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Quality of Life and Obstructive
Sleep Apnea Symptoms After
Pediatric Adenotonsillectomy
Susan L. Garetz, MD
a
, Ron B. Mitchell, MD
b
, Portia D. Parker, MS
c
, Reneé H. Moore, PhD
d
, Carol L. Rosen, MD
e
,
Bruno Giordani, PhD
f
, Hiren Muzumdar, MD
g
, Shalini Paruthi, MD
h
, Lisa Elden, MD
i
, Paul Willging, MD
j
,
Dean W. Beebe, PhD
k
, Carole L. Marcus, MBBCh
l
, Ronald D. Chervin, MD, MS
m
, Susan Redline, MD, MPH
n
abstract
BACKGROUND AND OBJECTIVES:
Data from a randomized, controlled study of adenotonsillectomy for obstructive
sleep apnea syndrome (OSAS) were used to test the hypothesis that children undergoing surgery had greater
quality of life (QoL) and symptom improvement than control subjects. The objectives were to compare changes
in validated QoL and symptom measurements among children randomized to undergo adenotonsillectomy or
watchful waiting; to determine whether race, weight, or baseline OSAS severity in
fl
uenced changes in QoL and
symptoms; and to evaluate associations between changes in QoL or symptoms and OSAS severity.
METHODS:
Children aged 5 to 9.9 years with OSAS (
N
= 453) were randomly assigned to undergo
adenotonsillectomy or watchful waiting with supportive care. Polysomnography, the Pediatric Quality of Life
inventory, the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire, the 18-item Obstructive Sleep
Apnea QoL instrument, and the modi
fi
ed Epworth Sleepiness Scale were completed at baseline and 7 months.
Changes in the QoL and symptom surveys were compared between arms. Effect modi
fi
cation according to race and
obesity and associations between changes in polysomnographic measures and QoL or symptoms were examined.
RESULTS:
Greater improvements in most QoL and symptom severity measurements were observed in children
randomized to undergo adenotonsillectomy, including the parent-completed Pediatric Quality of Life inventory
(effect size [ES]: 0.37), the 18-item Obstructive Sleep Apnea QoL instrument (ES:
–
0.93), the modi
fi
ed Epworth
Sleepiness Scale score (ES:
–
0.42), and the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire
(ES:
–
1.35). Effect modi
fi
cation was not observed by obesity or baseline severity but was noted for race in some
symptom measures. Improvements in OSAS severity explained only a small portion of the observed changes.
CONCLUSIONS:
Adenotonsillectomy compared with watchful waiting resulted in signi
fi
cantly more
improvements in parent-rated generic and OSAS-speci
fi
c QoL measures and OSAS symptoms.
WHAT
’
S KNOWN ON THIS SUBJECT:
Pediatric
obstructive sleep apnea syndrome (OSAS) has
been associated with decreased health-related
quality of life (QoL). Observational studies
suggest that adenotonsillectomy for pediatric
OSAS improves QoL, but these studies did not use
a randomized study design or a control group of
children with OSAS managed nonsurgically.
WHAT THIS STUDY ADDS:
A prospective,
randomized controlled study of adenotonsillectomy
for pediatric OSAS showed signi
fi
cantly greater QoL
and symptom improvements in children
undergoing adenotonsillectomy than in the
nonsurgical control arm. The extent of
improvement was not appreciably in
fl
uenced by
baseline OSAS severity or obesity.
a
Department of Otolaryngology
–
Head and Neck Surgery and Sleep Disorders Center,
f
Departments of Psychiatry and
Psychology and Sleep Disorders Center, and
m
Department of Neurology and Sleep Disorders Center, University of
Michigan Health Center, Ann Arbor, Michigan;
b
Departments of Otolaryngology and Pediatrics, Utah Southwestern
and Children
’
s Medical Center, Dallas, Texas;
c
SAS Institute Inc, Cary, North Carolina;
d
Department of Statistics, North
Carolina State University, Raleigh, North Carolina;
e
Department of Pediatrics, Rainbow Babies & Children
’
s Hospital,
University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;
g
Division of Pulmonary Medicine, Allergy, & Immunology, Children
’
s Hospital of Pittsburgh of UPMC, University of
Pittsburgh, Pittsburgh, Pennsylvania;
h
Department of Pediatrics, Cardinal Glennon Children
’
s Medical Center, Saint
Louis University, St Louis, Missouri; Departments of
i
Otolaryngology and
l
Pediatrics, Sleep Center, Children
’
s Hospital
of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania;
j
Department of Otolaryngology
–
Head and Neck
Surgery, University of Cincinnati College of Medicine, and
k
Department of Pediatrics, Cincinnati Children
’
s Hospital
Medical Center, Cincinnati, Ohio; and
n
Departments of Medicine and Neurology, Brigham and Women
’
s Hospital, and
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
This trial has been registered at
www.clinicaltrials.gov(identi
fi
er NCT00560859).
www.pediatrics.org/cgi/doi/10.1542/peds.2014-0620DOI:
10.1542/peds.2014-0620
Accepted for publication Nov 4, 2014
PEDIATRICS
Volume
135,
number
2,
February
2015
ARTICLE
Reprinted by permission of Pediatrics. 2015; 135(2):e477-e486.
68