PIH29 - Benefits of Adenotonsillectomy in Children with Mild Obstructive Sleep Apnea Syndrome

Abstract

The early treatment of mild obstructive sleep apnea syndrome (OSAS) with adenotonsillectomy (T&A) is controversial. The objectives were to compare changes in validated quality of life (QOL) and symptom measurements among a subset of children with OSAS who were randomized to one of 2 arms, adenotonsillectomy (T&A) or watchful waiting with supportive care (WWSC). Data from the Childhood Adenotonsillectomy Trial, a multicenter, randomized controlled study of adenotonsillectomy for OSAS were used to evaluate changes in quality of life and symptom improvement. Children aged 5 to <10 years with OSAS were randomized to undergo T&A or WWSC. Mild OSAS was defined to be an apnea-hypopnea index (AHI) < 5. Children underwent polysomnography, and parents completed the Peds QOL inventory, Pediatric Sleep Questionnaire (PSQ), the 18-item OSA QOL and the modified Epworth Sleepiness Scale (ESS) at baseline and at 7 months. Changes in the QOL and symptom surveys were assessed in each arm (paired t-tests) and compared between arms (independent samples t-tests). There were 241 children with mild OSAS, half of which (n = 120) received a T&A. There was no difference in treatment group in gender, ethnicity, race, BMI (normal, overweight, obese), tonsil size (0-50% vs 51-100%), and age. T&A patients had a decrease in AHI (p <0.0001), modified ESS (p <0.0001), total OSA QOL (p <0.0001) and total PSQ (p <0.0001). The WWSC patients also saw a change in modified ESS (p = 0.02), total OSA QOL (p = 0.006) and total PSQ (p = 0.04). The changes in the WWSC were not as large as the changes in the T&A group (p<0.001 for all). In children with mild OSA (AHI < 5), adenotonsillectomy, compared to watchful waiting, resulted in improved quality of life and parent reported symptoms.