Chest
Volume 148, Issue 5, November 2015, Pages 1204-1213
Journal home page for Chest

Original Research Sleep Disorders
Prognosis for Spontaneous Resolution of OSA in Children

https://doi.org/10.1378/chest.14-2873Get rights and content

Background

Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment.

Methods

The Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI) <2 and obstructive apnea index (OAI) <1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ]) < 0.33 with ≥ 25% improvement from baseline.

Results

After 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-black race (each P < .05). Among these, the independent predictors were lower AHI and waist circumference percentile < 90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-deficit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors.

Conclusions

Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT.

Trial Registry

ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.

Section snippets

Participants

The mean ± SD age among 194 participants was 6.5 ± 1.4 years, and 92 (47%) were girls. The mean ± SD baseline AHI was 6.7 ± 5.6 (range, 1.1-29.3) and mean ± SD minimum oxygen saturation was 88.8% ± 5.1% (range, 59%-97%). The mean ± SD baseline PSQ-SRBD score was 0.48 ± 0.18 (range, 0.05-0.90).

Polysomnographic Resolution of OSAS

Among the 194 participants, 82 (42%) experienced spontaneous resolution with AHI < 2 and OAI < 1 on PSG at 7 months. The likelihood of resolution did not vary by sex or age (Table 1). Black children in

Discussion

This sizable, multicenter study of outcomes in untreated childhood OSAS—analyses made possible by the control arm of CHAT—suggests that almost one-half (42%) of children considered to be surgical candidates by their otolaryngologists no longer have OSAS on PSG when it is repeated after 7 months of watchful waiting. In contrast, only 15% of untreated children who were significantly symptomatic at baseline experienced meaningful improvement and resolution of their OSAS symptoms. Few baseline

Acknowledgments

Author contributions: R. D. C. and C. L. R. assume responsibility for the content of the manuscript. R. D. C. and C. L. R. contributed to study design, acquisition of data, and interpretation of data, drafted the manuscript, approved the final version, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; S. S. E. and X. H. contributed to study design, analysis

References (30)

  • KD Tran et al.

    Child behavior and quality of life in pediatric obstructive sleep apnea

    Arch Otolaryngol Head Neck Surg

    (2005)
  • NA Goldstein et al.

    Child behavior and quality of life before and after tonsillectomy and adenoidectomy

    Arch Otolaryngol Head Neck Surg

    (2002)
  • C Guilleminault et al.

    Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning

    Eur J Pediatr

    (1982)
  • CL Marcus et al.

    A randomized trial of adenotonsillectomy for childhood sleep apnea

    N Engl J Med

    (2013)
  • CJ Coté et al.

    Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: Houston, we have a problem!

    Anesth Analg

    (2014)
  • Cited by (78)

    • Debates in pediatric obstructive sleep apnea treatment

      2021, World Journal of Otorhinolaryngology - Head and Neck Surgery
    • Alternatives to surgery in children with mild OSA

      2021, World Journal of Otorhinolaryngology - Head and Neck Surgery
    View all citing articles on Scopus

    originally published Online First March 26, 2015.

    FUNDING/SUPPORT: This study was supported by the National Institutes of Health [Grants HL083075, HL083129, UL1 RR024134, and UL1 RR024989].

    View full text