OSA-18 Total Scores Research Articles

Quality of life of elementary school students with sleep-disordered breathing and allergic rhinitis: A population-based study in Thailand.

Sleep-disordered breathing (SDB) and allergic rhinitis (AR) are common problems that can lead to worsening quality of life (QOL) in children with these conditions. There is scarce evidence on the QOL of children with SDB outside of the hospital setting with inconsistent evidence on the association of AR and QOL concerning the SDB in children. Thus, the primary objective of this study is to determine the QOL concerning the SDB of elementary school students by using OSA-18. We also aim to provide the relationship of allergic rhinitis to the QOL. A cross-sectional study was conducted on all elementary school students, aged 6-12 years, from 10 elementary schools. The QOL of all participants was evaluated by the Thai version of the caregiver-administered OSA-18 questionnaire. The simple and multiple linear regression models were used to determine the effect of allergic rhinitis on the OSA-18 total scores. A total of 3,053 children were included in the final analysis, 50.1% male. At least a moderate impact on QOL from SDB was observed in 9.4% of the population. Children with AR had significantly higher mean total OSA- 18 scores than the children without AR (47.5 ± 15.0 VS 38.5 ± 13.1, p < 0.001). After the adjustment for age, gender, body mass index, household income, and history of asthma, the point estimate of the adjusted beta regression coefficient on the OSA-18 total score in children with AR was 7.82 (95% CI: 6.00-9.65, p < 0.001). Significant associations were observed between AR and all domains except for emotional distress. A substantial number of elementary school children had at least a moderate impact on the QOL from SDB, especially those with AR. Thus, effective screening of SDB in children with AR should be done to improve the QOL of these children.

Multilevel Risk Factors for Sleep-Disordered Breathing-Related Symptom Burden in an Urban Pediatric Community-Based Sample

Pediatric sleep-disordered breathing (SDB) disproportionately affects children with low socioeconomic status (SES). The multilevel risk factors that drive these associations are not well understood. What are the associations between SDB risk factors, including individual health conditions (obesity, asthma, and allergies), household SES (maternal education), indoor exposures (environmental tobacco smoke [ETS] and pests), and neighborhood characteristics (neighborhood disadvantage), and pediatric SDB symptoms? Cross-sectional analyses were performed on 303 children (aged 6-12 years) enrolled in the Environmental Assessment of Sleep Youth study from 2018 to 2022. Exposures were determined by caregiver reports, assays of measured settled dust from the child's bedroom, and neighborhood-level Census data (deriving the Childhood Opportunity Index to characterize neighborhood disadvantage). The primary outcome was the SDB-related symptom burden assessed by the OSA-18 questionnaire total score. Using linear regression models, we calculated associations between exposures and SDB-related symptom burden, adjusting for sociodemographic factors, then health conditions, indoor environment, and neighborhood factors. The sample included 303 children (39% Hispanic, Latino, Latina, or Spanish origin; 30% Black or African American; 22% White; and 11% other). Increasing OSA-18 total scores were associated with low household SES after adjustment for demographic factors, and with asthma, allergies, ETS, pests (mouse, cockroach, and rodents), and an indoor environmental index (sum of the presence of pests and ETS; 0-2) after adjusting for sociodemographic factors. Even after further adjusting for asthma, allergies, and neighborhood disadvantage, ETS and pest exposure were associated with OSA-18 (ETS: β = 12.80; 95% CI, 7.07-18.53, also adjusted for pest; pest exposure: β = 3.69; 95% CI, 0.44-6.94, also adjusted for ETS). In addition to associations with ETS, a novel association was observed for indoor pest exposure and SDB symptom burden. Strategies to reduce household exposure to ETS and indoor allergens should be tested as approaches for reducing sleep health disparities.

O011 Effect of Continuous Positive Airway Pressure on Quality of Life and Treatment Burden in Children with Obstructive Sleep Apnoea

