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Chest. 2015 Nov;148(5):1204-1213. doi: 10.1378/chest.14-2873.

Prognosis for Spontaneous Resolution of OSA in Children.

Author information

1
Department of Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, MI. Electronic address: chervin@umich.edu.
2
Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
3
Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
4
Department of Otolaryngology/Head and Neck Surgery and Sleep Disorders Center, University of Michigan, Ann Arbor, MI.
5
Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA.
6
Division of Neuropsychology, Department of Psychiatry, University of Michigan, Ann Arbor, MI.
7
Department of Otolaryngology and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
8
Department of Otolaryngology/Head & Neck Surgery, University of Nebraska College of Medicine, University of Nebraska Medical Center, Omaha, NE.
9
Division of Respiratory and Sleep Medicine, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx NY.
10
Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
11
Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
12
Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.

Abstract

BACKGROUND:

Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment.

METHODS:

The 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 defined 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:

After 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, higher-positioned 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-deficit/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.

TRIAL REGISTRY:

ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.

PMID:
25811889
PMCID:
PMC4631037
DOI:
10.1378/chest.14-2873
[Indexed for MEDLINE]
Free PMC Article

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