Discrepancy between Objective and Subjective Outcomes after Adenotonsillectomy in Children with Obstructive Sleep Apnea Syndrome. (July 2014)

• Record Type: Journal Article
• Authors: Kang, Kun-Tai; Weng, Wen-Chin; Lee, Chia-Hsuan; Lee, Pei-Lin; Hsu, Wei-Chung
• Is Part Of: Otolaryngology--head and neck surgery. Volume 151:Number 1(2014:Jul.)
• Page Start: 150
• Page End: 158
• Publication Date: 2014-07
• Subjects: adenoidectomy -- adenotonsillectomy -- child -- quality of life -- sleep apnea syndromes -- polysomnography -- tonsillectomy; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599814529534
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: Adenotonsillectomy (T&A) is the first line therapy for pediatric obstructive sleep apnea (OSA); however, inconsistency between objective and subjective outcomes perplexes physicians. This study investigates changes of objective and subjective outcomes in children with OSA after T&A, in particular, to elucidate correlations and discrepancies between these 2 measures. Study Design: Case series with record review. Setting: Tertiary referral medical center. Subjects and Methods: Symptomatic children with polysomnographic diagnosis of OSA (apnea-hypopnea index [AHI] > 1) were included. All children underwent T&A to treat OSA, along with completely objective (polysomnography) and subjective (Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire [OSA-18]) measures before and 3 months after surgery. Results: One hundred nineteen children were included (mean age, 6.9 ± 3.3 years; 76% boys). Adenotonsillectomy significantly reduced AHI from 15.4 ± 21.2 per hour to 1.6 ± 2.5 per hour ( P < .001). The OSA-18 scores were significantly improved after surgery ( P < .001). A weak but statistically significant positive correlation was found between AHI and OSA-18 scores preoperatively (ρ = 0.22, P = .016) but not postoperatively (ρ = 0.04, P = .677). Among those cases with residual OSA after surgery, only 6% (3/54) had a residual effect on quality of life (OSA-18 score > 60). Conclusion: Adenotonsillectomy improves both objective and subjective outcomes. After surgery, quality of life significantly improved subjectively, despite an incomplete resolution of OSA objectively, leading to a better correlation between objective and subjective measures before as opposed to after surgery. Discrepancy between the 2 measures warrants an evaluation of a child both objectively and subjectively when treating OSA.