Abstract Introduction Increasing numbers of children with obstructive sleep apnoea (OSA) require treatment with continuous positive airway pressure (CPAP). We aimed to assess the impact on quality of life (QOL) and treatment burden for caregivers of children requiring CPAP. Methods Prospective study of children commencing outpatient CPAP in a tertiary sleep unit 2020-2022. Questionnaires regarding sleep-related symptoms (PROMIS Pediatric Sleep Disturbance and Sleep-Related Impairment), QOL (OSA-18, QI-Disability), caregiver burden (Caregiver Strain Questionnaire) and overall health impact (Glasgow Children’s Benefit Inventory) were completed by caregivers at commencement of CPAP and 6 weeks later. Progress Complete data available to date in 24 children (6F; median age 12.5y, range 6-18y; median OAHI 9.2/hr; median BMI 30.7). OSA-related QOL significantly improved at follow-up (OSA-18 total and domain scores all p&amp;lt;0.001). There were significant improvements in child general QOL (p&amp;lt;0.0001), sleep disturbance (p&amp;lt;0.01) and sleep-related impairment (p&amp;lt;0.001). Caregivers rated CPAP as beneficial to their child’s general condition (mean 30, where maximum harm -100, maximum benefit +100). Caregiver strain reduced at follow-up (p&amp;lt;0.001) and benefit outweighed inconvenience (p&amp;lt;0.0001). 3 caregivers scored inconvenience higher than benefit; 1 scored them equally. 1 caregiver rated CPAP harmful and 3 caregivers reported no effect on their child’s general health. Outcome CPAP results in significant improvements in QOL and sleep-related symptoms in children with OSA, and reductions in caregiver strain. Perceived benefits generally outweighed the burden of treatment, but not for all families. Further analysis will investigate how the balance of benefit to burden relates to adherence and the effect of co-morbidities.

Correlations between objective and subjective outcomes after adenotonsillar surgery in children with OSA.

To investigate whether the OSA-18 questionnaire and a postoperative patient-reported outcome measure (PROM) question correlated with polysomnography (PSG) data. 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 6-12months 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. 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%. 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. 3.

Evaluation of Upper Airway Stimulation for Adolescents With Down Syndrome and Obstructive Sleep Apnea

Patients with Down syndrome have a high incidence of persistent obstructive sleep apnea (OSA) and limited treatment options. Upper airway hypoglossal stimulation has been shown to be effective for adults with OSA but has not yet been evaluated for pediatric populations. To evaluate the safety and effectiveness of upper airway stimulation for adolescent patients with Down syndrome and severe OSA. This prospective single-group multicenter cohort study with 1-year follow-up was conducted between April 1, 2015, and July 31, 2021, among a referred sample of 42 consecutive adolescent patients with Down syndrome and persistent severe OSA after adenotonsillectomy. Upper airway stimulation. The prespecified primary outcomes were safety and the change in apnea-hypopnea index (AHI) from baseline to 12 months postoperatively. Polysomnographic and quality of life outcomes were assessed at 1, 2, 6, and 12 months postoperatively. Among the 42 patients (28 male patients [66.7%]; mean [SD] age, 15.1 [3.0] years), there was a mean (SD) decrease in AHI of 12.9 (13.2) events/h (95% CI, -17.0 to -8.7 events/h). With the use of a therapy response definition of a 50% decrease in AHI, the 12-month response rate was 65.9% (27 of 41), and 73.2% of patients (30 of 41) had a 12-month AHI of less than 10 events/h. The most common complication was temporary tongue or oral discomfort, which occurred in 5 patients (11.9%). The reoperation rate was 4.8% (n = 2). The mean (SD) improvement in the OSA-18 total score was 34.8 (20.3) (95% CI, -42.1 to -27.5), and the mean (SD) improvement in the Epworth Sleepiness Scale score was 5.1 (6.9) (95% CI, -7.4 to -2.8). The mean (SD) duration of nightly therapy was 9.0 (1.8) hours, with 40 patients (95.2%) using the device at least 4 hours a night. Upper airway stimulation was able to be safely performed for 42 adolescents who had Down syndrome and persistent severe OSA after adenotonsillectomy with positive airway pressure intolerance. There was an acceptable adverse event profile with high rates of therapy response and quality of life improvement. ClinicalTrials.gov Identifier: NCT02344108.

