95 / 232
substantially more after eAT than
WWSC. Bene
fi
ts from eAT were
evident in generic and disease-
speci
fi
c health-related QoL (as
measured by using the PedsQL and
OSA-18) and in OSAS symptoms (as
re
fl
ected by using the PSQ SRBD scale
and the mESS). Moderate to large
improvements were observed for
most QoL and symptom
measurements, including the parent-
completed PedsQL (total score,
school, emotional, and physical
function domains), OSA-18 (total and
all 5 domains), mESS, and the PSQ
SRBD (total score and snoring,
sleepiness, and inattentive/
behavioral subscales). Improvement
in OSAS severity measured by using
PSG variables explained only a small
proportion of the improvements seen
in OSAS symptoms and QoL. These
observations have important clinical
implications for the many children
with OSAS who are evaluated for AT.
The
fi
ndings are of particular
relevance, given the growing interest
from patients, payers, and providers
that QoL and symptom outcomes be
highlighted in the management of
chronic health conditions.
Clinically, many factors are
considered when making a decision
to perform surgery or to judge the
success of surgical interventions.
Previous studies measuring success
rates for AT in children with OSAS
have often focused somewhat
narrowly on normalization of PSG
parameters, with reports of surgical
success rates ranging from 27% to
83%; lower cure rates are typically
reported in obese children.
19,28
–
31
This emphasis on PSG measures of
disease resolution may be partially
due to assumptions that PSG severity
parallels severity of the symptoms
seen with OSAS. This concept is not
well supported by the current
literature for either neurobehavioral
morbidity or QoL.
19,26
Previous
studies of children with OSAS have
shown no association between
baseline OSA-18 scores and severity
of OSAS on PSG.
32
Moreover, studies
have failed to demonstrate clear
correlation between extent of PSG
improvements after AT and
improvement in QoL.
33,34
In CHAT, we
observed correlations between
changes in AHI or ODI and changes in
QoL and symptom severity measures.
However, PSG improvements
explained only a small portion of the
variance for the change scores (partial
r
2
ranging from
,
0.01 to 0.17). Thus,
both previous literature and current
data indicate that using PSG results as
the sole metric for effectiveness of AT
in pediatric OSAS may neglect other
bene
fi
ts that are important to children
and their families.
TABLE 4
Effect Modi
fi
cation on Change: Weight Category (Normal Versus Overweight Versus Obese)
Outcome
eAT
WWSC
P
a
P
b
Normal
Overweight
Obese
Normal
Overweight
Obese
Peds QL (parent) total
5.54
6
1.33
1.91
6
1.61
4.09
6
2.31
2
0.00
6
1.24
2
2.58
6
1.56
2
0.63
6
2.33 .99 .91
Peds QL (child) total
5.11
6
1.73
0.86
6
2.06
5.22
6
2.94
4.64
6
1.65
2
0.14
6
2.06
1.27
6
3.03 .89 .74
OSA-18 total
2
21.23
6
1.77
2
18.57
6
2.14
2
18.70
6
3.19
2
4.19
6
1.68
2
2.33
6
2.08
2
1.14
6
3.11 .79 .96
PSQ-SRBD total
2
0.28
6
0.02
2
0.24
6
0.02
2
0.24
6
0.03
2
0.03
6
0.02
2
0.00
6
0.02
2
0.01
6
0.03 .92 .76
PSQL snoring subscale
2
0.65
6
0.03
2
0.59
6
0.04
2
0.59
6
0.06
2
0.11
6
0.03
2
0.05
6
0.04
2
0.08
6
0.06 .89 .92
PSQL sleepiness subscale
2
0.28
6
0.03
2
0.26
6
0.04
2
0.28
6
0.06
2
0.04
6
0.03
2
0.02
6
0.04
0.08
6
0.06 .32 .36
PSQL behavior subscale
2
0.12
6
0.03
2
0.12
6
0.04
2
0.04
6
0.05
0.02
6
0.03
2
0.03
6
0.04
2
0.06
6
0.05 .10 .13
SLSC total (mESS)
2
2.37
6
0.41
2
1.14
6
0.50
2
2.77
6
0.72
2
0.20
6
0.39
2
0.41
6
0.48
0.13
6
0.72 .12 .09
Data are presented as mean
6
SD; marginal means adjusting for variables included in
P
value 1.
a
P
value for interaction term adjusting strati
fi
ed variables only: site, race (African American versus non
–
African American), and age (5
–
7 vs 8
–
10 years old).
b
P
value for interaction term adjusting for site, race (African American versus non
–
African American), age (continuous), gender, maternal education (less than high school, high school
or higher, or missing/not sure), income (
.
$30 000,
#
$30 000, and missing), baseline log AHI, and baseline outcome variable.
TABLE 5
Effect Modi
fi
cation on Change: Race (African American Versus Non
–
African American)
Outcome
eAT
WWSC
P
a
P
b
African American
Non
–
African American
African American
Non
–
African American
Peds QL (parent) total
3.18
6
2.07
7.44
6
1.82
2
0.12
6
2.47
2.12
6
2.22
.57
.77
Peds QL (child) total
4.55
6
2.50
0.85
6
2.17
3.09
6
3.03
2.44
6
2.65
.48
.26
OSA-18 total
2
17.85
6
2.84
2
22.51
6
2.51
2
10.71
6
3.36
2
5.07
6
3.03
.04
.09
PSQ-SRBD total
2
0.23
6
0.03
2
0.32
6
0.02
2
0.10
6
0.03
2
0.07
6
0.03
.01
.01
PSQL Snoring sub-scale
2
0.67
6
0.05
2
0.68
6
0.05
2
0.23
6
0.06
2
0.25
6
0.06
.91
.79
PSQL Sleepiness sub-scale
2
0.13
6
0.06
2
0.29
6
0.05
2
0.07
6
0.07
2
0.02
6
0.06
.03
.26
PSQL Behavior sub-scale
2
0.01
6
0.04
2
0.18
6
0.04
2
0.06
6
0.05
2
0.03
6
0.05
,
.01
,
.01
SLSC total (mESS)
2
1.67
6
0.60
2
2.57
6
0.53
2
0.90
6
0.72
2
0.91
6
0.65
.40
.32
Data are presented as mean
6
SD; marginal means adjusting for variables included in
P
value 1.
a
P
value for the effect modi
fi
cation adjusting for strati
fi
ed variables only: site, age (5
–
7 vs 8
–
10 years old), and overweight (
$
85th vs
,
85th BMI percentile).
b
P
value for the effect modi
fi
cation adjusting for site, age (continuous), obese (
,
95 vs
$
95 BMI percentile), gender, maternal education (less than high school, high school or higher, or
missing/not sure), income (
.
$30 000,
#
$30 000, or missing), baseline log AHI, and baseline outcome variable.
GARETZ et al
73