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Objective This study aimed to evaluate the effect of adenotonsillectomy on visual attention and daytime sleepiness in children with sleep-disordered breathing. Design This was a controlled prospective cohort study. Setting Outpatients from the Otorhinolaryngology Division of Edmundo Vasconcelos Hospital Complex, São Paulo, Brazil. Participants Patients aged 6-17 years with upper airway obstruction scheduled to undergo adenotonsillectomy (treatment group) in the Otorhinolaryngology Division of Edmundo Vasconcelos Hospital Complex, in São Paulo, Brazil. Participants of control group were consecutively selected from another outpatient clinic of paediatric surgery, but those with symptoms of sleep-disordered breathing were excluded. Main outcome measures Children were submitted to visual attention tests ( TAVIS-3) that discriminates normal subjects from those with attentional disorders in advance of the surgery and 2 months later, and in the same period for the control group. Parents were interviewed about lifestyle, sleep characteristics and daytime sleepiness. Results The analysis included 27 patients in the adenotonsillectomy group and 30 controls, who had similar age (10.0 ± 3.3 versus 10.3 ± 3.7 years; P = 0.8), gender (41% boys versus 57%, respectively) and body mass index. There was marked decrease in daytime sleepiness after surgery (delta between groups: −4.7 ± 3.8; P < 0.001), as well as reductions in reaction time, errors of omission and errors of commission in the treatment compared with the control group at both time points, before and after surgery. Conclusions This study shows that adenotonsillectomy in children and adolescents with sleep-disordered breathing reduces daytime sleepiness and improves the performance in tests of visual attention. [ABSTRACT FROM AUTHOR]