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Published on: December 6, 2016
A randomized trial of adenotonsillectomy for childhood sleep apnea
Carole L Marcus1, Reneé H Moore, Carol L Rosen
1Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA.
Insights
Early adenotonsillectomy in children with obstructive sleep apnea syndrome did not improve attention or executive function. However, surgery reduced symptoms and improved behavior, quality of life, and sleep study results compared to watchful waiting.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Pediatric Surgery
Background:
- Adenotonsillectomy is a common procedure for pediatric obstructive sleep apnea syndrome (OSAS).
- The effectiveness of adenotonsillectomy in improving cognition, behavior, quality of life, and polysomnographic outcomes in children with OSAS requires rigorous evaluation.
- This study investigated the benefits of early adenotonsillectomy versus watchful waiting in children with OSAS.
Purpose of the Study:
- To evaluate the efficacy of early adenotonsillectomy compared to watchful waiting in children with obstructive sleep apnea syndrome.
- To assess the impact of adenotonsillectomy on cognitive, behavioral, quality of life, and polysomnographic outcomes.
- To determine if early surgical intervention leads to improved outcomes in children with OSAS without prolonged oxyhemoglobin desaturation.
Main Methods:
- A randomized controlled trial involving 464 children aged 5-9 years with OSAS.
- Participants were assigned to either early adenotonsillectomy or a watchful waiting strategy with supportive care.
- Outcomes including polysomnography, cognitive function, behavior, and health status were assessed at baseline and 7 months post-intervention.
Main Results:
- Early adenotonsillectomy did not significantly improve attention or executive function scores compared to watchful waiting (P=0.16).
- Significant improvements were observed in behavioral outcomes, quality of life, and polysomnographic findings in the early adenotonsillectomy group.
- Normalization of polysomnographic findings occurred in a higher proportion of children who underwent early adenotonsillectomy (79%) versus watchful waiting (46%).
Conclusions:
- While early adenotonsillectomy did not enhance neuropsychological measures of attention and executive function in children with OSAS, it effectively reduced symptoms.
- The study provides evidence for the beneficial effects of early adenotonsillectomy on secondary outcomes, including behavior, quality of life, and polysomnographic parameters.
- Surgical treatment demonstrated a positive impact on key health indicators for pediatric obstructive sleep apnea syndrome when compared to a conservative approach.
Background:
Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.
Methods:
We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months.
Results:
The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%).
Conclusions:
As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.).
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