Assessing the need for adenotonsillectomy for sleep‐disordered breathing in a community setting: A secondary outcome measures analysis of a randomized controlled study

Abstract

Objective To assess whether children with sleep‐disordered breathing (SDB) symptom severity above a certain level, measured by a validated questionnaire, improve after adenotonsillectomy (AT) compared to no intervention. Methods Children with snoring and tonsillar hypertrophy (4 to 10‐years old), who were candidates for AT, were randomly assigned to two evaluation sequences (baseline and 3‐month follow‐up): (a) evaluation immediately before AT and at 3 months postoperatively (AT group); or (b) evaluation at the initial visit and at the end of the usual 3‐month waiting period for surgery (control group). Outcomes were (a) Pediatric Sleep Questionnaire sleep‐related breathing disorder scale (PSQ‐SRBD); (b) modified Epworth Sleepiness Scale (mESS); and (c) proportion of subjects achieving PSQ‐SRBD <0.33 (low‐risk for apnea‐hypopnea index ≥5/h) if they had score ≥0.33 at baseline. Results Sixty‐eight children were assigned to the AT and 72 to the control group and two‐thirds of them had PSQ‐SRBD ≥0.33. The AT group experienced significantly larger improvement between follow‐up and baseline than controls (between‐group difference [95% CI] for PSQ‐SRBD: −0.31 [−0.35 to −0.27]; and mESS: −2.76 [−3.63 to −1.90]; P < .001 for both). Children with baseline PSQ‐SRBD ≥0.33 in the AT group had an eight‐times higher probability of achieving PSQ‐SRBD <0.33 at follow‐up than controls with similar baseline score (risk ratio [95% CI]: 8.33 [3.92‐17.54]; P < .001). Conclusion Among children with snoring, tonsillar hypertrophy, and clinical indications for AT, those with preoperative PSQ‐SRBD score ≥0.33 show measurable clinical benefit postoperatively.

Perioperative Delta Weight and Pediatric Obstructive Sleep Apnea Resolution after Adenotonsillectomy

“…Surgeons should take into consideration demographic factors, baseline AHI, and the propensity of weight gain when counseling and managing expectations about postoperative outcomes and be prepared to introduce adjunctive treatments for OSA. This study corroborated previous retrospective studies 17 and meta-analyses, 4 by demonstrating that that AT remains an effective treatment option for significantly mitigating pediatric OSA, as 86.0% of our cohort achieved an AHI value of less than 5. Current theories about the reasons for postoperative weight gain include reduced Recent studies have shown that postsurgical weight gain after tonsillectomy lasts anywhere between 7 and 24 months.…”