title: Utility of symptoms to predict treatment outcomes in obstructive sleep apnea syndrome.
abstract: OBJECTIVE
  Polysomnography defines the pathophysiology of obstructive sleep apnea syndrome (OSAS) but does not predict some important comorbidities or their response to adenotonsillectomy. We assessed whether OSAS symptoms, as reflected on the Sleep-Related Breathing Disorders Scale of the Pediatric Sleep Questionnaire (PSQ), may offer clinical predictive value.
  
  
  METHODS
  Baseline and 7-month follow-up data were analyzed from 185 participants (aged 5-9 years with polysomnographically confirmed OSAS) in the surgical treatment arm of the multicenter Childhood Adenotonsillectomy Trial. Associations were assessed between baseline PSQ or polysomnographic data and baseline morbidity (executive dysfunction, behavior, quality of life, sleepiness) or postsurgical improvement.
  
  
  RESULTS
  At baseline, each 1-SD increase in baseline PSQ score was associated with an adjusted odds ratio that was ∼3 to 4 times higher for behavioral morbidity, 2 times higher for reduced global quality of life, 6 times higher for reduced disease-specific quality of life, and 2 times higher for sleepiness. Higher baseline PSQ scores (greater symptom burden) also predicted postsurgical improvement in parent ratings of executive functioning, behavior, quality of life, and sleepiness. In contrast, baseline polysomnographic data did not independently predict these morbidities or their postsurgical improvement. Neither PSQ nor polysomnographic data were associated with objectively assessed executive dysfunction or improvement at follow-up.
  
  
  CONCLUSIONS
  PSQ symptom items, in contrast to polysomnographic results, reflect subjective measures of OSAS-related impairment of behavior, quality of life, and sleepiness and predict their improvement after adenotonsillectomy. Although objective polysomnography is needed to diagnose OSAS, the symptoms obtained during an office visit can offer adjunctive insight into important comorbidities and likely surgical responses.
authors: Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; carol.rosen@case.edu.
authors: Carol L
authors: CL
authors: Rosen
authors: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
authors: Rui
authors: R
authors: Wang
authors: Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio;
authors: H Gerry
authors: HG
authors: Taylor
authors: Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, and.
authors: Carole L
authors: CL
authors: Marcus
authors: Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts;
authors: Eliot S
authors: ES
authors: Katz
authors: Department of Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University, St Louis, Missouri;
authors: Shalini
authors: S
authors: Paruthi
authors: Department of Pediatrics, Children's Hospital at Montefiore and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;
authors: Raanan
authors: R
authors: Arens
authors: Department of Pediatrics, Pittsburgh Children's Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania;
authors: Hiren
authors: H
authors: Muzumdar
authors: Departments of Otolaryngology and.
authors: Susan L
authors: SL
authors: Garetz
authors: Departments of Otolaryngology and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; and.
authors: Ron B
authors: RB
authors: Mitchell
authors: Department of Otolaryngology/Head & Neck Surgery, University of Nebraska College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
authors: Dwight
authors: D
authors: Jones
authors: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
authors: Jia
authors: J
authors: Weng
authors: Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
authors: Susan
authors: S
authors: Ellenberg
authors: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
authors: Susan
authors: S
authors: Redline
authors: Neurology and Sleep Disorders Center, University of Michigan, Ann Arbor, Michigan;
authors: Ronald D
authors: RD
authors: Chervin
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017286:Polysomnography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D016037:Single-Blind Method; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: adenotonsillectomy; apnea hypopnea index; clinical prediction; obstructive sleep apnea; polysomnography; questionnaires