Chest
Original Research Sleep DisordersPrognosis for Spontaneous Resolution of OSA in Children
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)
- et al.
Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996-2006
Otolaryngol Head Neck Surg
(2010) - et al.
Quality of life after adenotonsillectomy for SDB in children
Otolaryngol Head Neck Surg
(2005) - et al.
Risk factors and natural history of habitual snoring
Chest
(2004) - et al.
Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems
Sleep Med
(2000) - et al.
The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity
Ambul Pediatr
(2003) - et al.
Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy
J Pediatr
(2006) - et al.
Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns
Sleep Med
(2003) - et al.
Esophageal pressures, polysomnography, and neurobehavioral outcomes of adenotonsillectomy in children
Chest
(2012) - et al.
Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy
Pediatrics
(2006) - et al.
Behavioral changes in children with mild sleep-disordered breathing or obstructive sleep apnea after adenotonsillectomy
Laryngoscope
(2007)
Child behavior and quality of life in pediatric obstructive sleep apnea
Arch Otolaryngol Head Neck Surg
Child behavior and quality of life before and after tonsillectomy and adenoidectomy
Arch Otolaryngol Head Neck Surg
Children and nocturnal snoring: evaluation of the effects of sleep related respiratory resistive load and daytime functioning
Eur J Pediatr
A randomized trial of adenotonsillectomy for childhood sleep apnea
N Engl J Med
Death or neurologic injury after tonsillectomy in children with a focus on obstructive sleep apnea: Houston, we have a problem!
Anesth Analg
Cited by (78)
Characteristics associated with caregiver willingness to consider tonsillectomy for a child's obstructive sleep disordered breathing: Findings from a survey of families in an urban primary care network
2022, International Journal of Pediatric OtorhinolaryngologyRapid maxillary expansion versus watchful waiting in pediatric OSA: A systematic review
2022, Sleep Medicine ReviewsDebates in pediatric obstructive sleep apnea treatment
2021, World Journal of Otorhinolaryngology - Head and Neck SurgeryCitation Excerpt :In 2015, a systematic review (51 studies, n = 3413) found that, after AT, the AHI of children was lower by an average of 12.4 events/h than the pre-operative values. Additionally, the obstructive apnea, hypopnea, and central apnea indexes decreased, and the level of the lowest oxygen saturation increased significantly.6 The overall percentage of the apnea hypopnea index (AHI) < 1 events/h post-AT was 51%, whereas the overall percentage of AHI<5 events/h was 81%.
Alternatives to surgery in children with mild OSA
2021, World Journal of Otorhinolaryngology - Head and Neck SurgeryCitation Excerpt :In the initial multicenter trial assessing the outcomes of AT for pediatric OSA (CHAT study),77,78 the control group was assigned to watchful waiting for 7 months. Among these children, the majority of which had mild OSA, a significant proportion exhibited normalization of their respiratory disturbances during sleep.79 Similar findings have been recently reported by another group of investigators.80
Retropharyngeal medialized internal carotid artery encountered prior to pediatric tonsillectomy: A case report and review of the literature
2021, Otolaryngology Case ReportsCitation Excerpt :Adenotonsillectomy has been shown in several studies to significantly improve behavioral, quality-of-life, and polysomnographic outcomes [7,8]. However, studies have indicated that 42–46% of children with obstructive sleep apnea who undergo watchful waiting rather than tonsillectomy will have spontaneous normalization of their polysomnogram by 7 months [7,8]. These results reinforce that observation is a valid management option for high-risk surgical candidates.
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].