Correlations between disease-specific quality of life and polysomnographic findings in children with obstructive sleep apnea

ObjectivesObstructive sleep apnea (OSA) can have a negative impact on quality of life in children. The OSA-18 is a disease-specific quality of life questionnaire for children. The questionnaire has been found to be a poor predictor of OSA diagnosed with polysomnography (PSG), yet OSA-18 scores do markedly improve after adenotonsillectomy. The aim of this study was to examine the correlations between OSA-18 and PSG findings, beyond the apnea hypopnea index (AHI). MethodsThis study was a prospective study of children 2–6 years of age who were referred to an Ear, Nose and Throat department for adenoidectomy and/or tonsillectomy. Prior to surgery, all of the children underwent PSG and a physical examination, and their parent completed the OSA-18 questionnaire. Spearman correlations were used to determine the associations between OSA-18 scores and PSG parameters. ResultsThe sample consisted of 97 children who underwent PSG and their parents who answered the OSA-18 questionnaire. We found positive correlations between the AHI and both the OSA-18 total score (rho = 0.21, p = 0.04) and the sleep disturbance subscale (rho = 0.51, p < 0.01). The only other PSG parameter that significantly correlated with the OSA-18 was the number of awakenings and arousals per hour of sleep (rho = 0.29, p < 0.01). ConclusionWe only found weak correlations between the OSA-18 score and PSG findings, suggesting the two methods are measuring different aspects of pediatric OSA. Clinical trialNCT 02233166.

Intranasal Budesonide and Quality of Life in Pediatric Sleep-Disordered Breathing: A Randomized Controlled Trial.

Objective To study the efficacy of budesonide nasal spray on the health-related quality of life and symptoms among children with sleep-disordered breathing. Study Design Randomized, parallel, double-blind, placebo-controlled trial. Setting Tertiary referral center. Subjects and Methods Sixty children (ages, 4-10 years) who were referred because of snoring and/or apneas for >3 months were included between January 2015 and June 2016 and randomized in a double-blind design to treatment with 64 μg/mL of budesonide nasal spray (n = 30) or placebo nasal spray (n = 30) twice daily for 6 weeks. The primary outcome measurement was the change in the mean OSA-18 total score from baseline. Other variables examined were individual OSA-18 domains, a visual analog scale for quality of life, symptoms (snoring, apneas, and nasal obstruction), and adenoid and tonsil size. The trial was investigator initiated and not sponsored by the pharmaceutical industry. Results Fifty-five children completed the trial. An intention-to-treat analysis revealed a significantly greater improvement in the mean OSA-18 total score after treatment with budesonide than placebo (19.5 vs 7.5, P = .0014). Intranasal budesonide also improved 2 OSA-18 domains (sleep disturbance, caregivers' concerns), the visual analog scale score for quality of life, as well as snoring, apneas, and nasal obstruction. No serious adverse events were reported that could be linked to the treatment. Conclusion Among children with sleep-disordered breathing, 6 weeks' treatment with intranasal budesonide significantly improved quality of life and symptoms as compared with placebo nasal spray.

Quality of life after adenotonsillectomy in children with obstructive sleep apnea: Short-term and long-term results

ObjectiveTo assess short-term and long-term changes in quality of life after adenotonsillectomy (T&A) in children with obstructive sleep apnea (OSA). Materials and methodsChildren aged 2–18 years old were enrolled. All subjects had clinical symptoms, overnight polysomnography diagnosis of OSA, and received T&A as treatment. Caregivers were asked to complete the OSA-18 survey before surgery, within 6 months after surgery (short-term), and more than 6 months after surgery (long-term). ResultsA total of 114 children were included (mean age, 7.0±3.5 years; 75% boys). The mean OSA-18 total score was 71.5±16.0 before surgery. After surgery, the mean OSA-18 total score was significantly decreased in both the short-term (40.3±12.2, p<0.001) and the long-term (42.0±13.7, p<0.001). All five OSA-18 domains were also significantly decreased during short-term and long-term postoperative follow up (p<0.001). Short-term and long-term outcomes were compared. Mean OSA-18 total scores, sleep disturbance score, emotional distress score, daytime function score, and caregiver concerns score did not differ significantly between the short-term and long-term periods, while the physical symptom score was slightly higher in the long-term than the short-term period (9.7±3.3 vs. 8.7±3.0, p=0.02). Additionally, the physical symptoms score was higher in the long-term period in the female (p=0.01), older age (>6 years) (p=0.03), and non-obese (p=0.04) subgroups. ConclusionT&A improves short-term and long-term quality of life in children with OSA. Nevertheless, caregivers observed children with aggravation of physical symptoms of quality of life during long-term follow up, especially in the female, older, and non-obese subgroups.

