A randomized trial of adenotonsillectomy for childhood sleep apnea
- PMID: 23692173
- PMCID: PMC3756808
- DOI: 10.1056/NEJMoa1215881
A randomized trial of adenotonsillectomy for childhood sleep apnea
Abstract
Background: Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes.
Methods: We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months.
Results: The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [±SD] improvement, 7.1±13.9 in the early-adenotonsillectomy group and 5.1±13.4 in the watchful-waiting group; P=0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-waiting group (79% vs. 46%).
Conclusions: As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy. (Funded by the National Institutes of Health; CHAT ClinicalTrials.gov number, NCT00560859.).
Conflict of interest statement
No other potential conflict of interest relevant to this article was reported.
Figures
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Comment in
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Let's CHAT about adenotonsillectomy.N Engl J Med. 2013 Jun 20;368(25):2428-9. doi: 10.1056/NEJMe1305492. Epub 2013 May 21. N Engl J Med. 2013. PMID: 23692171 No abstract available.
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Symptoms of obstructive sleep apnoea are treated by adenotonsillectomy, but without change in neurocognitive outcome.Evid Based Med. 2014 Apr;19(2):62. doi: 10.1136/eb-2013-101483. Epub 2013 Oct 16. Evid Based Med. 2014. PMID: 24132053 No abstract available.
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Adenotonsillectomy in childhood obstructive sleep apnea syndrome improves polysomnographic measures of breathing and sleep, but not attention and executive function.J Pediatr. 2013 Nov;163(5):1530-1. doi: 10.1016/j.jpeds.2013.08.056. J Pediatr. 2013. PMID: 24160660 No abstract available.
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Adenotonsillectomy or watchful waiting in the management of childhood obstructive sleep apnea.J Clin Sleep Med. 2013 Nov 15;9(11):1225-7. doi: 10.5664/jcsm.3182. J Clin Sleep Med. 2013. PMID: 24235909 Free PMC article. No abstract available.
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Early adenotonsillectomy for obstructive sleep apnoea improved quality of life and symptoms but not attention or executive function.Arch Dis Child Educ Pract Ed. 2014 Oct;99(5):199. doi: 10.1136/archdischild-2014-305960. Epub 2014 Apr 2. Arch Dis Child Educ Pract Ed. 2014. PMID: 24694575 No abstract available.
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