Quality of Life and Obstructive Sleep Apnea Symptoms After Pediatric Adenotonsillectomy

Garetz, Susan L.; Mitchell, Ron B.; Parker, Portia; Moore, Reneé H.; Rosen, Carol L.; Giordani, Bruno; Muzumdar, Hiren; Paruthi, Shalini; Elden, Lisa; Willging, Paul; Beebe, Dean W.; Marcus, Carole L.; Chervin, Ronald D.; Redline, Susan

doi:10.1542/peds.2014-0620

Cited by 117 publications

(137 citation statements)

References 37 publications

(35 reference statements)

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“…Starting early in life, children with OSAS have increased utilisation of healthcare services, mostly related to respiratory morbidity and thus increased societal costs (class III) [112]. Both generic and disease-specific health-related quality of life measures improve after adenotonsillectomy (class I) [113].…”

Section: Decreased Quality Of Lifementioning

confidence: 99%

“…In the CHAT study, changes in the attention and executive function objective scores from baseline to follow-up did not differ between the early-adenotonsillectomy and the watchful-waiting study groups (class I) [126]. However, there was a significant improvement in executive functioning, attention, behaviour and excessive daytime sleepiness as rated by parents, which was predicted by the preoperative severity of symptoms but not by the AHI (class I) [113,177]. Similarly, two systematic reviews of mostly class III and IV studies concluded that adenotonsillectomy is followed by improvements in behavioural problems and neurocognitive skills irrespective of SDB severity [178,179].…”

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confidence: 91%

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Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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This document summarises the conclusions of a European Respiratory Society Task Force on the diagnosis and management of obstructive sleep disordered breathing (SDB) in childhood and refers to children aged 2-18 years. Prospective cohort studies describing the natural history of SDB or randomised, double-blind, placebo-controlled trials regarding its management are scarce. Selected evidence (362 articles) can be consolidated into seven management steps. SDB is suspected when symptoms or abnormalities related to upper airway obstruction are present (step 1). Central nervous or cardiovascular system morbidity, growth failure or enuresis and predictors of SDB persistence in the long-term are recognised (steps 2 and 3), and SDB severity is determined objectively preferably using polysomnography (step 4). Children with an apnoea-hypopnoea index (AHI) >5 episodes·h, those with an AHI of 1-5 episodes·h −1 and the presence of morbidity or factors predicting SDB persistence, and children with complex conditions (e.g. Down syndrome and Prader-Willi syndrome) all appear to benefit from treatment (step 5). Treatment interventions are usually implemented in a stepwise fashion addressing all abnormalities that predispose to SDB (step 6) with re-evaluation after each intervention to detect residual disease and to determine the need for additional treatment (step 7). @ERSpublications Management of obstructive sleep disordered breathing in childhood should follow a stepwise approach

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Section: Decreased Quality Of Lifementioning

confidence: 99%

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confidence: 91%

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

et al. 2015

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“…27,28 One explanation for these small effects is that sleep-related cognitive weaknesses may be less evident on highly structured tests than under "free-living" conditions in which children have to regulate their own behavior according to environmental demands. 45,46 Other possibilities are that the effects of chronic sleep disturbances on brain function are more difficult to reverse than responses to environmental conditions or that longer follow-up is needed to detect more substantial effects of AT on test performance.…”

