Childhood Obstructive Sleep Apnea
From 2008 to 2011, 397 children were enrolled in the study. The study groups were similar at entry, with a mean age of 6.5 years. Slightly more than 50% of the children were black, approximately one third were white, and about 8% were of Hispanic ethnicity. About 47% of the children were overweight, with one third being obese.
The early-tonsillectomy group demonstrated a 7.1-unit change from baseline on the NEPSY, compared with a 5.1-unit change from baseline in the watchful-waiting group, but this difference did not reach statistical significance. However, almost all of the secondary outcomes favored early adenotonsillectomy. For example, both caregiver and teacher behavioral rating scales of children with early adenotonsillectomy showed much greater improvement, on the order of 3 or more times greater than the children in the watchful-waiting group. The improvement in quality-of-life scores was also greater in children who underwent early adenotonsillectomy.
With respect to sleep study outcomes, 79% of the children in the early-adenotonsillectomy group experienced normalization of sleep study findings compared with 46% of the children in the watchful-waiting group. Children with more severe obstructive sleep apnea showed greater absolute improvement in many of the secondary outcomes, but many of these children still had abnormal sleep studies at follow-up testing.
Marcus and colleagues concluded that surgical treatment for OSAS did not meet their prespecified therapeutic outcome of improved neurocognitive testing results, but many of the secondary outcomes, including behavioral measures and quality-of-life measures, were improved in children who underwent the early procedure compared with those in the watchful-waiting group.
Study Findings
From 2008 to 2011, 397 children were enrolled in the study. The study groups were similar at entry, with a mean age of 6.5 years. Slightly more than 50% of the children were black, approximately one third were white, and about 8% were of Hispanic ethnicity. About 47% of the children were overweight, with one third being obese.
The early-tonsillectomy group demonstrated a 7.1-unit change from baseline on the NEPSY, compared with a 5.1-unit change from baseline in the watchful-waiting group, but this difference did not reach statistical significance. However, almost all of the secondary outcomes favored early adenotonsillectomy. For example, both caregiver and teacher behavioral rating scales of children with early adenotonsillectomy showed much greater improvement, on the order of 3 or more times greater than the children in the watchful-waiting group. The improvement in quality-of-life scores was also greater in children who underwent early adenotonsillectomy.
With respect to sleep study outcomes, 79% of the children in the early-adenotonsillectomy group experienced normalization of sleep study findings compared with 46% of the children in the watchful-waiting group. Children with more severe obstructive sleep apnea showed greater absolute improvement in many of the secondary outcomes, but many of these children still had abnormal sleep studies at follow-up testing.
Marcus and colleagues concluded that surgical treatment for OSAS did not meet their prespecified therapeutic outcome of improved neurocognitive testing results, but many of the secondary outcomes, including behavioral measures and quality-of-life measures, were improved in children who underwent the early procedure compared with those in the watchful-waiting group.
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