Surgery for children with sleep apnea improves quality of life

April 18, 2005

CHICAGO - Children with obstructive sleep apnea (OSA) have improvements in their quality of life as well as their sleep disorder after surgical removal of the tonsils and adenoid tissue, according to an article in the April issue of Archives of Otolaryngology-Head & Neck Surgery, one of the JAMA/Archives journals.

In recent years, there has been an increased frequency of adenotonsillectomy (the surgical removal of the tonsils and adenoid tissue) for abnormal enlargement and sleep breathing disturbance rather than chronic infection, according to background information in the article. In addition, previous studies have shown that quality of life (QOL) is impaired for children with sleep disturbances, both global and in some specific areas likely to be problematic for children with obstructive sleep apnea, including behavior, infections, and airway and breathing.

Michael G. Stewart, M.D., of the Baylor College of Medicine, Houston, and colleagues assessed polysomnogram (PSG) results and global and specific quality of life in children with sleep-disordered breathing who were suspected of having obstructive sleep apnea at baseline and then were asked to return for follow-up assessment at six months and one year. In children, obstructive sleep apnea is characterized by a disorder of breathing during sleep caused by an airway obstruction. PSG is an overnight test to evaluate sleep disorders. Quality of life was measured using standard questionnaires.

Forty-seven children were enrolled in the study on the basis of suspected sleep breathing disturbance. Thirty-one children, 22 boys and nine girls, were diagnosed with obstructive sleep apnea on the basis of a polysomnogram and adenotonsillectomy was recommended. Of the 31 children, 29 returned for follow-up at six months. Of that group, 24 had undergone surgery and five had not. There were no significant differences between the two groups. "...only 19 children returned for testing one year after treatment or enrollment," the authors write. "We compared QOL data subscale scores between the six month and one-year follow-up periods, and there were no significant differences ... Therefore, since the sample size was larger for the six-month group, we used that group for further analysis of the QOL data."

"Children who underwent adenotonsillectomy had significant improvements in QOL scores and PSG parameters," the researchers state. "We found significantly larger QOL changes in children who underwent surgery compared with children without surgery. ... No strong association was identified between QOL scores and PSG parameters."

"The improvements in QOL were seen six months after surgery and were sustained at one year," the authors write. "Even though not all children were cured of OSA (using PSG parameters), the improvement in QOL was nevertheless significant. This indicates that some of the effects of sleep-disordered breathing on QOL are not measured by the PSG."
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(Arch Otolaryngol Head Neck Surg. 2005;131:308-314. Available post-embargo at www.archoto.com.)

Editor's Note: This study was supported by a grant from the National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md.

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email mediarelations@jama-archives.org.

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