Utility of Symptoms to Predict Treatment Outcomes in Obstructive Sleep Apnea Syndrome

Abstract

BACKGROUND AND OBJECTIVES: Polysomnography defines the pathophysiology of obstructive sleep apnea syndrome (OSAS) but does not predict some important comorbidities or their response to adenotonsillectomy. We assessed whether OSAS symptoms, as reflected on the Sleep-Related Breathing Disorders Scale of the Pediatric Sleep Questionnaire (PSQ), may offer clinical predictive value.METHODS: Baseline and 7-month follow-up data were analyzed from 185 participants (aged 5-9 years with polysomnographically confirmed OSAS) in the surgical treatment arm of the multicenter Childhood Adenotonsillectomy Trial. Associations were assessed between baseline PSQ or polysomnographic data and baseline morbidity (executive dysfunction, behavior, quality of life, sleepiness) or postsurgical improvement.RESULTS: At baseline, each 1-SD increase in baseline PSQ score was associated with an adjusted odds ratio that was ∼3 to 4 times higher for behavioral morbidity, 2 times higher for reduced global quality of life, 6 times higher for reduced disease-specific quality of life, and 2 times higher for sleepiness. Higher baseline PSQ scores (greater symptom burden) also predicted postsurgical improvement in parent ratings of executive functioning, behavior, quality of life, and sleepiness. In contrast, baseline polysomnographic data did not independently predict these morbidities or their postsurgical improvement. Neither PSQ nor polysomnographic data were associated with objectively assessed executive dysfunction or improvement at follow-up.CONCLUSIONS: PSQ symptom items, in contrast to polysomnographic results, reflect subjective measures of OSAS-related impairment of behavior, quality of life, and sleepiness and predict their improvement after adenotonsillectomy. Although objective polysomnography is needed to diagnose OSAS, the symptoms obtained during an office visit can offer adjunctive insight into important comorbidities and likely surgical responses. WHAT'S KNOWN ON THIS SUBJECT:Obstructive sleep apnea syndrome (OSAS) is associated with significant comorbidity: behavioral problems, sleepiness, and impaired quality of life. However, the utility of OSAS symptoms versus polysomnography in the prediction of comorbidities or response to treatment is not well known.WHAT THIS STUDY ADDS: Among children with OSAS, the Pediatric Sleep Questionnaire, a wellvalidated, simple 1-page symptom inventory, predicts key adenotonsillectomy-responsive OSAS comorbidities and their improvement after adenotonsillectomy. In contrast, polysomnographic results do not offer similar predictive value. Less work has been done to define what adjunctive measures, in addition to PSG, may assist pediatricians, otolaryngologists, and families who are considering adenotonsillectomy to understand what adverse impact OSAS is having for the child and what the probability is that this adverse impact will be ameliorated by surgery. For example, few studies have examined whether baseline OSAS symptoms can predict postoperative changes in parentperceived behavior, sle...

Cognitive Effects of Adenotonsillectomy for Obstructive Sleep Apnea

“…The results provide impetus for more research on the cognitive and neurobiological effects of AT for pediatric OSAS. 5,10,29,44 The findings are also consistent with previous research suggesting that tests of nonverbal reasoning, attention, and fine motor skills are selectively affected by OSAS and thus more likely to improve after AT.…”

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

“…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].…”

“…c) A positive respiratory polygraphy or nocturnal oximetry in the context of clinical symptoms indicative of obstructive SDB has been used as an indication for adenotonsillectomy (class III or IV) [136,162,184]. Results of the CHAT study indicate that improvements in morbidity from the central nervous system, quality of life and symptoms of SDB occur post-adenotonsillectomy regardless of the severity of abnormalities in preoperative polysomnography (class I) [113,177].…”

Adenoidectomy for Obstructive Sleep Apnea in Children

“…As for OSA, the PSQ showed a sensitivity of 77% to 81% and a specificity of 87% compared to PSG. 13,33 Obviously, physiologic evaluation by objective PSG is needed to diagnose OSA and should be applied in future studies as the main outcome measure. Nevertheless, the symptoms obtained during office visit by the structured PSQ offer adjunctive insight into important comorbidities and likely surgical responses, 33 and hence may be used in addition.…”