Impact of Adenotonsillectomy for Obstructive Sleep Disorders on Quality of Life

Abstract

Otolaryngology| August 01 2002 Impact of Adenotonsillectomy for Obstructive Sleep Disorders on Quality of Life AAP Grand Rounds (2002) 8 (2): 16–17. https://doi.org/10.1542/gr.8-2-16 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Impact of Adenotonsillectomy for Obstructive Sleep Disorders on Quality of Life. AAP Grand Rounds August 2002; 8 (2): 16–17. https://doi.org/10.1542/gr.8-2-16 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: quality of life, sleep disorders, tonsillectomy and adenoidectomy Source: de Serres LM, Derkay C, Sie K, et al. Impact of adenotonsillectomy on quality of life in children with obstructive sleep disorders. Arch Otolaryngol Head Neck Surg. 2002;128:489–496. De Serres and colleagues, from 7 tertiary pediatric otolaryngology practices across the United States, conducted a prospective observational study to determine the impact of adenotonsillectomy on quality of life (QOL) in children with obstructive sleep disorders (OSDs). Participants were a convenience sample of caregivers of children aged 2–12 years undergoing adenotonsillectomy for OSDs. Before surgery, the physicians completed a physical assessment form for each patient that documented the method of diagnosis for OSDs (history, physical examination, nasopharyngoscopy, lateral radiograph, sleep audiotape, or sleep study), OSD symptoms, and physical examination findings, including degree of tonsillar obstruction. Data were collected at the initial visit, on the day of surgery, and at the postoperative visit (usually 4–6 weeks after surgery). A 6-item, disease-specific QOL instrument (Obstructive Sleep Disorders-6 survey or OSD-6), a validated measure of assessing changes in patients with OSDs who undergo adenotonsillectomy, was used. The 6 domains in OSD-6 reflect a child’s functioning regarding: physical suffering, sleep disturbance, speech and swallowing difficulties, emotional distress, activity limitations, and level of concern of the caregiver relating to the patient’s sleep disorder and associated symptoms. Domains were rated on a scale of 0 (“no problem”) to 6 (“worst”). To distinguish QOL changes resulting from surgery from other potentially confounding factors, parents were also asked to complete a validated satisfaction survey at the initial visit. A total of 115 caregivers were enrolled, but 14 were lost to follow-up, yielding a final study group of 101. Patients’ mean age was 6.2 years. All patients were snorers and 92% had restless sleep. Less common complaints included enuresis (13%), nocturnal sweating (7%), and morning headaches (3%). Changes in QOL were determined by measuring the differences in OSD-6 scores between consecutive visits. The change in scores between the initial and the pre-operative visits was trivial. The score change between pre-operative and postoperative visits indicated a large improvement in QOL (P<.001). After surgery, 73/101 demonstrated a large degree of improvement in QOL, 6 had moderate improvement, 7 had small improvement, and 7 had trivial improvement. Five patients had a worsening of their QOL after surgery, but no predictive factors were identified. Statistical analysis did not reveal any predictive factors for improvement in QOL. Specifically, factors such as age, sex, degree of tonsillar obstruction, parental satisfaction with decision for surgery, parental satisfaction with office visit, and sleep symptoms were not related to QOL outcome. There was no linear relationship between the length of follow-up and improved QOL, indicating that patients with later postoperative visits did not show greater improvement in QOL. The authors conclude that adenotonsillectomy produces large improvements in at least short-term QOL in most children with OSDs. OSDs are a spectrum of sleep-disordered breathing that is severe enough to cause clinical symptoms. The prevalence of sleep-disordered breathing in children may be close to... You do not currently have access to this content.