Quality of life after adenotonsillectomy for children with sleep-disordered breathing: A linear mixed model analysis

ObjectiveTo study changes in quality of life (QoL) after adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and to elucidate discrepancies in QoL improvements after T&A in children of different gender, age, adiposity status, and disease severity. Materials and methodsChildren aged 2–18 years were recruited. All children had SDB-related symptoms and underwent preoperative full-night polysomnography (PSG). Caregivers completed the first obstructive sleep apnea 18-items questionnaire (OSA-18) prior to T&A and the second OSA-18 survey within 3 months after surgery. Disease severity was defined as primary snoring (apnea/hypopnea index, AHI<1), mild obstructive sleep apnea (OSA) (5>AHI≥1), and moderate-to-severe OSA (AHI≥5). Discrepancies in OSA-18 score changes after T&A for different groups were assessed using the linear mixed model. ResultsIn total, 144 children were enrolled (mean age, 7.0±3.6 years; 76% boy). The OSA-18 total score changes after surgery were not significantly different by gender (boys vs. girls), age group (≥6 years vs. <6 years), or adiposity (obese vs. non-obese). The OSA-18 total score changes after surgery differed by disease severity (primary snoring vs. moderate-to-severe OSA, P=0.004; mild OSA vs. moderate-to-severe OSA, P=0.003). Children with moderate-to-severe OSA had greater improvement in OSA-18 total score after surgery than those with mild OSA or primary snoring. ConclusionsChildren with SDB had QoL improvement after T&A, as documented by OSA-18 score changes. The QoL improvement after T&A for SDB children increased as disease severity increased, and the improvement was not affected by gender, age, or adiposity.

Sleep related quality of life before and after adenotonsillar surgery in pediatric population

ObjectiveTo assess the quality of life in children with adenotonsillar problems before and after adenotonsillectomy in short term follow-up. MethodsQuasi-experimental study (before and after study) of children with adenotonsillar problems at Tehran University of Medical Sciences, Amir’Alam hospital. Eighty six pediatric patients aged 3 through 13 years (58 boys and 28 girls) who underwent adenotonsillectomy, for treatment of sleep disordered breathing or recurrent throat infection, were recruited. Parents completed OSA-18 quality of life survey and Brouillette score questionnaire before and one month after surgery. ResultsReliability of the Brouillette score and OSA-18 survey was established by evaluating the Cronbach α value. Cronbach α for Brouillette score was 0.70 and for OSA-18 survey it was 0.88. Preoperative values for the OSA-18 total and domain scores were high in children: mean±SD; 61.65±20.78. Preoperative values for the Brouillette score were: mean±SD; 0.41±2.34. The total OSA-18 survey score and the scores for all domains showed significant improvement after surgery: mean±SD; 28.01±9.09 (P<0.001). Post-operative Brouillette score had a significant improvement: mean±SD; −3.57±0.91 (P<0.001). ConclusionConsidering the OSA-18 survey and Brouillete score results, surgical therapy with adenotonsillectomy is associated with marked improvement in quality of life in both obstructive and infective adenotonsillar disease.

Obstructive sleep apnea in children

To study the correlation between obstructive sleep apnea (OSA), obesity, behavior, and quality of life. Case-control study of pediatric OSA documented by polysomnography at a tertiary-care hospital. Caregivers signed a consent document and completed the Behavior Assessment System for Children (BASC-2) and the 18-item OSA Quality-of-Life Survey (OSA-18) questionnaires. Demographic and polysomnographic data were collected. Children were classified as obese with OSA, normal weight with OSA, or primary snoring ([PS] normal weight, sleep-disordered breathing, no OSA). The correlation between OSA severity and the degree of obesity as well as behavior and quality of life were compared among the three groups. A P value ≤.05 was considered significant. Seventy-three patients were included in the study. Thirty-five children were obese with OSA (48%), 21 were of normal weight with OSA (29%), and 17 were considered PS (23%). There was no linear correlation between the degree of obesity and OSA severity. Apnea/hypopnea index was significantly higher for OSA-obese versus OSA-normal weight children (20.0 vs. 9.0, P = .02). The OSA-18 total score and BASC-2 mean score was worse for the OSA-obese than the OSA-normal group (P = .01 for both). There was no difference in quality-of-life scores or behavioral scores between the OSA-normal and PS groups. The degree of obesity does not linearly predict OSA severity in children. Obese children have worse OSA, behavioral problems, and quality of life than normal-weight children. In normal-weight children with OSA or PS, behavior and quality-of-life scores are similar regardless of the severity of the sleep disorder. 3b.

