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 - 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.
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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 -