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



Case series with record review.



Tertiary referral medical center.



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.



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).



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.
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Kun-Tai
KT
Kang
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.
Wen-Chin
WC
Weng
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan Department of Otolaryngology, China Medical University Hospital, Taipei Branch, Taiwan.
Chia-Hsuan
CH
Lee
Sleep Center, National Taiwan University Hospital, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Pei-Lin
PL
Lee
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan Sleep Center, National Taiwan University Hospital, Taipei, Taiwan hsuwc@ntu.edu.tw.
Wei-Chung
WC
Hsu
D000233:Adenoidectomy / Q000379:methods; D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D017286:Polysomnography; D011182:Postoperative Care; D011300:Preoperative Care; D011788:Quality of Life; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000379:methods; D016896:Treatment Outcome
adenoidectomy; adenotonsillectomy; child; polysomnography; quality of life; sleep apnea syndromes; tonsillectomy