Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children
Author:
Redline Susan1, Cook Kaitlyn23, Chervin Ronald D.4, Ishman Stacey5, Baldassari Cristina M.6, Mitchell Ron B.7, Tapia Ignacio E.8, Amin Raouf9, Hassan Fauziya10, Ibrahim Sally11, Ross Kristie11, Elden Lisa M.12, Kirkham Erin M.13, Zopf David13, Shah Jay1415, Otteson Todd1415, Naqvi Kamal16, Owens Judith17, Young Lisa8, Furth Susan8, Connolly Heidi18, Clark Caron A. C.19, Bakker Jessie P.1, Garetz Susan20, Radcliffe Jerilynn8, Taylor H. Gerry21, Rosen Carol L.22, Wang Rui1323, Rueschman Michael N24, Tully Meg24, Arnold Jean24, Nicholson Michelle24, Kaplan Emily24, Mobley Dan24, Morrical Michael24, Karamessinis Laurie24, Ward Michelle24, Cornaglia Mary Ann24, Bradford Ruth24, Ciampaglia Alyssa24, Groubert Hayley24, Denallo Erica24, Rajashari Rasal24, Pyzoha Morgan24, Rogers Heather24, McKibben Kieran24, Hicks Suzie24, Carter Belinda24, Boh Melodie24, Swegheimer Krista24, Niehaus Stacey24, Herresoff Emily24, Heffner Marianne24, Fetterolf Judy24, Geal Bill24, Brand Sarah24, DeWeese Braden24, Johnson Libby24, Brierly Kristin24, Jordan Allison24, Pavelka Kacee24, Sands Jay24, Szpara Ashley24, Chambers Francesca24, Vargas Laura24, Eshon Constance24, George Florence24, Martin Mary24, Sparks Vernell24, Young Victoria24, Stone Laura24, Boykin Amy24, Riggan Emily24, Boswick Thomas24, Bailey Michael24, Stetler Amanda24, Tham Addy24,
Affiliation:
1. Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 2. Program in Statistical and Data Sciences, Smith College, Northampton, Massachusetts 3. Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts 4. Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor 5. Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 6. Department of Otolaryngology, Eastern Virginia Medical School, Children’s Hospital of The King’s Daughters, Norfolk 7. Departments of Otolaryngology-Head and Neck Surgery and Neurology Sleep Disorders Center, UT Southwestern Medical Center, Children’s Medical Center, Dallas 8. Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia 9. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 10. Sleep Disorders Center and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor 11. Department of Pediatrics, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio 12. Division of Pediatric Otolaryngology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia 13. Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor 14. Department of Otolaryngology, University Hospitals Rainbow Babies 15. University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, Ohio 16. Department of Pediatrics, UT Southwestern Medical Center, Dallas 17. Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts 18. Department of Pediatrics, University of Rochester, Rochester, New York 19. Department of Educational Psychology, University of Nebraska-Lincoln 20. Department of Otolaryngology–Head and Neck Surgery and Department of Neurology-Sleep Disorders Center, University of Michigan, Ann Arbor 21. Abigail Wexner Research Institute at Nationwide Children’s Hospital and The Ohio State University, Columbus 22. Case Western Reserve University School of Medicine, Department of Pediatrics, Cleveland, Ohio 23. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 24. for the Pediatric Adenotonsillectomy Trial for Snoring (PATS) Study Team
Abstract
ImportanceThe utility of adenotonsillectomy in children who have habitual snoring without frequent obstructive breathing events (mild sleep-disordered breathing [SDB]) is unknown.ObjectivesTo evaluate early adenotonsillectomy compared with watchful waiting and supportive care (watchful waiting) on neurodevelopmental, behavioral, health, and polysomnographic outcomes in children with mild SDB.Design, Setting, and ParticipantsRandomized clinical trial enrolling 459 children aged 3 to 12.9 years with snoring and an obstructive apnea-hypopnea index (AHI) less than 3 enrolled at 7 US academic sleep centers from June 29, 2016, to February 1, 2021, and followed up for 12 months.InterventionParticipants were randomized 1:1 to either early adenotonsillectomy (n = 231) or watchful waiting (n = 228).Main Outcomes and MeasuresThe 2 primary outcomes were changes from baseline to 12 months for caregiver-reported Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC) T score, a measure of executive function; and a computerized test of attention, the Go/No-go (GNG) test d-prime signal detection score, reflecting the probability of response to target vs nontarget stimuli. Twenty-two secondary outcomes included 12-month changes in neurodevelopmental, behavioral, quality of life, sleep, and health outcomes.ResultsOf the 458 participants in the analyzed sample (231 adenotonsillectomy and 237 watchful waiting; mean age, 6.1 years; 230 female [50%]; 123 Black/African American [26.9%]; 75 Hispanic [16.3%]; median AHI, 0.5 [IQR, 0.2-1.1]), 394 children (86%) completed 12-month follow-up visits. There were no statistically significant differences in change from baseline between the 2 groups in executive function (BRIEF GEC T-scores: −3.1 for adenotonsillectomy vs −1.9 for watchful waiting; difference, −0.96 [95% CI, −2.66 to 0.74]) or attention (GNG d-prime scores: 0.2 for adenotonsillectomy vs 0.1 for watchful waiting; difference, 0.05 [95% CI, −0.18 to 0.27]) at 12 months. Behavioral problems, sleepiness, symptoms, and quality of life each improved more with adenotonsillectomy than with watchful waiting. Adenotonsillectomy was associated with a greater 12-month decline in systolic and diastolic blood pressure percentile levels (difference in changes, −9.02 [97% CI, −15.49 to −2.54] and −6.52 [97% CI, −11.59 to −1.45], respectively) and less progression of the AHI to greater than 3 events/h (1.3% of children in the adenotonsillectomy group compared with 13.2% in the watchful waiting group; difference, −11.2% [97% CI, −17.5% to −4.9%]). Six children (2.7%) experienced a serious adverse event associated with adenotonsillectomy.ConclusionsIn children with mild SDB, adenotonsillectomy, compared with watchful waiting, did not significantly improve executive function or attention at 12 months. However, children with adenotonsillectomy had improved secondary outcomes, including behavior, symptoms, and quality of life and decreased blood pressure, at 12-month follow-up.Trial RegistrationClinicalTrials.gov Identifier: NCT02562040
Publisher
American Medical Association (AMA)
Cited by
2 articles.
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