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Published on: December 6, 2016
Correlations between objective and subjective outcomes after adenotonsillar surgery in children with OSA
Isabella Sjölander1, Anna Borgström2, Pia Nerfeldt2
1Department of Surgical Sciences Uppsala University Uppsala Sweden.
Insights
The OSA-18 questionnaire and a patient-reported outcome measure (PROM) question showed significant correlation with polysomnography (PSG) data in children with obstructive sleep apnea (OSA) after surgery. Changes in OSA-18 sleep disturbance scale correlate well with obstructive apnea-hypopnea index (OAHI) changes.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Clinical Outcomes Research
Background:
- Obstructive sleep apnea (OSA) significantly impacts children's health and quality of life.
- Adenotonsillectomy is a common treatment for pediatric OSA, but objective and subjective outcome measures are needed.
- The OSA-18 questionnaire and patient-reported outcome measures (PROMs) are potential tools for assessing treatment effectiveness.
Purpose of the Study:
- To investigate the correlation between the OSA-18 questionnaire and a postoperative PROM question with polysomnography (PSG) data in children undergoing adenotonsillectomy for OSA.
- To assess the relationship between changes in the obstructive apnea-hypopnea index (OAHI) and the OSA-18 total symptom score (TSS) and sleep disturbance subscale (SDS).
- To evaluate the correlation of a PROM question on symptom improvement with PSG findings and OSA-18 scores.
Main Methods:
- A prospective study involving otherwise healthy young children with moderate to severe OSA.
- Collected PSG data (OAHI) and OSA-18 scores (TSS and SDS) preoperatively and 6-12 months post-adenotonsillectomy.
- Administered a 4-grade Likert scale PROM question regarding symptom improvement postoperatively.
Main Results:
- Significant correlations were found between changes in OAHI and changes in OSA-18 TSS (r=0.29) and SDS (r=0.53).
- The PROM question correlated with changes in OAHI (r=0.36), OSA-18 TSS (r=0.24), and SDS (r=0.34).
- The PROM question demonstrated 82% specificity and 38% sensitivity for predicting a postoperative OAHI < 2.
Conclusions:
- Changes in the OSA-18, particularly the sleep disturbance scale, significantly correlate with changes in OAHI postoperatively.
- The OSA-18 sleep disturbance scale may serve as a valuable tool for evaluating treatment outcomes in follow-up assessments.
- Postoperative PROM questions show promise in correlating with objective PSG measures and subjective symptom changes.
Objectives:
To investigate whether the OSA-18 questionnaire and a postoperative patient-reported outcome measure (PROM) question correlated with polysomnography (PSG) data.
Methods:
A prospective study of otherwise healthy young children with moderate to severe obstructive sleep apnea (OSA) to investigate if the obstructive apnea-hypopnea index (OAHI) before and 6-12 months after adenotonsil surgery correlated with the OSA-18 total symptom score (TSS) and the sleep disturbance subscale (SDS), as well as a PROM question on symptom improvement with responses on a 4-grade Likert scale.
Results:
Of 201 children, 173 (86%) had complete data of OAHI and OSA-18 pre- and postoperatively. The mean age was 3.2 years (SD 1.0) and the mean OAHI was 15.9 (11.3). Significant correlations between changes in the OAHI and OSA-18 were found, both TSS (r = 0.29, p < .001) and SDS (r = 0.53, p < .001). A total of 136 (68%) patients responded to the PROM question, the majority of whose symptoms had disappeared (n = 102) or almost disappeared (n = 30). Four patients had unchanged symptoms, and none had worsening symptoms. A correlation was found between the PROM question and a change in the OAHI (r = 0.36, p < .001), as well as a change in the OSA-18 TSS (r = 0.24, p = .006) and the SDS (r = 0.34, p < .001). The specificity of the PROM question for prediction of a postoperative OAHI < 2 was 82%, and the sensitivity was 38%.
Conclusion:
Changes in the OAHI significantly correlated with changes in the OSA-18, especially with the sleep disturbance scale, which could be an alternative for evaluation at follow-ups.
Level Of Evidence:
3.
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