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confidence: 99%

Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea

et al. 2016

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OBJECTIVE: Research reveals mixed evidence for the effects of adenotonsillectomy (AT) on cognitive tests in children with obstructive sleep apnea syndrome (OSAS). The primary aim of the study was to investigate effects of AT on cognitive test scores in the randomized Childhood Adenotonsillectomy Trial. METHODS:Children ages 5 to 9 years with OSAS without prolonged oxyhemoglobin desaturation were randomly assigned to watchful waiting with supportive care (n = 227) or early AT (eAT, n = 226). Neuropsychological tests were administered before the intervention and 7 months after the intervention. Mixed model analysis compared the groups on changes in test scores across follow-up, and regression analysis examined associations of these changes in the eAT group with changes in sleep measures. RESULTS:Mean test scores were within the average range for both groups. Scores improved significantly (P < .05) more across follow-up for the eAT group than for the watchful waiting group. These differences were found only on measures of nonverbal reasoning, fine motor skills, and selective attention and had small effects sizes (Cohen's d,. As additional evidence for AT-related effects on scores, gains in test scores for the eAT group were associated with improvements in sleep measures. CONCLUSIONS:Small and selective effects of AT were observed on cognitive tests in children with OSAS without prolonged desaturation. Relative to evidence from Childhood Adenotonsillectomy Trial for larger effects of surgery on sleep, behavior, and quality of life, AT may have limited benefits in reversing any cognitive effects of OSAS, or these benefits may require more extended follow-up to become manifest. 1 The prevalence of OSAS is ~1% to 6%, with higher rates in African Americans and children from families of lower socioeconomic status. 2 -4 Children with untreated OSAS are at risk for adverse outcomes ranging from daytime sleepiness and compromised cardiovascular health to behavior problems and impairments in cognition and academic performance. 5 -11 Problems in behavior and emotional regulation are common in children with OSAS compared with healthy controls, but evidence for adverse effects of OSAS on children's cognitive abilities is more mixed. 6 Some studies fail to find differences between children with OSAS and healthy controls, 12,13 and those that do report variable associations of measures of sleep disturbance with cognitive test scores. 7, 14 -18 Similarly, studies of outcomes of adenotonsillectomy (AT) in children with OSAS indicate variable benefits on such tests, with little evidence for associations of these effects with the severity of OSAS and sleep disruption. 8, 13, 14, 16, 19 -26 In the recently completed multicenter Childhood Adenotonsillectomy Trial (CHAT), children with OSAS without prolonged oxyhemoglobin desaturation assigned to early AT (eAT) improved more than those assigned to watchful waiting with supportive care (WWSC) on key secondary outcomes. 27 -29 Specifically, the eAT group improved more tha...

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“…It gives a global health overview, and usefully has two forms: the parent proxy report form and the age-specific child self-report form. [49][50][51] Similarly, the KINDL-R questionnaire for measuring health-related QoL in children and adolescents, 60,61 the Child Health Questionnaire ('CHQ') 38,[54][55][56] and the Child Behavior Checklist ('CBCL') 20,21,62 are general patient-reported outcome measures that have different forms for various age groups. These tools have the benefit of age-appropriate questions, but their use would potentially limit comparison of the findings outside of that age group.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of patient-reported outcome measures in paediatric otolaryngology

Powell

Robson

2017

J. Laryngol. Otol.

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Background:Recently, there has been increased emphasis on the development and application of patient-reported outcome measures. This drive to assess the impact of illness or interventions, from the patient's perspective, has resulted in a greater number of available questionnaires. The importance of selecting an appropriate patient-reported outcome measure is specifically emphasised in the paediatric population. The literature on patient-reported outcome measures used in paediatric otolaryngology was reviewed.Methods:A comprehensive literature search was conducted using the databases Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycInfo, using the terms: ‘health assessment questionnaire’, ‘structured questionnaire’, ‘questionnaire’, ‘patient reported outcome measures’, ‘PROM’, ‘quality of life’ or ‘survey’, and ‘children’ or ‘otolaryngology’. The search was limited to English-language articles published between 1996 and 2016.Results:The search yielded 656 articles, of which 63 were considered relevant. This included general paediatric patient-reported outcome measures applied to otolaryngology, and paediatric otolaryngology disease-specific patient-reported outcome measures.Conclusion:A large collection of patient-reported outcome measures are described in the paediatric otolaryngology literature. Greater standardisation of the patient-reported outcome measures used in paediatric otolaryngology would assist in pooling of data and increase the validation of tools used.

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Quality of Life and Obstructive Sleep Apnea Symptoms After Pediatric Adenotonsillectomy

Cited by 117 publications

References 37 publications

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Obstructive sleep disordered breathing in 2- to 18-year-old children: diagnosis and management

Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea

A systematic review of patient-reported outcome measures in paediatric otolaryngology

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