Context

Adenotonsillectomy (T&A) in children is a very common surgical intervention for sleep disordered breathing and obstructive sleep apnoea (OSA). OSA in children causes cardiovascular, behavioural, developmental and cognitive sequelae. Controversies exist about many aspects of this condition including diagnosis, treatment and perioperative management.

In children with severe OSA there are neurocognitive deficits and altered brain development.1 There is a body of evidence to support the effectiveness of T&A in improving polysomnograms (PSG) and quality of life in OSA, but there are fewer studies that show T&A treats neurocognitive deficits, although there is a widely held belief that this is the case. The majority of children undergoing T&A for OSA have mild or moderate OSA, and several small series and case studies have identified small, but measurable, deficits in …