Prognosis for spontaneous resolution of OSA in children

Ronald D. Chervin, Susan S. Ellenberg, Xiaoling Hou, Carole L. Marcus, Susan L. Garetz, Eliot S. Katz, Elise K. Hodges, Ron B. Mitchell, Dwight T. Jones, Raanan Arens, Raouf Amin, Susan Redline, Carol L. Rosen

Research output: Contribution to journalArticle

49 Scopus citations

Abstract

BACKGROUND: Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment. METHODS: Th e Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defi ned respectively by an apnea/hypopnea index (AHI), 2 and obstructive apnea index (OAI), 1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ]), 0.33 with 25% improvement from baseline. RESULTS: Aft er 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higherpositioned soft palate, smaller neck circumference, and non-black race (each P<.05). Among these, the independent predictors were lower AHI and waist circumference percentile<90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-defi cit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors. CONCLUSIONS: Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT.

Original languageEnglish (US)
Pages (from-to)1204-1213
Number of pages10
JournalChest
Volume148
Issue number5
DOIs
StatePublished - Nov 2015

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Chervin, R. D., Ellenberg, S. S., Hou, X., Marcus, C. L., Garetz, S. L., Katz, E. S., Hodges, E. K., Mitchell, R. B., Jones, D. T., Arens, R., Amin, R., Redline, S., & Rosen, C. L. (2015). Prognosis for spontaneous resolution of OSA in children. Chest, 148(5), 1204-1213. https://doi.org/10.1378/chest.14-2873