Validation of the Chinese version OSA-18 quality of life questionnaire in Taiwanese children with obstructive sleep apnea

The OSA-18 questionnaire is one of the most widely-used sleep quality measurements in children. We tested the applicability and cross-cultural validation of the traditional Chinese version OSA-18 questionnaire. This cross-sectional study was conducted in a tertiary medical referral center. The translation and cultural adaptation of the OSA-18 questionnaire were performed based on Brislin's revised model. A total of 109 children aged 2-18 years old with sleep problems were recruited. Overnight polysomnography and the OSA-18 questionnaire were administered. The reliability and validity of the traditional Chinese version of OSA-18 questionnaire were verified. Excellent test-retest reliability and good internal consistency were achieved, and the validity of OSA-18 with overnight polysomnography was confirmed. The domain of sleep disturbance, daytime function, caregiver concerns, and the OSA-18 total scores were significantly higher in sleep apnea patients. The domain of caregiver concern had the highest score, while those of emotional distress had the lowest scores. The optimal cut-off point of the OSA-18 total scores for detecting obstructive sleep apnea was 67. The traditional Chinese version of OSA-18 demonstrated high reliability and good validity in our study. The domain of caregiver concern is the major element in Taiwanese children with sleep-disordered breathing.

Pediatric Obstructive Sleep Apnea in Obese and Normal-Weight Children: Impact of Adenotonsillectomy on Quality-of-Life and Behavior

Objectives: To evaluate the impact of adenotonsillectomy (T&A) on quality-of-life (QOL) and behavior in obese versus normal-weight children with Obstructive Sleep Apnea (OSA). Design: Prospective, non-randomized, controlled study. Methods: Children with an apnea-hypopnea index (AHI) ≥2 were studied. Polysomnography was performed before and after T&A. An age- and gender-specific body mass index (BMI-for-age) percentile was determined preoperatively. Children who were obese (>95th percentile) were compared to normal-weight children (BMI-for-age > 5th–85th percentile). Caregivers completed the OSA-18 QOL survey and the Behavioral Assessment Survey for Children (BASC) before surgery and 3–6 months postoperatively. Pre- and postoperative scores were compared using paired t-tests, and the impact of covariants was analyzed using ANOVA. Results: The study population consisted of 89 children, 40 of whom were obese (45%). Postoperative scores for AHI, OSA-18 total and domain scores, and BASC scales and composites were significantly lower (improved) compared to pre-operative values in all children (p < .001). All mean OSA-18 and BASC scores were higher (indicating worse quality-of-life and behavior) pre- and postoperatively in obese than in normal-weight children. Postoperatively, the majority of OSA-18 total scores and domain scores were significantly higher in obese children. A comparison of the total OSA-18 scores between children with a postoperative AHI < 2 and AHI ≥ 2 in obese children and a similar comparison in normal-weight children was not statistically significant. There was no significant difference for BASC scores pre- and postoperatively between obese and normal-weight children. The pre- and postoperative scores for the AHI had a poor correlation with the pre- and postoperative Behavioral Symptoms Index (BSI) and total OSA-18 scores (r = .09), respectively. Conclusions: Following T&A all children have improvements in AHI, QOL, and behavior. Obese children are more likely to have persistent OSA and poor QOL scores after T&A. Behavior improves postoperatively to a similar extent in all children regardless of obesity.

Adenotonsillectomy for Obstructive Sleep Apnea in Children: Outcome Evaluated by Pre‐ and Postoperative Polysomnography

