Clinical assessment of pediatric obstructive sleep apnea.
OBJECTIVE
To determine whether children with a clinical assessment suggestive of obstructive sleep apnea (OSA) but with negative polysomnography (PSG) have improvement in their clinical assessment score after tonsillectomy and adenoidectomy (T&A) as compared with similar children who do not undergo surgery.


METHODS
In a prospective, randomized, investigator-blinded, controlled trial, 59 otherwise healthy children (mean age: 6.3 years [3.0]; 31 boys, 28 girls) with a clinical diagnosis of OSA (clinical assessment score 40) were recruited from the pediatric otolaryngology and pediatric pulmonary private offices and clinics of a tertiary care, academic medical center. A standardized assessment was performed on all patients, including history, physical examination, voice recording, tape recording of breathing during sleep, lateral neck radiograph, echocardiogram, and PSG. A clinical assessment score was assigned. Children with positive PSG (n = 27) were scheduled for T&A, whereas children with negative PSG (n = 29) were randomized to T&A (n = 15) or no surgery (n = 14). Children were reassessed in an identical manner at a planned 6-month follow-up.


RESULTS
Follow-up was available for 21 patients with positive PSG, 11 patients with negative PSG randomized to T&A, and 9 nonsurgery patients. In the randomized subjects, the median reduction in clinical assessment score was 49 (range: 32-61) for the T&A patients as compared with 8 (range: -9 to 29) for the nonsurgery patients. Nine (82%) of the T&A patients were asymptomatic (clinical assessment score <20) compared with 2 (22%) of the nonsurgery patients.


CONCLUSIONS
Children with a positive clinical assessment of OSA but negative PSG have significant improvement after T&A as compared with observation alone, thus validating the clinician's role in diagnosing upper airway obstruction.
Goldstein
Nira A
NA
Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York 11203, USA. ngoldstein@downstate.edu
Pugazhendhi
Vasanthi
V
Rao
Sudha M
SM
Weedon
Jeremy
J
Campbell
Thomas F
TF
Goldman
Andrew C
AC
Post
J Christopher
JC
Rao
Madu
M
D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015588:Observer Variation; D017286:Polysomnography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D014068:Tonsillectomy