title: Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy.
abstract: OBJECTIVE
  Data from a randomized, controlled study of adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) were used to test the hypothesis that children undergoing surgery had greater quality of life (QoL) and symptom improvement than control subjects. The objectives were to compare changes in validated QoL and symptom measurements among children randomized to undergo adenotonsillectomy or watchful waiting; to determine whether race, weight, or baseline OSAS severity influenced changes in QoL and symptoms; and to evaluate associations between changes in QoL or symptoms and OSAS severity.
  
  
  METHODS
  Children aged 5 to 9.9 years with OSAS (N = 453) were randomly assigned to undergo adenotonsillectomy or watchful waiting with supportive care. Polysomnography, the Pediatric Quality of Life inventory, the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire, the 18-item Obstructive Sleep Apnea QoL instrument, and the modified Epworth Sleepiness Scale were completed at baseline and 7 months. Changes in the QoL and symptom surveys were compared between arms. Effect modification according to race and obesity and associations between changes in polysomnographic measures and QoL or symptoms were examined.
  
  
  RESULTS
  Greater improvements in most QoL and symptom severity measurements were observed in children randomized to undergo adenotonsillectomy, including the parent-completed Pediatric Quality of Life inventory (effect size [ES]: 0.37), the 18-item Obstructive Sleep Apnea QoL instrument (ES: -0.93), the modified Epworth Sleepiness Scale score (ES: -0.42), and the Sleep-Related Breathing Scale of the Pediatric Sleep Questionnaire (ES: -1.35). Effect modification was not observed by obesity or baseline severity but was noted for race in some symptom measures. Improvements in OSAS severity explained only a small portion of the observed changes.
  
  
  CONCLUSIONS
  Adenotonsillectomy compared with watchful waiting resulted in significantly more improvements in parent-rated generic and OSAS-specific QoL measures and OSAS symptoms.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery and Sleep Disorders Center, garetz@umich.edu.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Garetz
authors.affiliation: Departments of Otolaryngology and Pediatrics, Utah Southwestern and Children's Medical Center, Dallas, Texas;
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
authors.affiliation: SAS Institute Inc, Cary, North Carolina;
authors.forename: Portia D
authors.initials: PD
authors.lastname: Parker
authors.affiliation: Department of Statistics, North Carolina State University, Raleigh, North Carolina;
authors.forename: Reneé H
authors.initials: RH
authors.lastname: Moore
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Departments of Psychiatry and Psychology and Sleep Disorders Center, and.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giordani
authors.affiliation: Division of Pulmonary Medicine, Allergy, & Immunology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania;
authors.forename: Hiren
authors.initials: H
authors.lastname: Muzumdar
authors.affiliation: Department of Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University, St Louis, Missouri;
authors.forename: Shalini
authors.initials: S
authors.lastname: Paruthi
authors.affiliation: Departments of Otolaryngology and.
authors.forename: Lisa
authors.initials: L
authors.lastname: Elden
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, and.
authors.forename: Paul
authors.initials: P
authors.lastname: Willging
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Dean W
authors.initials: DW
authors.lastname: Beebe
authors.affiliation: Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
authors.affiliation: Department of Neurology and Sleep Disorders Center, University of Michigan Health Center, Ann Arbor, Michigan;
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.affiliation: Departments of Medicine and Neurology, Brigham and Women's Hospital, and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D020181:Sleep Apnea, Obstructive / Q000523:psychology* / Q000601:surgery*; D011795:Surveys and Questionnaires; D014068:Tonsillectomy; D057832:Watchful Waiting
keywords: adenotonsillectomy; obstructive sleep apnea; pediatric; quality of life