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A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea
Journal article   Open access   Peer reviewed

A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea

Carole L. Marcus, Renee H. Moore, Carol L. Rosen, Bruno Giordani, Susan L. Garetz, Gerry Taylor, Ron B. Mitchell, Raouf Amin, Eliot S. Katz, Raanan Arens, …
The New England journal of medicine, v 368(25), pp 2366-2376
20 Jun 2013
DOI: https://doi.org/10.1056/NEJMoa1215881
PMID: 23692173
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1056/NEJMoa1215881View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

General & Internal Medicine Life Sciences & Biomedicine Medicine, General & Internal Science & Technology
BACKGROUND Adenotonsillectomy is commonly performed in children with the obstructive sleep apnea syndrome, yet its usefulness in reducing symptoms and improving cognition, behavior, quality of life, and polysomnographic findings has not been rigorously evaluated. We hypothesized that, in children with the obstructive sleep apnea syndrome without prolonged oxyhemoglobin desaturation, early adenotonsillectomy, as compared with watchful waiting with supportive care, would result in improved outcomes. METHODS We randomly assigned 464 children, 5 to 9 years of age, with the obstructive sleep apnea syndrome to early adenotonsillectomy or a strategy of watchful waiting. Polysomnographic, cognitive, behavioral, and health outcomes were assessed at baseline and at 7 months. RESULTS The average baseline value for the primary outcome, the attention and executive-function score on the Developmental Neuropsychological Assessment (with scores ranging from 50 to 150 and higher scores indicating better functioning), was close to the population mean of 100, and the change from baseline to follow-up did not differ significantly according to study group (mean [+/- SD] improvement, 7.1 +/- 13.9 in the early-adenotonsillectomy group and 5.1 +/- 13.4 in the watchful-waiting group; P = 0.16). In contrast, there were significantly greater improvements in behavioral, quality-of-life, and polysomnographic findings and significantly greater reduction in symptoms in the early-adenotonsillectomy group than in the watchful-waiting group. Normalization of polysomnographic findings was observed in a larger proportion of children in the early-adenotonsillectomy group than in the watchful-aiting group (79% vs. 46%). CONCLUSIONS As compared with a strategy of watchful waiting, surgical treatment for the obstructive sleep apnea syndrome in school-age children did not significantly improve attention or executive function as measured by neuropsychological testing but did reduce symptoms and improve secondary outcomes of behavior, quality of life, and polysomnographic findings, thus providing evidence of beneficial effects of early adenotonsillectomy.

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Collaboration types
Domestic collaboration
Web of Science research areas
Pediatrics
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