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Discrepancy between Objective and Subjective Outcomes after Adenotonsillectomy in Children with Obstructive Sleep
Kun-Tai Kang1, Wen-Chin Weng2, Chia-Hsuan Lee3
1Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Insights
Adenotonsillectomy significantly improves pediatric obstructive sleep apnea (OSA) outcomes. Quality of life improves subjectively even with residual OSA, highlighting the need for both objective and subjective assessments post-surgery.
Area of Science:
- Pediatric Sleep Medicine
- Otolaryngology
- Respiratory Medicine
Background:
- Pediatric obstructive sleep apnea (OSA) is commonly treated with adenotonsillectomy (T&A).
- Physicians face challenges due to discrepancies between objective and subjective outcome measures after T&A.
Purpose of the Study:
- To investigate changes in objective (polysomnography) and subjective (OSA-18) outcomes after T&A in children with OSA.
- To elucidate correlations and discrepancies between objective and subjective measures post-T&A.
Main Methods:
- A case series review of 119 children diagnosed with OSA (AHI > 1) who underwent T&A.
- Objective (Apnea-Hypopnea Index - AHI) and subjective (OSA-18 Quality-of-Life) measures were recorded preoperatively and 3 months postoperatively.
Main Results:
- T&A significantly reduced AHI (15.4 to 1.6, P < .001) and improved OSA-18 scores (P < .001).
- A weak positive correlation between AHI and OSA-18 existed preoperatively (ρ = 0.22, P = .016) but not postoperatively (ρ = 0.04, P = .677).
- Only 6% of cases with residual OSA experienced a significant impact on quality of life.
Conclusions:
- Adenotonsillectomy effectively improves both objective and subjective outcomes in pediatric OSA.
- Subjective quality of life improves despite incomplete objective resolution of OSA, indicating a shift in the correlation between measures.
- Comprehensive objective and subjective evaluation is crucial for managing pediatric OSA post-T&A.
Objective:
Adenotonsillectomy (T&A) is the first line therapy for pediatric obstructive sleep apnea (OSA); however, inconsistency between objective and subjective outcomes perplexes physicians. This study investigates changes of objective and subjective outcomes in children with OSA after T&A, in particular, to elucidate correlations and discrepancies between these 2 measures.
Study Design:
Case series with record review.
Setting:
Tertiary referral medical center.
Subjects And Methods:
Symptomatic children with polysomnographic diagnosis of OSA (apnea-hypopnea index [AHI] > 1) were included. All children underwent T&A to treat OSA, along with completely objective (polysomnography) and subjective (Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire [OSA-18]) measures before and 3 months after surgery.
Results:
One hundred nineteen children were included (mean age, 6.9 ± 3.3 years; 76% boys). Adenotonsillectomy significantly reduced AHI from 15.4 ± 21.2 per hour to 1.6 ± 2.5 per hour (P < .001). The OSA-18 scores were significantly improved after surgery (P < .001). A weak but statistically significant positive correlation was found between AHI and OSA-18 scores preoperatively (ρ = 0.22, P = .016) but not postoperatively (ρ = 0.04, P = .677). Among those cases with residual OSA after surgery, only 6% (3/54) had a residual effect on quality of life (OSA-18 score > 60).
Conclusion:
Adenotonsillectomy improves both objective and subjective outcomes. After surgery, quality of life significantly improved subjectively, despite an incomplete resolution of OSA objectively, leading to a better correlation between objective and subjective measures before as opposed to after surgery. Discrepancy between the 2 measures warrants an evaluation of a child both objectively and subjectively when treating OSA.
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