title: Adenotonsillectomy vs observation for management of mild obstructive sleep apnea in children.
abstract: OBJECTIVE
  To determine the impact of adenotonsillectomy vs observation on quality of life (QOL) in children with mild obstructive sleep apnea (OSA).
  
  
  METHODS
  Prospective, nonrandomized trial.
  
  
  METHODS
  Tertiary children's hospital.
  
  
  METHODS
  Sixty-four children (ages 3-16 years) with mild OSA (apnea hypopnea index between 1 and 5 on polysomnogram) completed the study. Caregivers chose between management options of adenotonsillectomy and observation and completed validated QOL instruments (OSA-18 and Children's Health Questionnaire) at baseline, early, and late follow-ups. The primary outcome measure was QOL.
  
  
  RESULTS
  Thirty patients chose adenotonsillectomy, while 34 were observed. Total OSA-18 scores at baseline were significantly poorer (P = .01) in the surgery group (72.3) compared with the observation group (58.5). Four months following surgery, OSA-18 scores improved by 39.1 points over baseline (P = .0001), while there was no change for the observation group (P = .69). After 8 months, OSA-18 scores remained improved in the surgery group, and observation group scores improved by 13.4 points over baseline (P = .005). While OSA-18 scores at the late follow-up visit were poorer in the observation group, the difference was not statistically significant (P = .05). Six observation patients opted for adenotonsillectomy during the study.
  
  
  CONCLUSIONS
  Quality of life significantly improves in children with mild OSA after adenotonsillectomy. In children with mild OSA who are observed, QOL improvements at early follow-up are less pronounced, but significant improvements in QOL are evident after 8 months. QOL instruments may be useful tools to help providers determine which children with mild OSA may benefit from early intervention.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Volsky
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Woughter
authors.forename: Hind A
authors.initials: HA
authors.lastname: Beydoun
authors.forename: Craig S
authors.initials: CS
authors.lastname: Derkay
authors.forename: Cristina M
authors.initials: CM
authors.lastname: Baldassari
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019370:Observation; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000601:surgery; D014068:Tonsillectomy
keywords: adenoidectomy; child; obstructive; quality of life; sleep apnea; tonsillectomy