To evaluate the outcome of adenotonsillectomy for obstructive sleep apnea (OSA) in children using objective data from polysomnography supplemented by subjective proxy reports from the OSA-18 quality of life instrument. Prospective cohort study. Children 3 to 14 years of age with OSA diagnosed principally on the basis of polysomnography as having an obstructive apnea/hypopnea index (AHI) of 5 or greater underwent adenotonsillectomy. OSA was classified as mild (AHI > or = 5 < 10), moderate (AHI > or = 10 < 20), or severe (AHI > or =20). Children enrolled in the study also had postoperative polysomnography 3 to 6 months after surgery. Caregivers completed the OSA-18 survey before surgery and within 6 months after surgery. Pearson correlation was used to compare the pre- and postoperative AHI values with the pre- and postoperative OSA-18 total scores. SAS procedures (SAS Corp., Cary, NC) were used for statistical analyses. A P value less than or equal to .05 was considered significant. The study population included 79 healthy children, 40 of who were male. The mean age was 6.3 (range, 3.0-14.0) years. Only tonsillar size was correlated significantly with a high preoperative AHI. For all children, the preoperative AHI value was higher than the postoperative value. The mean preoperative AHI for the study population was 27.5, whereas the mean postoperative AHI was 3.5. This change was highly significant (P < .001). The percentage of children with normal polysomnography parameters after adenotonsillectomy ranged from 71% to 90% as a function of the criteria used to define OSA. It was highest when an obstructive apnea index less than 1 was used and lowest when an AHI less than 1 was used to define resolution of OSA. Overnight respiratory parameters after adenotonsillectomy were normal for all children with mild OSA. Three (12%) children with moderate preoperative OSA, and 13 (36%) children with severe preoperative OSA had persistent OSA after adenotonsillectomy. Resolution of OSA occurred in all children with a preoperative AHI less than or equal to 10 and in 73% of children with a preoperative AHI greater than 10. The mean total OSA-18 score and the mean scores for all domains showed significant improvement after surgery (P < .001). The preoperative AHI values had a fair correlation with the preoperative total OSA-18 scores (r = 0.28), but postoperative AHI values had a poor correlation with the postoperative total OSA-18 scores (r = 0.16). Caregivers reported snoring some, most, or all of the time in 22 (28%) children; this group included all children with persistent OSA. Adenotonsillectomy for OSA results in a dramatic improvement in respiratory parameters as measured by polysomnography in the majority of healthy children. Quality of life also improves significantly after adenotonsillectomy for OSA in children. However, the correlation between improvements in respiratory parameters and improvements in quality of life is poor. Severe preoperative OSA is associated with persistence of OSA after adenotonsillectomy. Postoperative reports of symptoms such as snoring and witnessed apneas correlate well with persistence of OSA after adenotonsillectomy.

Quality of Life after Adenotonsillectomy for SDB in Children

To evaluate the relationship between quality of life and the relative severity of sleep-disordered breathing (SDB) and to compare changes in quality of life after adenotonsillectomy in children with similar demographics but with either obstructive sleep apnea syndrome (OSAS) or with milder forms of SDB. All study participants underwent polysomnography to document the severity of SDB. The effectiveness of adenotonsillectomy for the relief of SDB was evaluated by using the OSA-18 quality of life survey (OSA-18). Preoperative and postoperative OSA-18 scores for each group of children (OSAS and mild SDB) were compared by using a repeated measures ANOVA. Changes between the 2 groups were compared by using an analysis of covariance with the preoperative score as a covariate. The study population included 61 children, 43 with OSAS and 18 with mild SDB. The demographics in the 2 groups were similar. The mean apnea-hypopnea index for children with OSAS was 21 (range, 5-46), and for children with mild SDB, it was 3 (range 0-4.9). The total OSA-18 score and the scores for all domains showed significant improvement after surgery for both groups of children (P < .001). A comparison of mean difference in total and domain scores for the 2 groups of children was not significant. Preoperative values for the OSA-18 total and domain scores are high in children with either OSAS or mild SDB. Both groups of children show a dramatic improvement in quality of life after adenotonsillectomy and the degree of improvement is similar. Fortunately, surgical therapy with adenotonsillectomy is associated with marked improvement in quality of life for children with either OSAS or mild SDB.

Outcome of adenotonsillectomy for severe obstructive sleep apnea in children

To study changes in sleep behavior and quality of life in children after adenotonsillectomy for severe obstructive sleep apnea identified by a respiratory distress index > or = 30. Children enrolled in the study underwent adenotonsillectomy and had both pre- and post-operative polysomnography. Caregivers also completed an OSA-18 quality of life survey prior to polysomnography and within 6 months of surgery. Paired Student's t-tests were used to compare pre- and post-operative scores. The study population included 29 children. The mean age was 7.1 years (range 1.4-17.0). The most common comorbidities were obesity, asthma and allergic disease. The mean pre-operative RDI was 63.9 and the mean post-operative RDI was 14.2 (P < .0001). The mean total OSA-18 score before surgery was 77.6 and after surgery was 33.2. The differences in pre- and post-operative OSA-18 total scores and domain scores were significant (P < .0001). Children with severe OSA who undergo adenotonsillectomy show a significant improvement in RDI and in quality of life over a period of several months after surgery. However, OSA does not resolve in the majority of these children and post-operative PSG is recommended to identify those who may require additional therapy.