Baseline apnea-hypopnea index threshold and adenotonsillectomy consideration in children with OSA

Adenotonsillectomy (AT) is the first line of treatment for pediatric obstructive sleep apnea (OSA). In some treatment guidelines, children with moderate to severe OSA, defined as apnea-hypopnea index (AHI) ≥ 5, may be recommended AT regardless of symptoms. The differences in outcomes between childre...

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Bibliographic Details
Published in:International journal of pediatric otorhinolaryngology 2021-12, Vol.151, p.110959-110959, Article 110959
Main Authors: Gourishetti, Saikrishna C., Hamburger, Emily, Pereira, Kevin D., Mitchell, Ron B., Isaiah, Amal
Format: Article
Language:English
Subjects:
Adenoidectomy
Adenotonsillectomy
Apnea hypopnea index
Child
Humans
Obstructive sleep apnea
Quality of Life
Sleep Apnea, Obstructive - diagnosis
Sleep Apnea, Obstructive - surgery
Tonsillectomy
Treatment Outcome
Watchful waiting
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Summary:Adenotonsillectomy (AT) is the first line of treatment for pediatric obstructive sleep apnea (OSA). In some treatment guidelines, children with moderate to severe OSA, defined as apnea-hypopnea index (AHI) ≥ 5, may be recommended AT regardless of symptoms. The differences in outcomes between children randomized to watchful waiting with supportive care (WWSC) or AT were compared based on baseline OSA severity threshold of AHI≥ 5. A secondary analysis of the Childhood Adenotonsillectomy Trial, a randomized controlled trial of children with OSA aged 5–9 years who underwent AT or WWSC, was performed. The primary outcome was the change in neurocognition measured by Developmental Neuropsychological Assessment (NEPSY). Secondary outcomes included changes in behavior, symptoms of OSA, and quality of life. Outcomes were measured at baseline and the seven-month follow-up after grouping children based on whether their AHI was greater than or equal to 5. Comparisons were performed using two-way analysis of covariance (ANCOVA) while controlling for age, sex and race. Differences in treatment effect were measured using Cohen's d. Of the 397 children included, 203 received WWSC and 194 underwent AT. The treatment effects on post-randomization changes in neurocognition, measured by NEPSY in children with AHI ≥5 (Cohen's d = 0.1 [95% CI, −0.1 to 0.4]) was not significantly different from children with AHI
ISSN:0165-5876
1872-8464
DOI:10.1016/j.ijporl.2021.110959