Μίχος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Χρυσάνθη Τζουμάκα-Μπακούλα, Ομότιμη Καθηγήτρια, Ιατρική, ΕΚΠΑ
Summary:
Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. Obstructive sleep disordered breathing (SDB), which often presents with daytime symptoms similar to ADHD, represents a spectrum of disorders for which adenotonsillectomy (AT) is usually the first-line treatment.
Objectives: To assess post-adenotonsillectomy improvement of attention deficit/hyperactivity symptoms, in children aged 4-18 years.
Methods: Systematic review of the literature was performed, according to the PRISMA statement. Pubmed/Medline, Scopus and Cochrane Central Registry of Controlled Trials electronic databases were searched through May 12, 2017. Eligible were prospective studies with participants 4-18 years old that underwent AT, without underlying disease or prescription medication for ADHD. The main outcome of the study was the pre- versus post-operative mean difference in ADHD scores, in caregiver-completed behavior assessment tools.
Results: 16 interventional studies met all eligibility criteria and were included in the systematic review, representing 769 children that had undergone AT. 14 studies (750 children) reported statistically significant improvement of inattention and/or hyperactivity and/or overall scores in the behavior assessment tool that was used. Μeta-analysis was done for 10 studies (419 children) with complete data on attention deficit subscales (overall effect size= 1,987, 95% CI: 2,981, 0,992) and for 9 studies (444 children) with complete data on hyperactivity subscales (overall effect size= -2,143, 95% CI: -3,512, -0,773).
Conclusion: Children that underwent AT demonstrated statistically significant post-operative improvement in their ADHD scores. Based on these results, a more systematic adherence to the AAP recommendations to screen all children with ADHD symptoms for SDB, and ideally to provide SDB treatment prior to ADHD treatment when needed, is considered necessary.
