TY - JOUR
T1 - Prognosis for spontaneous resolution of OSA in children
AU - Chervin, Ronald D.
AU - Ellenberg, Susan S.
AU - Hou, Xiaoling
AU - Marcus, Carole L.
AU - Garetz, Susan L.
AU - Katz, Eliot S.
AU - Hodges, Elise K.
AU - Mitchell, Ron B.
AU - Jones, Dwight T.
AU - Arens, Raanan
AU - Amin, Raouf
AU - Redline, Susan
AU - Rosen, Carol L.
N1 - Funding Information:
Conflict of interest: R. D. C. is named in or has developed patented and copyrighted materials owned by the University of Michigan and designed to assist with assessment or treatment of sleep disorders. These materials include the Pediatric Sleep Questionnaire Sleep-Related Breathing Disorder scale, used in the research now reported. Currently, this questionnaire is licensed online at no charge by the University of Michigan to appropriate users, and licensed (for electronic use) to Zansors LLC. R. D. C. serves on the boards of the American Academy of Sleep Medicine and the International Pediatric Sleep Society, is an editor for UpToDate, is a book editor for Cambridge University Press, has received support for research and education from Philips Respironics (Koninklijke Philips NV) and Fisher & Paykel Healthcare Ltd, and has consulted for MC3 Inc and Zansors LLC. C. L. M. received a loan of research equipment from Philips Respironics (Koninklijke Philips NV) and Ventus Medical Inc. S. R. reports that Brigham and Women's Hospital received research grant support from ResMed Foundation and research equipment (unrelated to this study) from Philips Respironics (Koninklijke Philips NV) and ResMed Inc. C. L. R. has consulted for Natus Medical Inc, Advance Medical Inc, and Jazz Pharmaceuticals plc. The study received equipment from Philips Respironics (Koninklijke Philips NV) for use in this trial. None declared (S. S. E., X. H., S. L. G., E. S. K., E. K. H., R. B. M., D. W. J., R. Arens, R. Amin).
Publisher Copyright:
© 2015 American College of Chest Physicians.
PY - 2015/11
Y1 - 2015/11
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84946563816&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84946563816&partnerID=8YFLogxK
U2 - 10.1378/chest.14-2873
DO - 10.1378/chest.14-2873
M3 - Article
C2 - 25811889
AN - SCOPUS:84946563816
SN - 0012-3692
VL - 148
SP - 1204
EP - 1213
JO - Chest
JF - Chest
IS - 5
ER -